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The author of A Midwife in Venice gives us a brief history of forceps

I am an underachiever when it comes to birthing babies. Once was enough. But I became interested in midwifery when I was in Venice a few years ago and conceived the protagonist of my latest novel: Hannah, a 16thcentury midwife. I wanted her to be the best midwife in Venice. That, after all, is the stuff of which heroines are made. So I bestowed upon her a technical advantage: birthing spoons, a rudimentary form of forceps fashioned from two spoon ladles and hinged in the middle.

The idea of forceps did not occur to me from nowhere. My daughter was born in London, England with the aid of for- ceps, which is probably why the concept of birthing spoons captured my imagination. But I wanted to make their invention by my swashbuckling midwife realistic — I did not want readers to regard them as a fanciful anachronism. In historical fiction, a thing must be possible but it must also be plausible.

So how would a conventional, religious, unworldly Jewish woman come up with a notion that history books contend was not invented until many years later?

One night when my heroine, Hannah was ladling out beet soup for Shabbat dinner, she dropped a soup ladle into the serving tureen. She went to the cupboard and found another ladle. With it she fished out the first ladle. Her hands were red from peeling beets. The tureen was white; the opening was small. She was reminded of the many difficult labours she had attended.

The next day she went to a silversmith with a rough sketch. Soon the birthing spoons were ready and Hannah was practicing her dexterity by extracting large onions from the cavities of chickens.

When I settled down to business and began my research on the history of forceps I was gratified to discover they were invented in the late 16th century by Peter Chamberlen, a member of a Huguenot family who had immigrated to London from France. The Chamberlen family quickly rose to prominence as physicians. They carved out a niche in the profession of ‘manmidwifery’ and limited their practice to the rich and aristocratic. For the next hundred years they kept their forceps a secret by arriving at patients’ homes with livered footmen carrying aloft a gilded box the size of a coffin. All female relatives were banished from the room. The mother was draped from the waist down and often blindfolded.

Today such withholding of a life-saving device would be considered unethical, but in those days, it was good business tac- tics to jealously guard trade secrets. What needless suffering their greed must have caused. In time, other physicians working independently invented forceps. The styles of these instruments, developed over the last three hundred years, are many and various but do not differ significantly from the 16th-century versions.

Birth is the most dangerous time in a person’s life for both baby and mother. Depending on social class and country, maternal mortality in the 16th century was about one in eight; infant mortality about the same. Because of poor nutrition, the rachitic pelvis ( deformed from rickets) was commonplace. This condition led to prolonged labours, sometimes as long as three weeks.

Forceps reduced delivery time, critical when maternal exhaustion, glaucoma, hypertension, aneurysm and heart disease made pushing difficult. They had a profound effect on safety of delivery.

Childbirth in 16th- century Venice was governed by folklore, superstition, herbal potions and fumigations. It was controlled by the Church of Rome: interference with the natural process was considered a violation of God’s Will. The use forceps, therefore, was not only illegal but a mortal sin. Hannah, if caught using her birthing spoons, would have been arrested for witchcraft.

Alas, perhaps because they are useful only for head presentations, forceps have fallen out of favour. They can cause bruising and, in the wrong hands, skull fractures, nerve damage and cervical cord injury.

Few obstetricians now are trained in their use, with Caesarean section and the Ventouse ( or vacuum extractor) having taken their place.

But forceps saved countless lives in the past, and in certain circumstances may be called on to do so again. As Thoreau once remarked: “Even old roads may be sometimes be profitably trodden.”