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OBSTETRICS

A Brief History of Obstetrical Care at Pennsylvania Hospital

In the early history of Pennsylvania Hospital, the need for a maternity department was not officially recognized by the medical profession. The Managers opposed it because they did not wish to appear to encourage immorality; it was considered improper for legitimate children to be born outside of the home. The Managers also opposed establishing a foundling asylum, thought to be a necessary adjunct. Obstetrical cases were, however, occasionally received. The birth of the first child at the hospital was on July 17, 1765: "Born a female child of Martha Robinson a poor patient."

The advantages of having accommodations for such cases wasn't realized until 37 years after that first birth and some 50 years after the hospital's founding. An act of the Legislature dated April 11, 1793 set forth provisions for establishing a Lying-in (maternity) Department at Pennsylvania Hospital; ten years later these provisions were finally acted upon. The Lying-in Department officially opened on May 20, 1803; the first admission, though, had been on March 30th, and the first birth of a female child on April 27th.

The first physician specialty recognized by the Board of Managers was obstetrics. When the annual election of physicians and surgeons was held on May 12, 1823, the members of the staff were defined separately for the first time in the hospital's history. Designated "Physicians for the Lying-in Department" were Thomas Chalkey James and John Moore. Unfortunately, the department was closed in 1854, partially due to a terrible outbreak of puerperal (childbed) fever that claimed the lives of many lying-in patients.

Pennsylvania Hospital's involvement with obstetrical care had not ended. Affiliations with other lying-in facilities in the city eventually led the hospital back into the "baby business." One was the Philadelphia Lying-in Charity for Attending Indigent Women in their own Home, founded in 1828 by Dr. Joseph Warrington and chartered in 1832. In 1839, he organized the Philadelphia Nurse Society, which in part trained women in obstetric nursing. The Lying-in Charity and the Nurse Society were united as one institution in 1851. In 1856, Dr. Elwood Wilson assumed its head. In 1863, the institution became known as the Philadelphia Lying-in Charity and Nurse Society. By 1923, its Board of Managers was made up largely of men who were also Managers of Pennsylvania Hospital, and an affiliation was made between the two institutions. The Spruce Building was erected in 1929 to house the new combined service; the lying-in facility was located there until 1971, when they were moved to the newly erected Preston Building.

A second affiliate, organized in 1872 to provide care for unmarried women, was originally called the State Hospital for Women and Infants; the name was changed in 1882 to the Maternity Hospital. For forty years only unmarried women were admitted. One of the main objects of the hospital had been to offer privacy and a chance for social readjustment to unfortunate young women. Many hospitals sent their student nurses to the Maternity Hospital for obstetrical training. In 1930, the Maternity Hospital was affiliated with Pennsylvania Hospital and merged with the services in the Spruce Building.

In 1960, a third affiliation was made with the Preston Retreat, named for Dr. Jonas Preston, a 19th century Philadelphia obstetrician and philanthropist. He created an endowment to benefit "indigent married women of good character," and the Preston Retreat was founded in 1865 through this bequest. Prior to the formal affiliation, the institutions shared mutually beneficial programs (the retreat providing a training site for the hospital's School of Nursing). In September 1971, the Preston Building opened (as the result of another bequest of Dr. Preston). Lying-in services were moved to the new building and the Spruce Building ceased to operate as a maternity facility.

Since the opening of the Preston Building, Pennsylvania Hospital has been the home of many innovations in fertility treatment and obstetrical care. In 1978, the first antenatal testing unit (ATU) in the region was created to diagnose and evaluate the fetus. In 1985, the first GIFT (gamete intrafallopian transfer) pregnancy in Philadelphia was achieved, one of the first GIFT programs in the United States; by 1995, Pennsylvania Hospital had hosted 1,000 live births from GIFT and other assisted reproductive technologies. The first laparoscopic assisted vaginal hysterectomy in Philadelphia was performed at Pennsylvania Hospital in 1985. And in 1996, Pennsylvania Hospital opened the first perinatal evaluation and treatment unit (PETU) in the region to assist in the evaluation of high-risk situations which develop during labor, as well as perform procedures such as amniocentesis and fetal surgery. In the over 230 years since the first birth here, Pennsylvania Hospital has laid the groundwork for many crucial advances in obstetrical care and remains committed to continuing that tradition in the years to come.

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