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What is pelvimetry?
This blog post delves into the history of pelvimetry, a technique used in midwifery and obstetrics to measure the dimensions of the mid pelvis, outlet, and inlet of the pelvis (Lanni et al., 2017). Pelvimetry is used by some birth professionals to predict if a birthing person could deliver their baby vaginally and identify potential complications during childbirth (Pattinson et al., 2017; Yeomans, 2006). However, it is important to recognize the past misuse of this method in eugenic practices. By examining its past and how it was utilized, we can make a more informed decision on its place in modern midwifery practice.
The search to understand
Simple tools and methods employed through history reflect a desire to understand the correlation between a birthing person’s pelvis size and their ability to deliver a child vaginally. While primarily associated with the scientific advancements of the last two centuries, the practice of pelvimetry can be traced back to misogynistic, eugenic, and racist practices (Plotkin, 2014). Initial insights into the significance of pelvic dimensions were gleaned through keen observation and rudimentary measurement attempts during periods such as the Islamic Golden Age in 700-1300 AD (Fadel & Al-Hendy, 2022). Ancient midwives may have used manual palpation and comparisons to known objects to gauge pelvic size, shaping early childbirth practices. However, the accuracy of such methods remained a matter of conjecture due to their imprecision.
Pelvimetry was used by Eugenicists
Pelvimetry, like craniometry, was manipulated as a tool to justify racist, misogynistic, and eugenic ideologies, with some practitioners erroneously associating pelvic size with racial hierarchy or fitness for parenthood (Plotkin, 2014). Eugenicists such as Gustavo Aldolfo Trangay have used pelvimetry to implement sterilization campaigns (O’Brien, 2013). In the 1930’s pelvimetry was used to distinguish the worth of women prior to marriage because “to be married to a woman with infantile organs and an infantile nervous system can be more disagreeable to a man than it is to a woman being married to a syphilitic” (Blacker, 1935, p. 34).
These discriminatory practices and beliefs have since been discredited, yet their echoes remain a stark reminder of the importance of ethical considerations in medical practice. Knowledge of its past use in eugenics and racist practices should foster a commitment to applying this tool with care, ensuring it benefits all birthing people, regardless of race or background, and upholds the highest ethical standards of medical practice.
Pelvimetry Use today
Contemporary pelvimetry employs a variety of tools and techniques. Modern methods include CT scans, MRI, ultrasound, and clinical measurements like external pelvic examination and digital pelvimetry (Adam et al., 1985; Badr et al., 1997). These allowed for more accurate assessments of pelvic size, enhancing our understanding of pelvic anatomy and the refinement of measurement techniques. Though these methods offer more accuracy and less subjectivity than their predecessors, their use is informed by a history that requires acknowledgment and reflection. These advancements’ contributions to midwifery helped set the stage for contemporary methods and ongoing debates about the relevance and application of pelvimetry.
In conculsion
In conclusion, the story of pelvimetry is complex, marked by significant advancements, and marred by the misuse of the practice in the service of eugenics and racist ideologies. From its rudimentary origins to the refined techniques used in contemporary obstetrics, the role of pelvimetry has undeniably evolved. Today, it can predict potential complications during childbirth, such as cephalopelvic disproportion (Pattinson et al., 2017). Nevertheless, the echoes of its controversial past persist as a stark reminder of the ethical considerations necessary in medical practice. The responsibility to use this tool with the utmost care lies in the hands of modern healthcare professionals, who must remain vigilant against its misuse.
As a future midwife
As a future midwife, I will acknowledge and learn from pelvimetry’s history to ensure it is used in a manner that upholds the dignity and safety of all birthing individuals, regardless of their race or background. After discussing it’s use with my midwifery mentors, I comprehend that it can offer helpful information on possible helpful positions during labor for parents. I also understand that the history of pelvimetry sheds light on its evolution and provides critical context for its current use and future discussions in midwifery. As such, learning about pelvimetry in depth offered me an exploration of academic exercise and the importance of centering in the pursuit of equitable, respectful, and competent care as a future midwife.
References
Adam, P., Alberge, Y., Castellano, S., Kassab, M., & Escude, B. (1985). Pelvimetry by digital radiography. Clinical Radiology, 36(3), 327-330. https://doi.org/10.1016/S0009-9260(85)80084-2
Badr, I., Thomas, S., Cotterill, A., Pettett, A., Oduko, J., Fitzgerald, M., & Adam, E. (1997). X-ray pelvimetry — Which is the best technique? Clinical Radiology, 52(2), 136-141. https://doi.org/10.1016/S0009-9260(97)80107-9
Blacker, C. P. (1935). Fitness for marriage. The Eugenics Review, 27(1), 33-39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2985418/
Fadel, H. E., & Al-Hendy, A. (2022). Development of Obstetric Practice During the Early Islamic Era. Reproductive Sciences, 29(9), 2587-2592. https://doi.org/10.1007/s43032-022-00887-1
Lanni, S. M., Gherman, R., & Gonik, B. (2017). Malpresentations. Obstetrics: Normal and Problem Pregnancies (7th Edition). 368–394. https://doi.org/10.1016/B978-0-323-32108-2.00017-2
O’Brien E. (2013). Pelvimetry and the persistence of racial science in obstetrics. Endeavour, 37(1), 21–28. https://doi.org/10.1016/j.endeavour.2012.11.002
Pattinson, R. C., Cuthbert, A., & Vannevel, V. (2017). Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery. The Cochrane Database of Systematic Reviews 2017, (3). https://doi.org/10.1002/14651858.CD000161.pub2
Plotkin, L. (2014). Question of the week: what is pelvimetry? University College London. https://blogs.ucl.ac.uk/researchers-in-museums/2014/09/10/question-of-the-week-what-is-pelvimetry/#:~:text=However%2C%20in%20the%20Victorian%20period,as%20opposed%20to%20her%20brain.
Yeomans, E. (2006). Clinical Pelvimetry, Clinical Obstetrics and Gynecology, (49)1, 140-146 doi.org/10.1097/01.grf.0000198185.944
