History of Obstetrics

The Philosophical Roots of the Medical Model

To understand how the modern medical model came to view the human body as a machine, something to be observed, managed, and controlled, we need to look at the philosophical foundations that shaped Western science itself.

One of the key figures behind this transformation was René Descartes (1596–1650), a French philosopher and mathematician whose ideas profoundly shaped how the West came to see the human being. His philosophy, known as mechanicism, proposed that the entire universe, including living creatures and the human body, functions like a mechanical system, predictable and governed by physical laws.

Mechanism is the belief that natural wholes (principally living things) are similar to complicated machines or artifacts, composed of parts lacking any intrinsic relationship to each other.

This represented a major break from earlier traditions. Before Descartes, most people in Europe still held remnants of the belief that living beings possessed an inner life, something immaterial that animated them.

While the pre-Islamic philosophers and Christian scholastics distorted and mixed this concept with falsehoods, they at least acknowledged that creation had purpose, that life was not random. But with Descartes, came a full shift toward philosophical materialism, the belief that only what can be seen and measured is real.

In his view, the body was nothing more than a biological machine; complex, but soulless.

It could be dissected, measured, and manipulated without any sacred boundary.

And while he still reserved a separate place for the “mind” or “soul,” this separation laid the groundwork for the Western belief that the body and spirit are distinct, unrelated realities... an idea utterly foreign to the understanding of the Muslims.

For us, the human being is one integrated creation, body, soul, and heart, each inseparable from the other, all dependent on Allah. The Qur’an never divides the human being in this artificial way. It describes the nafs, qalb, and ruh as intertwined aspects of the same being. Allah created us as holistic creations, sustained every moment by His decree, not mechanical entities running on autopilot.

The Animal-Machine and the Loss of Sacredness

Descartes also argued that animals were mere automata, “machines of flesh” with no soul, emotion, or consciousness. In his philosophy, their cries of pain meant nothing; they were simply mechanical reactions. This concept, called the animal-machine thesis, stripped life itself of sacredness and compassion.

From this idea, Western science developed its cold and detached relationship to living beings, including the human body. The same mentality that could cut open a cat or dog without flinching became the mentality that could cut open a woman giving birth and call it “progress.”

Philosophy vs. Revelation:
A Foundation Built on Darkness

It’s important to understand that these ideas did not come from divine revelation; not from Allah, not from the prophets, and not from any true source of ‘ilm. They came from the speculation of men disconnected from the guidance of Allah. And this is the danger of philosophy (falsafah): it builds upon assumption, not upon revelation.

Philosophy asks: “What if reality works this way?” Revelation tells us: “This is how Allah created reality.”

The philosophers of Europe were groping in the dark, trying to understand creation without the light of wahi (revelation). They examined the signs of Allah, the heavens, the stars, the body, but without recognizing the Creator behind them. And so they mistook the mechanism for the Maker, the creation for the cause.

Allah says in the Qur’an:

“They know what is apparent of the worldly life, but they are heedless of the Hereafter.”

(Surah Ar-Rum, 30:7)

This is the foundation of modern science, a knowledge of the apparent, divorced from meaning and purpose.

And when the knowledge of creation is separated from the knowledge of the Creator, the result is arrogance, not understanding.

How This Philosophy Shaped Modern Medicine

From Descartes’ worldview came the roots of the biomedical model that dominates today. Once the body was seen as a mechanical system, it could be dissected, monitored, and “fixed.” Women’s bodies were studied as if they were faulty machines. Birth was removed from the home and placed under fluorescent lights, under the authority of doctors who believe themselves to be mechanics of human life.

Every intervention, every surveillance technology, every attempt to control or “manage” birth, all of it stems from this same root: a worldview that sees the body without the soul, creation without the Creator, and knowledge without humility before Allah.

But this is not knowledge (‘ilm). True ‘ilm is what leads us to fear and revere Allah, to see His wisdom in every cell and every process of life. The Muslim view of the body is not mechanical, it is sacred. Allah designed the womb as a place of mercy (rahmah). He placed within it intelligence and order beyond our comprehension.

Our body has rights over us. The Qur’an itself describes the development of the child in the womb as a sign for those who reflect:

“We created you from dust, then from a drop, then from a clinging clot, then from a lump of flesh - partly formed and partly unformed - that We may show you Our power.”

(Surah Al-Hajj, 22:5)

This is the knowledge of creation, not learned through dissection or machines, but through tadabbur (reflection) upon the ayat of Allah.

In the early 1800s, almost all births were attended by traditional midwives. The role of a midwife was looked down on and seen as a “dirty” or “lowly” job. Midwives in the USA at the time were known as “granny midwives”, they were enslaved elder Black women who attended the births of other Black slave women as well as white women.

They were known for their knowledge of traditional birth and postpartum care. Midwifery would be later replaced by obstetrics and gynecology. Due to the rise of reproductive health issues in female black slaves in America, young white male doctors began to become more curious about treating these health conditions and eventually made their way slowly into the field of midwifery.

Black female slaves in America were forced to have children at ages as young as 13 years old, and often suffered through back to back pregnancies in order to grow the slave population in the Southern United States. Because of these traumatic pregnancies, black female slaves began to suffer from a condition called vaginal fistulas- which is a hole that forms between the vagina and other nearby organs in the pelvis, like the bladder or anus.

This condition causes urinary and fecal incontinence, abnormal vaginal discharge, tissue damage, and kidney infections. As the field of medicine was growing and doctors were becoming more sophisticated, white slave owners in the South would seek out medical help for their black female slaves who had this condition.

J. Marion Sims was the most well known surgeon at the time who performed many surgical experiments on black female slaves who suffered from this condition.

J. Marion Sims is considered to be the founding father of obstetrics and gynecology.

He is most known for his surgical work on repairing vaginal fistulas on black female slaves in the Southern USA. He invented the Sims speculum, an instrument used today for vaginal and cervical exams. Sims also invented the sigmoid catheter and “Sims position”- usually used for rectal examination, treatments, enemas, and examining women for vaginal wall prolapse.

Sims is known for his unethical and horrific surgical experiments on enslaved Black women of the southern USA.

Sims’ attempts to cure vaginal fistulas were all carried out on enslaved Black women, who could not give consent. All surgeries were performed without anesthesia. According to Sims’ own records, surgeries were performed on a Black female slave while other slaves held her down on the table while he made experimental attempts to stitch the damaged vaginal tissue.

The women he used for his surgical experiments were kept in a small hospital behind his house in Alabama. Between late 1845 and the summer of 1849, he carried out repeated operations on these women in an effort to repair their injuries.

One young woman, a slave named Anarcha with a particularly difficult combination vesicovaginal and rectovaginal fistula, underwent 30 operations before Sims was able to close the holes in her bladder and rectum. (Wall LL. The medical ethics of Dr J Marion Sims: a fresh look at the historical record. J Med Ethics. 2006).

Sims became an “expert” on anesthesia later in his surgical career however he did not use anesthesia on his patients. A common racist belief at the time that still exists in modern medicine today is that black people don’t feel pain as much as white people. Sims was also extremely negligent towards his patients; one example is his surgery done on a female patient named Lucy, who nearly died of sepsis in the presence of twelve doctors, because Sims left a sponge inside of her urethra and bladder after Sims used it to wipe urine with during surgery. Sims would often invite his other colleagues and peers to observe his experimental surgeries on these slave women.

White male doctors other than J. Marion Sims continued to perform horrific surgical experiments on black slave women in America as a way to further modern medicine. Women were resistant at first in allowing men to attend their births and deliver their babies, due to the fact that this was a women’s field of work. In order to persuade women to allow male OBGYNs to deliver their babies, propaganda was produced against granny midwives as a way to demonize them and elevate the status of male OBGYNs at the time.

Giving birth in a hospital with an OBGYN became a “status symbol” as a result of this propaganda created against traditional midwives.

Midwifery soon became illegal in some states in the USA, and in the states where it was still legal, heavy regulations were put against midwifery in order to restrict midwives as much as possible.

As a result of the eradication of traditional midwifery, hospitals became the most popular and respected place for women to give birth.

The Twilight Sleep Era

By the late 1800s and early 1900s, childbirth in America was already being pulled away from the home and into hospitals, largely through the demonization of midwives and the elevation of male physicians. But the next century would witness further medical interventions that radically altered how women experienced birth... interventions that were promoted as “progress” but often left women powerless, silenced, and deeply harmed.

In the early 1900s, a drug combination known as twilight sleep (morphine and scopolamine) became a popular form of pain management in birth. It was first developed in Germany and quickly spread to the United States, especially among wealthy white women who viewed it as a “modern” way to give birth.

Twilight sleep did not actually take away pain; instead, it caused women to lose memory of the experience, often leaving them semi-conscious, delirious, or violently restrained.

Women under twilight sleep frequently had to be strapped to their beds to prevent injury as they thrashed and screamed through the effects of the drugs. Nurses sometimes gagged women or tied their wrists to keep them still.

Although it was marketed as liberation from the “burden” of childbirth, twilight sleep stripped women of agency and awareness, turning birth into a medical event entirely controlled by doctors. It also resulted in a cascade of interventions, including the routine use of forceps to “deliver” babies from drugged, unconscious mothers.

This era marked the normalization of women’s voices being silenced in birth; a legacy that still influences obstetric practices today.

The Rise of Epidurals

As medicine advanced into the mid 1900s, the twilight sleep era waned, but another intervention rose in its place: the epidural. Promoted as a safer, more effective way to relieve pain, epidurals became routine in hospital births, with many women feeling pressured to accept them.

While epidurals can temporarily numb pain, they also interfere with the natural hormonal flow of birth, slow down labor, and increase the likelihood of interventions such as Pitocin augmentation, vacuum extraction, or cesarean section.

This reinforced the idea that birth is not something a woman’s body does naturally by Allah’s design, but rather something that must be managed, monitored, and controlled by medical staff.

Over time, many women came to expect that birth would be painful, frightening, and medicalized, an outlook directly shaped by the technocratic model.

The Feminist Origins of the Epidural

Epidurals became a trend due to the feminist movement in America and Britain. The origin of the epidural dates back to 1898 by German doctor Karl August Bier, who originally injected cocaine into his assistant's lower back. The concept of seeking pain relief became a widespread trend due to the feminist movement in Britain and America. Feminists wanted to “banish the suffering of childbirth”.

In 1914, doctors from Germany began using methods to do so using scopolamine and morphine. This would cause women to fall into a semi-conscious state and wake up hours later after birth. This was known as the Twilight Sleep Era.

American feminists demanded that this become standard procedure in American hospitals. Feminist Frances Carmody founded a hospital in Brooklyn, New York that would administer the drug to women. She ended up dying after her second “twilight sleep” birth due to hemorrhage, a common complication as a result of the drug use.

Twilight Sleep became trendy just like epidurals are today. Doctors could ignore women in labor for hours and abuse them without any consequence. By the 1930s, American women almost always gave birth heavily medicated.

Today, epidurals make laboring mothers easier to manage, and hospitals/doctors make money.

The feminist movement had an extremely destructive influence on childbirth and the obstetric system.

In the 1960s and 70s, some feminists began to critique the oppressive medicalization of birth and called for women to reclaim agency. This movement helped to revive interest in natural birth, homebirth, and midwifery in certain circles.

However, mainstream feminism often reinforced the technocratic model by framing birth as something from which women needed to be freed, especially through drugs, surgery, and control over reproduction (contraception and abortion).

Many feminists embraced hospital births, epidurals, and later elective cesareans as a form of “choice” and empowerment, even though these choices still operated within the same medical-industrial system that had always devalued women’s natural capacity to give birth.

By emphasizing autonomy as “control over technology,” feminism often neglected the deeper truth: that real empowerment for women lies in trusting the fitrah Allah created within them, honoring the natural design of the female body, and rejecting unnecessary interference in a process Allah has perfected.

The Legacy of Obstetrics

The combined impact of twilight sleep, epidurals, feminist redefinitions of birth, and the erasure of traditional midwifery created the modern reality: a world where birth is assumed to be dangerous, medicalized, and managed by experts.

The Western history of obstetrics is thus not neutral science; it is a story of oppression, racism, exploitation, and misplaced trust in technology. And it is a stark reminder that the medical system cannot be our guiding framework for understanding birth.

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