HHH Column: Unspoken birth stories and historical imagination by Jolien Gijbels

The HHH column is a monthly blog in which History, Health & Healing members share their thoughts on research, current affairs, or anything to do with medical history. Each edition is written by a different member – in due time, we hope to offer everybody a chance to publish a contribution. This month, the floor is for Jolien Gijbels, assistant professor of History at Vrije Universiteit Brussel. In this column, Jolien shares the story of Angélique, a woman who, against all odds, survived a complicated cesarean section, and explores the often overlooked patient perspective in stories like these.

Unspoken birth stories and historical imagination

Jolien Gijbels

In 1837, Angélique became pregnant under the most difficult circumstances. As a wife of a shoemaker and a mother of three children, she lived in poverty in a little cabin in the cemetery of a village in East Flanders. She suffered from a serious rheumatic condition which had gotten worse over the years. She constantly felt pain in her back, shoulders and lower body. Her pregnancy did not help her condition. Resting on a pile of straw, barely clothed, she tried to move as little as possible. She depended almost entirely on her husband for everything she needed.

Jan-Pieter Hoebeke is the reason why we know about Angélique’s difficult pregnancy. In the 1830s, he practiced medicine in Zottegem and surrounding areas in rural East Flanders. Around this time, the country doctor gained a reputation as one of the few Belgian physicians who regularly performed cesarean sections in cases of difficult births. By 1840, Hoebeke had carried out sixteen cesarean sections, eleven of which saved the mother’s life. His reported successes in medical journals were exceptional at a time when maternal death after abdominal surgery was common. Hoebeke only performed his operations on women like Angélique who could not give birth without surgery because of pelvic deformities. Her exceptionally small pelvis was also the main reason why Hoebeke wanted to share her case with fellow doctors. 

During the nineteenth century, East Flanders became known among Belgian doctors as a breeding ground of osteomalacia, a disease that progressively softened the bones of people who had a deficiency in vitamin D, calcium or phosphate. It dramatically affected poor populations who did not get enough sunlight exposure and nutritious foods. Just like many other women with osteomalacia, Angélique’s first children were born vaginally without a problem. Only recently, the disease had affected her pelvis to such extent that a cesarean birth had become inevitable. Hoebeke was a witness of her difficult life, but he did not understand the direct link between bone deformities and the burden of poverty. Instead, he described the harmful effects of whale oil that people in East Flanders used to ease their rheumatic pain, which, according to him, only worsened their condition. 

Hoebeke’s observations mainly reveal his thoughts and actions, while remaining silent about Angélique’s responses. We will probably never know what exactly was going on in her mind. Yet, as historians we can imagine that Angélique must have felt horrified at the prospect of undergoing a cesarean section. Hoebeke’s case history does not give a clue, but other doctors mentioned patients’ fear of abdominal surgery in their observations. Cesarean sections were not only mortal but also extremely painful in the 1830s, when they still happened without anesthesia. Doctors needed to hold patients still with the help of assistants and operate as quickly as possible. In Angélique’s case, there were several complications that prolonged the operation. Three assistants were supposed to provide candlelight and hold Angélique on a table covered with straw, while Hoebeke performed the operation. There was also a fellow physician who passed the instruments and a local priest who helped where he could. Everybody was standing very close to each other in the claustrophobic cabin, which offered barely any room for action. Soon, the surgical assistants started to feel sick. At some point, they collectively passed out and left the room, leaving Hoebeke operating in the dark. In his publication, Hoebeke praises the coolness of the priest who remained at his side. No word, however, about Angélique’s perseverance and despair as she was probably conscious when all of this happened.

Historical imagination is crucial to interpret silences in medical sources. This is of particular necessity in a time when physicians increased their authority over patients’ treatments. What prevails are paternalistic attitudes that indicate a lack of trust in patients’ ability to make decisions on their health. Hoebeke for instance wrote disapprovingly about the use of whale oil by his patients. Yet, by using historical imagination, it is revealed that people in poverty sought solutions for their problems. Angélique possibly did not consider her rheumatic complaints as signs of a disease that needed medical treatment. She might have considered her pain as an unfortunate part of life. Medical feelings of surprise, horror and disgust are also of use to historians who want to make sense of what is unspoken. Some medical observations are exceptionally detailed, particularly when encounters with patients left a strong impression on physicians. Hoebeke’s report elaborated on the interior of Angélique’s home and her helpless state of being. He clearly pitied her for her poor living conditions. 

Angélique was one of Hoebeke’s eleven patients who survived a cesarean section. She withstood an eventful recovery period of three weeks after which she was declared cured. Her twins also survived the operation and the first precarious weeks. Yet, it is unlikely that the girls made it into adulthood. Many babies whose mothers lived in poverty died shortly after birth. Angélique’s story is about much more than a difficult birth. It’s about a life in hardship, a life with a disease that immobilized and disabled her. Hoebeke’s observations end with Angélique’s cesarean section, but her life did not. She faced an uncertain future after her delivery.