Justine Siegemundin

German midwife

• Born: 1636 or 1650
• Birthplace: Rohnstock, Silesia (now in Poland)
• Died: 1705
• Place of death: Berlin, Prussia (now in Germany)

Based on her extensive experience assisting in difficult births, Siegemundin published an obstetrics text for midwives that remained an authority through the nineteenth century. One of her birthing techniques, the double handhold, is still used.

Early Life

Little is known about the life of Justine Siegemundin (yoos-TEE-neh seeg-eh-MOON-dihn), who was born Justine Dittrichin Siegmundin, other than what she wrote in the book that was to make her the authority on midwifery during her day. It is known that she was the daughter of Elias Diettrich, a country pastor in Rohnstock, who died before she became an adult. At the age of nineteen, she married a man surnamed Siegemund, and she became known by the feminine form of this surname, Siegemundin.

The next year, at the age of twenty, a midwife believed Justine was pregnant, and at the fortieth week found what she thought was a fetus in the correct position; the midwife insisted that the fetus be delivered. In reality, Siegemundin had experienced a false pregnancy, which was recognized by a soldier’s wife from the village, and not by any of the midwives consulted. Instead of being pregnant, Justine had a damming up of blood, a condition cured by a physician.

After this experience, Justine wanted to study midwifery. No midwifery schools existed in Germany at the time, however, so she studied books and outlines of the subject and discussed the material with local midwives. When she was twenty-three years old, one of the midwives called on her to deliver a farm wife’s baby, whose elbow had emerged first. She was soon to accompany the midwives in their work and perform difficult deliveries for village women and farm women, including the poor, whom she felt blessed to serve. In particular, people called on her to deliver women whose babies had died. Word of her successful techniques spread, and she was often called to attend women in difficult labor at distances of 4, 6, and even 8 miles, a great distance then. In addition, well-to-do women, including pastors’ wives and noblewomen, sought her help with their difficult labors as well. She spent twelve years delivering babies in her locale.

Life’s Work

Siegemundin’s fame and reputation grew, and she gained recognition and influence among the nobility as well as physicians. She published an influential, and what would become authoritative, book on obstetrics for midwives called Die Chur-Brandenburgische Hoff-Wehe-Mutter (1690; The Court Midwife of the Electorate of Brandenburg , 2005). The book includes her pointed assertion that without her knowledge or her desire, she had received an invitation to travel to Liegnitz (now called Legnica, Poland), where she would receive permission to practice midwifery in 1683. She did go to Liegnitz, and her appointment was somewhat unusual, given that there existed a Prussian regulation stipulating that a midwife had to have given birth herself before she could become a midwife.

While in Liegnitz, a deathly ill noblewoman had suffered with a growth in her uterus, suspected by a physician to be a moon-calf (a mole or monstrous uterine growth) that had begun to decay. Siegemundin removed the growth, and the woman survived, which brought Siegemundin even more fame. The rapid growth of her reputation attracted the attention of the elector of Brandenburg, Frederick William , who invited her to Berlin to be the court midwife. She accepted, and she remained in Berlin until her death in 1705.

Siegemundin’s habit of taking notes about her cases came to good use, as she used the notes to form the basis of her textbook. She was further spurred by the recommendations of the princess of Nassau and the queen of England. In 1689, Siegemundin presented her manuscript to the medical faculty at the University of Frankfurt at the Oder River, earning scientific approval of her work. She also acquired assurance from clerics that her book contained nothing heretical. The text appears in nontechnical, accessible German, suitable for reading by the midwives who had no formal education and who could not read Latin, which was the language of the universities. The initial passages of the book present an impassioned defense of her practice of midwifery, despite having borne no children. For example, she asks the reader if it were necessary that a physician experience all the illnesses that he treated before he could practice medicine, and then gives an account of her history of successful deliveries.

The actual text presents a dialogue between Christina, a student of midwifery, and Justina, clearly representing Siegemundin. In the first part of the work, Siegemundin devotes chapters to reproductive anatomy, births with normally positioned fetuses, the means by which the position of the fetus is determined, and the management of obstructed births in which the fetuses lie in positions that prevent birth. Other chapters address prolonged labor, the placenta, and rupturing of the membranes. Following this last chapter are the testimonies of ten women, who attested to Siegemundin’s skills. In the second part of the work, the student Christina challenges Justina’s teachings “in order,” a pedagogical tool used to demonstrate whether or not a student has understood her teacher.

In cases of difficult labors, for example, those lasting more than three days, Siegemundin directed her efforts toward saving the mother’s life. She developed techniques to rotate the fetus in utero to lessen the pain of labor, to prevent hemorrhage (by piercing the placenta in the case of a placenta praevia, for example), and if need be, to use a hook to perform a craniotomy to extract a dead fetus. She also described techniques of finger palpation and explained when to rupture the membranes artificially. Intervention and the use of instruments formed part of her repertoire, but she rejected their use when they caused unnecessary pain. When, for example, Christina asked why the hook was acceptable, but not the vaginal speculum, Justina replied that the latter produced too much pain. Moreover, Justina also indicated when not to intervene in the birthing process. In the case of a fetus who presented an occiput posterior position (back part of the skull or head), the midwife should do nothing, even though the birth would usually be more difficult.

The book contains a number of copper plates, including one based on the anatomy of the female reproductive organs by Dutch physician Regnier de Graaf (1641-1673), as well as a number of instructional illustrations depicting a number of obstetric techniques. Plate 1 of the text illustrates Justine’s first case and shows how to push a fetus’s arm back into the uterus. A number of the plates depict how to perform a fetal version (that is, a turning of the fetus in the uterus to aid in its delivery), one technique being to hook a looped cord around the feet of the fetus and then rotate it so that the feet are pointed toward the cervix; the birth would most likely take place feet first, then, guided by the midwife’s hand. This podalic (feet-first) version was common in the seventeenth century, and Siegemundin devoted more space to it than to the cephalic (head-first) version. However, if the membranes were intact, Siegemundin recommended the cephalic version, a procedure that later came to bear her name. It should be noted that the forceps, invented in the seventeenth century, were unknown in Germany in Siegemundin’s time.

Significance

Siegemundin’s text was translated into Dutch in 1691 and appeared in seven German editions between 1690 and 1756; it was translated into English in 2005. The work quickly gained popularity among the private sector as well as acceptance by physicians, and it remained authoritative through the eighteenth century and into the nineteenth century, by which time male physicians had replaced midwives on a fairly wide scale.

Johan van Hoorn, who wrote the first book on midwifery in 1697 (in Swedish), was influenced by Siegemundin’s book, which had other imitators. Of significance is the fact that Siegemundin’s work did not rely on previously published material, but was the product of years of her own experience as a midwife. By her count, Siegemundin tended to more than five thousand births. The Gedoppelten Handgriff (Siegemundin-Handgriff), or the double handhold, is a still-used technique she developed to turn a fetus that is lying in a transverse position.

Siegemundin’s approach to the management of labor and birth differed from many standard practices. She focused on saving the life of the mother and on a successful delivery concluded not only by the version and birth of a baby but also by delivering a woman successfully of a dead fetus. This attitude may have been gendered, as male practitioners seemed to focus on the preservation of an infant, and not on the mother, necessarily. Also of significance is Siegemundin’s silence about the character of midwives and about the marital state of the parturient women (the woman giving birth), as well as her omission from the text of superstitious beliefs.

Bibliography

Banks, Amanda Carson. Birth Chairs, Midwives, and Medicine. Jackson: University of Mississippi Press, 1999. A study of the birthing chair in the context of changing social attitudes toward childbirth and midwives, who were replaced by physicians by the nineteenth century.

Lundgren, Ingela. Releasing and Relieving Encounters: Experiences of Pregnancy and Childbirth. Uppsala, Sweden: Acta Universitatis Upsaliensis, 2002. A general account of the experience of childbirth, with a brief section placing the work of Siegemundin in the context of Renaissance developments in midwifery and obstetrics.

O’Dowd, Michael J., and Elliot E. Philipp. The History of Obstetrics and Gynaecology. New York: Parthenon, 1994. A massive history, arranged by topics such as “the speculum” and “infertility, ” and with a chapter on midwifery.

Speert, Harald. Obstetric and Gynecologic Milestones Illustrated. New York: Parthenon, 1996. A book focusing on major advances in the practice and understanding of gynecology and obstetrics, with lavish illustrations. Contains a section on older historical works.

Tatlock, Lynn. “Specularum Feminarum: Gendered Perspectives on Obstetrics and Gynecology in Early Modern Germany.” Signs 17 (1992): 725-760. An analysis contrasting the voices in the writings of Siegemundin and those who were highly critical of female midwives. Places these works within the larger context of German midwifery.