A dangerous journey to the beginning of life

Every year we celebrate the remarkable day when our lives began. The importance of that moment is reflected in diverse cultures throughout the world: in the enduring images of the Virgin Mary and her child in the stable in Bethlehem; of the birth of Buddha under an ashoka tree; and in the still widely held belief that the position of the stars and planets at the moment of our birth influence our personalities and the course of our lives.

Yet before the relatively recent advent of anaesthetic, forceps, or an understanding of how infection spreads, women going into labour were going to their likely death. As many as one in five women died in childbirth; it was an expected tragedy and the most common cause of death in young woman right up until the 18th century.

The odds of survival improved with the invention of forceps by Peter Chamberlen in 1600. They remained a family 'secret' for over a hundred years, establishing the Chamberlens as the only people who could miraculously help a mother and baby through a difficult birth. Legend has it that the Chamberlen men travelled with the forceps hidden in a chest and only produced them once the woman in childbirth and her family were blindfolded.

By the 18th century this carefully guarded 'secret' had either been leaked, or other people had had the same idea. From 1720 onwards, forceps began to be widely used in delivery, something that was encouraged by physicians William Smellie in England and Jean-Louis Baduelocque in France, who both worked to make obstetrics a scientific discipline.

Since only trained physicians were permitted to use forceps - and women were banned from university medical training - this period also saw the decline of the traditional midwife in favour of male doctors or obstetricians (who became known as 'man-wives').

Traditionally, midwives, who alone were privy to the intimate secrets of the birth chamber, were believed to have special knowledge and 'powers'. But by the early 19th century, they were portrayed as uneducated, ignorant and drunk, like the midwife in Thomas Rowlandson's caricature of 1811. It was not until 1902 that the Midwives Act established midwifery as a profession in England.

The 19th century saw the defeat of one of the most terrifying and baffling spectres that haunted the birthing chamber: puerperal or childbed fever. In 1847, Dr Jakob Kolletschka, a physician at the Vienna General Hospital in Austria, died after pricking his finger with a knife that had been used in an autopsy and contracting an infection. His colleague, Dr Ignaz Semmelweis, was struck by the similarity of his symptoms to those of women who had been dying at an alarming rate of puerperal fever after giving birth in the hospital.

Dr Semmelweis came to the conclusion that there must be a connection between the two, and hypothesised that medical students transmitted 'cadaver particles' from autopsies to women giving birth, thereby causing the fatal fever. Full of remorse for his own part in the deaths of so many women, he decreed that everyone performing a dissection should disinfect their hands in chlorine before examining patients. As a result the death rate dropped from nearly 20 per cent to less than 1 per cent by the end of the year. A decade later, Louis Pasteur identified bacteria as the infecting agent of puerperal disease.

Developments during the 20th century - ultrasound, antibiotics, new surgical techniques for caesareans and epidurals - have all combined to make birth a safer and easier process, and to widen the choices available to women. The late 1950s and 1960s saw an increasing interest in education about the birth process, breastfeeding, and giving birth naturally with as little intervention as possible.

In the UK, the National Childbirth Trust, established in 1956, seeks to improve the experience of becoming a parent by offering a wide range of support services, including antenatal and postnatal classes and support groups, telephone helplines and evidence-based information on labour and breastfeeding. In April 2007, the UK government declared its commitment to offering pregnant women the choice of whether to give birth at home, at a hospital or in a dedicated birth centre.