French obstetrician Marie Louise LaChapelle (1769-1821) introduced many innovations to the management of childbirth, especially in the cases of difficult labor. She attended thousands of births and produced a massive three-volume book describing her observations and recommendations. Her book went through several editions and was an important resource for teaching the art of delivering a baby with minimal interference by the attendant.
For what little has been written in English about the life of Marie LaChapelle, history is mainly indebted to Kate Campbell Hurd-Mead, M.D., whose 1938 work, A History of Women in Medicine, devoted portions of seven pages to describing LaChapelle's life and accomplishments.
Born in Troubled Times
Marie Louise LaChapelle was born in Paris in 1769. The eighteenth century was a tumultuous time in French history. The country was engaged in wars throughout much of it, culminating in the huge upheaval of the French Revolution (1789-99). Revolutionary activities centered on Paris, where people had endured years of high taxes and recurrent food shortages.
The practice of medicine at the time was very primitive, ranging from outright neglect of poor patients to frequent bloodletting in the case of the wealthy. (Bloodletting, the treatment of choice for nearly every condition, including pregnancy, was the removal of an arbitrary quantity of blood using instruments, leeches, or both.) Midwives attended most births. Their talents and training varied widely. Convinced that France's infant mortality rate was too high, King Louis XV initiated measures to try to lower it in the mid-eighteenth century. Midwives were sent into the countryside to instruct peasant women in the art of childbirth. Laws were gradually passed to regulate health care practitioners. The laws excluded women from the practice of every kind of medicine except obstetrics. However, women were not allowed to receive a degree designating them as doctors of obstetrics. Instead, the laws prescribed a rigorous and expensive three-year apprenticeship for aspiring midwives who chose to apply for the training. Nina Rattner Gelbart described the eighteenth-century French midwife's qualifying exam as "a hair-raising test administered by a panel composed of the king's first surgeon or his lieutenant, a number of Paris surgeons, various deans of the medical faculty and royal surgical school, four sworn midwives of Paris and receivers, provosts, class masters, and council members. An intimidating ordeal, an awesome rite of passage" and one that was ignored by the vast majority of practicing midwives of the time.
LaChapelle's mother was a licensed midwife. Apparently known to history only as Madame Duges, she had learned the craft from her own mother and also received instruction from her husband (LaChapelle's father), a French health officer who had some knowledge of obstetrics. Madame Duges then finished her training at La Maternite. According to Hurd-Mead, Madame Duges was appointed "medico-legal midwife" to the local courts and prison. (In addition to assisting at births, midwives were often called upon to testify in court, settling such questions as whether a girl was still a virgin, or whether a dead baby died in the womb or was killed after birth.) From that position Madame Duges went to the Hotel Dieu, a famous hospital of Paris devoted to the care of the poorest of the poor. Hospital conditions of that time were generally very bad, but the conditions at Hotel Dieu were reportedly among the worst. Its maternity ward lodged four or more girls or women in each soiled bed, delivery rooms were open to any and all passersby, and germs were freely passed from patient to patient. Puerperal (childbed) fever was common. Puerperal fever is an infection of the birth canal that occurs following delivery of a baby; symptoms include headache, muscle aches, appetite loss, rapid heartbeat, and abdominal pain. By some estimates, as many as ten percent of mothers who delivered babies in eighteenth-century Parisian hospitals died of the fever.
Madame Duges cleaned up and reorganized the maternity ward at the Hotel Dieu. She taught her craft to other aspiring midwives and probably to some male doctors of obstetrics as well. Madame Duges also wrote several instructive books on the topic of delivering babies, and she was instrumental in making the Hotel Dieu a major center for the teaching of labor and delivery methods.
Intensive Training as Midwife
As a girl, LaChapelle was her mother's frequent companion and learned from her the trade of midwifery. In 1792 she married a surgeon by the name of LaChapelle, but he died only three years later. Thereafter, she devoted herself full-time to her profession. Upon her mother's death in 1797, LaChapelle took over as head of the maternity department at the Hotel Dieu. When she tried to introduce reforms to the practice of obstetrics and gynecology, LaChapelle ran afoul of the renowned Dr. Baudelocque, who taught obstetrics at the hospital. Although he admired her work, Baudelocque did not agree with some of her methods and ideas. Over LaChapelle's protests, he favored the frequent use of instruments to hasten labor, especially forceps, which were used to extract the baby from the womb. Baudelocque did not believe that puerperal fever was contagious and that unnecessary onlookers at a birth frequently carried the disease from patient to patient. (In fact, the contagiousness of puerperal fever was debated well into the nineteenth century. Today, doctors agree that a risk factor for the development of puerperal fever is repeated vaginal examinations with unsterilized equipment during labor. The custom of allowing large numbers of unnecessary people in the delivery area has been abandoned since LaChapelle's day.)
Despite the obstacles LaChapelle faced in implementing her obstetric innovations, France and especially Germany were considered fairly enlightened when it came to women practicing in certain areas of medicine. And according to Eric v. d. Luft, "Female students of midwifery in the mid-nineteenth century in Germany received a level of medical education superior to that which was offered to female medical students in the same era in America." At some point LaChapelle went to Heidelberg, Germany, to study under the great obstetrician, Franz Naegele, for whom Naegele's Rule is named (still in use today, it is a way of calculating a pregnant woman's expected date of delivery). Upon her return to Paris, LaChapelle set about organizing a maternity and children's hospital at Port-Royal de Paris, the Hopital de la Maternite (formerly a prison). There she continued to introduce new techniques in patient care and attempted to modernize the training of midwives.
But old customs die hard, and LaChapelle had little success in convincing other birth attendants to change the practices she opposed. According to Hurd-Mead, she was more successful in introducing new labor management techniques, including "the immediate repair of a torn perineum [the area between the anus and the posterior part of the external genitalia], and in cases of placenta praevia [an abnormal positioning of the placenta that causes it to precede the child at birth, usually causing severe maternal bleeding] she insisted upon quick dilation of the os uteri [mouth of the uterus] with tampons and the extraction of the infant by version [turning], thus saving the lives of both mother and child." She invented a technique for repositioning a fetus that eliminated the need for forceps. She also compiled statistical tables based on her observations that were helpful in settling questions about pregnancy and labor.
Master Work Published After Her Death
LaChapelle died of stomach cancer in 1821. She left behind one daughter (a Roman Catholic nun) and a portrait of herself. According to Hurd-Mead, the portrait showed "an attractive woman in a Gainsborough hat trimmed with ostrich plumes. She wears a ruffled collar, immense puffed sleeves, an absurdly small waist, and an elaborate gown with beautiful laces."
LaChapelle's master work was published in three volumes over a four-year period beginning in 1821. It was called Pratique des Accouchemens, ou Memoirs et Observations choisies, sur les points les plus importans de l'Art; Par Mme. Lachapelle, sage-femme en chef de la maison d'Accouchement de Paris (Childbirth Practices, or memories and choice observations on the most important points of the art, by Madame Lachapelle, midwife and head of the Paris childbed house). According to Hurd-Mead, the book opposed and annoyed the great Baudelocque in several respects. In volume one, LaChapelle "classified the positions of the fetus better than he did, reducing his 94 positions to 22. She insisted that instruments should be used as little as possible, and never for the mere sake of shortening labor. She showed how to insert forceps deftly. In all her 40,000 cases she interfered with nature in only 1.73%, using forceps only 93 times, version 155 times, symphisiotomy twice, and Caesarian section but once." Volume two described her most unusual cases and the treatment she had employed, and volume three dealt with the then-new operation of symphisiotomy, a surgical procedure to bring about an immediate dramatic increase in the size of the pelvic outlet to permit delivery of a baby. LaChapelle's book became an important resource in the training of midwives throughout Europe.
Gelbart, Nina Rattner, The King's Midwife: A History and Mystery of Madame du Coudray, University of California Press, 1998.
Ogilvie, Marilyn Bailey, Women in Science: Antiquity Through the Nineteenth Century: A Biographical Dictionary With Annotated Bibliography, MIT Press, 1986.
Hurd-Mead, Kate Campbell, Women in Medicine: From the Earliest Times to the Beginning of the Nineteenth Century, Haddam Press, 1938.
Luft, Eric v.d., Ph.D., M.L.S., "Mid-Nineteenth Century Attitudes Toward Women Physicians: Reflections on Elizabeth Blackwell and the 150th Anniversary of Women in Medicine," http://www.upstate.edu/library/history/cppblackwell.html (January 15, 2001).
"Modern History Sourcebook: Oliver Wendell Holmes (1809-1894): Contagiousness Of Puerperal Fever, 1843," http://www.fordham.edu/halsall/mod/1843holmes-fever.html (January 14, 2001). □