Dar a luz en Chile, siglo XIX: De la “ciencia de hembra” a la ciencia obstétrica

Resumen

This five-hundred-page book provides a comprehensive, well-researched, and definitive medical history of childbirth in nineteenth-century Chile. Zárate examines physicians’ increasing interest in the female body and childbirth and their increasing, if always limited, control over labor and delivery. In the early republican era, where Zárate’s story begins in earnest, medicine itself was not a well-regulated or well-defined profession. But in 1834 physicians codified procedures for their own training and licensing and began to insist that only they attend to difficult births and to assert control over the schooling of midwives. They set up a first school for midwives in 1834, and the protomedicato (medical college) subsequently examined and licensed midwives. With the passage of an 1866 law requiring midwives to obtain licenses, physicians and their “obstetrical science” further encroached on midwives’ “ciencia de hembra.”As Zárate points out, the process whereby physicians asserted control over childbirth was part of a broader trend in which scientific medicine encroached on popular medicine. In examining this shift, the author attends to how gender shaped medical authority. The gendered nature of medicine (an almost exclusively male profession) and midwifery (all female) allows Zárate to clearly delineate how the advance of scientific medical knowledge drew on, and reaffirmed, masculine prerogatives. Physicians would carry out surgical interventions, while midwives were relegated to assisting only unproblematic and “natural” childbirths.While attentive to gender, Zárate does not portray midwives as victims. In Valparaíso, she tells us, a group of trained midwives asked the protomedicato in 1870 – 72 to deny licenses to their lay competitors. Nor were relations between doctors and midwives always antagonistic. When women or babies died in childbirth, doctors inevitably blamed midwives, whom the doctors viewed as ignorant. But Zárate looks behind sources that focus on midwife births that went wrong: newspaper stories, medical case reports, and files of the protomedicato. Outside of major cities, Zárate shows, doctors were often unavailable, and midwives’ authority remained intact. Zárate also finds evidence that lay and trained midwives called in doctors for difficult deliveries. In cities, doctors often recommended midwives to their patients. In fact, many midwives were trained by local doctors to deliver babies, and the protomedicato gave many lay midwives license to practice while they prepared to take the protomedicato’s licensing examination. But despite the lax enforcement of licensing measures and the evidence of collaboration between doctors and midwives, Zárate is careful to point out that doctors insisted on determining who could or could not attend births.Zárate’s documentary base does not allow her much access to the experiences of the women who gave birth. But they are implicitly and sometimes explicitly part of her account. Medical doctors’ control over childbirth depended on the support of women and their families, who could choose whether or not to let doctors into birthing chambers. The limitations of obstetric science often led women to avoid physicians, Zárate explains. And midwives apparently found ready clients for the wide range of gynecological services they provided.Zárate analyzes how doctors’ authority and the limits on that authority were linked to the growth of hospitals as institutions. No women’s hospital existed in Santiago until the second half of the nineteenth century, a sign of medical science’s lack of interest in the female body. But once the formal training of doctors and midwives began, hospital-based birthing clinics became a necessary part of their education. A strength of Zárate’s account is that she pays close attention to how social class influenced women’s differential access to medical care. Poor women, unable to afford medical attention at home, were frequently forced to go to the Casa de Maternidad if they had difficult pregnancies. There, they came under the medical gaze and risked contracting puerperal fever. Medical personnel fully understood and practiced antisepsis only in the last decade of the nineteenth century. Only then did the benefits of giving birth in the hospital outweigh the risks. Henceforth, physicians would be able to use hospital care to secure their medical authority. However, Zárate’s story ends at a moment when obstetricians’ limited power to avert death still curtailed their authority and influence.Overall, Zárate gives us a nuanced history of childbirth. Drawing on the historiography on childbirth in the United States, Latin America, and Europe, she is able to show how changes in Chile were related to changes in other locales, but she does not portray the Chilean case as derivative. Especially when she puts us in the birthing room, her narrative can be dramatic and engaging. More aggressive editing would have allowed those episodes to shine more brightly. Moreover, some readers will wish the author had drawn out the implications of the history she uncovers for understanding state power and its relation to the growth of the professions, topics that have been central to the history of medicine in Chile and Latin America. Still, readers of this book will find a detailed, useful narrative of the uneven process whereby a masculine medical science extended its reach.