When Chainsaws Helped Deliver Babies

Before the advent of modern medicine, childbirth was not only excruciating, it was downright dangerous. Without anesthesia, antiseptics or effective surgical intervention, labor carried many risks and was often deadly. In pre-industrial England, roughly 10 in every 1,000 births ended in the mother’s death, a mortality rate nearly 50 times higher than today. For much of human history, childbirth stood as one of the leading causes of death for women.

When a complication or emergency arose, like an obstructed birth, there were few surgical options or obstetricians to intervene. The first instruments and procedures introduced to help deliver babies in distress could be considered barbaric today, most notably the chainsaw.

But history isn’t always as simple as it seems.

“I think that we have in the modern day a tendency to look at...these early techniques and think they are 'barbaric,'” says Dr. Sara Ray, senior director of interpretation and engagement at the Mütter Museum in Philadelphia. An expert on 18th-century fetal abnormalities, Ray studies how midwives and physicians—and the surgical instruments they wielded—navigated some of the most difficult and dangerous births. These extreme interventions weren’t because surgeons wanted to use chainsaws on women, says Ray. The reality is they faced a life-and-death choice for the mother and baby.

Everybody understood how dangerous childbirth was in the 1700s and 1800s, especially women who went through it. Unlike today, women received little to no prenatal care and gave birth without antibiotics or anesthesia. People in the 1700s rarely even washed their hands.

Until about the mid-1800s, delivering babies was largely considered women's work. “Really in this period between 1550 and 1850, almost exclusively delivery of children was performed by women. It was women's work managed by midwives. Men were truly uninvolved in it,” Ray says. If complications arose, a laboring woman relied on those around her—female relatives, neighbors and perhaps a midwife—most of whom had no formal medical training.

Few safe surgical options were available, either. If the mother hemorrhaged during labor, she was likely to bleed to death. If her baby got stuck in the birth canal, a cesarean section generally wasn’t even considered. Prior to 1900, a C-section was mostly used to remove a living fetus from a deceased mother, Ray says. Practices generally considered unthinkable today, including craniotomy (which involved crushing a baby’s skull to deliver it) and embryotomy (cutting the fetus to save the mother), were attempted instead.

“What changed in the 1740s is that surgery as a discipline really started to professionalize," says Ray. This is also when surgeons started to become the medical partners of midwives, and obstetrical instruments like forceps were introduced. Midwives knew tools could help them do things like turn a breech baby around, and surgeons began creating those specialized instruments.

By the 1770s, French doctor Jean-René Sigault devised a possible solution to deliver babies stuck in the birth canal. His idea took shape after he read an account from the late 1500s in which French surgeon Séverin Pineau described a pregnant woman who had been hanged and was found to have a “diastasis of the pubis,” or separation of the pubic bones. Pineau speculated that surgically cutting the joint at the front of the pelvis to widen it might help women having difficult labor deliver safely.

Sigault and his assistant Alphonse Leroy tested the theory in 1777 on a pregnant patient who had already delivered four stillbirths because of a pelvis abnormality caused by rickets. Sigault used a sharp knife to successfully cut the woman’s pubic cartilage to widen her pelvis and safely deliver the baby.

Sigault’s operation was called the symphysiotomy, performed with a small knife without anesthesia. In 1785, Scottish doctors John Aitken and James Jeffray wanted to improve on the method with a tool to make the procedure faster and easier. That’s how the chainsaw became part of childbirth.

Aitken and Jeffray developed a flexible saw made of a chain link held between wooden handles at both ends. It was designed so a surgeon could quickly separate the mother's pelvis joint, widen the birth canal and reduce the damage to her surrounding soft tissue. It worked and became known as the Aitken's saw.

In 1834, German surgeon Bernhard Heine improved on the Aitken's saw design with his chain osteotome, which featured a handle to manually crank a chain to cut through bone even quicker. But the Heine osteotome was difficult to master and very few surgeons commanded the skills needed to use it. The Aitken's saw remained the tool of choice for childbirth emergencies until the end of the 19th century.

Surgeons continued searching for instruments that were safer, more precise and easier to control. That pursuit led Italian surgeon and obstetrician Leonardo Gigli to develop the Gigli saw. It was a thin, flexible wire fitted with handles at either end and operated with a steady back-and-forth motion. It cut more precisely through bone with a small incision.

Gigli used the saw to improve a procedure he proposed for high-risk deliveries, specifically cases of maternal pelvic deformities. The procedure became known as the lateralized pubiotomy and cut through the bone of the pelvis itself to widen it and allow the baby to be delivered. The Gigli saw is still used today for amputations, craniotomies and in veterinary medicine to cut antlers, horns and tusks.

The use of these chainsaw tools may have helped deliver babies in the 19th century, but the procedures didn’t leave the mothers without complications. Common issues included vaginal or uterine prolapse, hemorrhage, urinary fistulas, incontinence and difficulty walking.

The chainsaw tools were phased out toward the end of the 19th century as better surgical techniques and anesthesia were developed for use in childbirth, including the cesarean section. As germ theory gained acceptance and antiseptic practices spread, more physicians and midwives began advocating for hospital births.

“This is really a history of technology or engineering,” Ray says. She also reiterates that, while these instruments may seem inhumane today, we cannot look back on history through a distorted lens.

“We owe the benefits we’ve gotten from the sacrifices of people in the past,” she says, “so we can’t judge the decisions that they had to make under really different and often unfathomably dire situations. There is no more compelling field than obstetrics, I think, where you see this.”