[Obstetrics--a women's discipline for men]. / Fødselshjelp--et kvinnefag for mannfolk.

In recent years there has been a considerable increase in the number of female gynaecologists in Norway. This contrasts sharply with the difficulties pioneering Norwegian female physicians had in entering this specialty. Three generations ago, leading Norwegian physicians argued against female gynaecologists. This article describes the controversy in 1914 when Dr. Louise Isachsen (1875-1932) claimed discrimination when she was not appointed senior registrar at the National Hospital's Midwifery Clinic. Her case was fiercely debated, not only in the medical profession, but also in newspapers and in Parliament. The clinic's director, Professor Kristian Brandt (1859-1932), found women unsuited for operative gynaecology and emergency obstetrics. We compare his arguments against female physicians with the requirements for Norwegian midwives, all female at the time. Brandt himself played a crucial role in formulating these requirements through his teaching and textbooks.

[The introduction of obstetric forceps in Norway--a 250-year anniversary]. / Fødselstangens innføring i Norge--et 250-årsminne.

Johan Gottfried Erichsen (1713-68), born in Germany and chief medical officer in Bergen from 1747, was probably the first to perform a forceps delivery in Norway, on 14 February 1748. The mother, who had been in labour for five days, survived; the child, however, did not. The obstetric forceps had been a secret in the Chamberlen family and had become more widely known only a few decades earlier. Erichsen, who was the first man-midwife in Norway, had learned obstetrics in Paris by the younger Grégoire. He mastered both the techniques of internal version and forceps delivery. This article describes Erichsen's medical and obstetric background and his qualifications for operative obstetrics. He worked in the period when the obstetric forceps changed obstetrics, birth delivery became an arena also for men, and a part of medicine. Obstetrics was established as a science and physicians had a tool whereby also children could be saved during complicated delivery.

["An appropriate forceps"--150-year anniversary of Simpson's forceps]. / "En hensigtsmaessig tang"--Simpsons tang 150 år.

Despite the increasing use of caesarean section and vacuum extraction, obstetric forceps is still in frequent use in obstetric wards. There has, in fact, been an increase due to more active management of births. More than 600 obstetric forceps have been described in detail, but only three of them are in use in Norway today: Simpson's and Kielland's forceps for vertex presentation and Piper's forceps for aftercoming head in breech presentation. This year it is 150 years since James Young Simpson (1811-70) of Edinburgh presented his forceps for the first time. Simpson's forceps has been the most widely used forceps in Norway over the last 120 years. This article describes James Young Simpson, his long forceps, and its use in Norwegian obstetrics.

[Sterilization of women. Waiting lists, surgical techniques and type of anesthesia]. / Sterilisering av kvinner. Ventelister, operasjonsteknikk og anestesiform.

The surgical and anaesthesiological techniques of tubal sterilization in Norway were studied by means of questionnaire. All hospitals returned the questionnaire. 94% of the operations were performed by gynaecologists, and in 99% of the cases by bipolar or endothermal laparoscopy. Local analgesia was used in one of the 60 hospitals. There were significant regional differences in sterilization rates and waiting time. We found no simple relation between sterilization technique and waiting lists.

[Ambulatory laparoscopic sterilization--should local analgesia and intravenous sedation replace general anesthesia? A comparative clinical trial]. / Poliklinisk laparoskopisk sterilisering--bør lokalanalgesi og intravenøs sedasjon erstatte generell anestesi? En sammenliknende klinisk undersøkelse.

A prospective, randomized study comprised 125 outpatient laparoscopic sterilization patients who had received either general anaesthesia or local anaesthesia together with intravenous sedation. The patients who had received local anaesthesia suffered significantly less postoperative pain and sore throat. Recovery and discharge were similar in the two groups, but those given a general anaesthetic were more drowsy in the evening on the day of operation. The time spent in the operating theatre was significantly shorter for the group given local anaesthesia, and the costs were lower. The majority of patients from both groups would prefer local anaesthesia and sedation for a similar procedure in the future. We conclude that local anaesthesia by intravenous sedation is the method of choice for laparoscopic sterilization.

Laparoscopic sterilization under local or general anesthesia? A randomized study.

OBJECTIVE: To assess the safety, acceptability, and economy of local anesthesia and intravenous (IV) sedation versus short-term general anesthesia for laparoscopic sterilization. METHODS: We randomly allocated 125 of 150 consecutively sterilized women to either local or general anesthesia. No women were excluded, but 25 chose not to participate. The women were interviewed before surgery, and they returned a standardized questionnaire after discharge from the hospital. All laparoscopic tubal sterilizations were performed by senior gynecologists. Midazolam was used as premedication. In the local-anesthesia group, lidocaine with adrenaline was infiltrated infraumbilically and bupivacaine was applied to each tube. Midazolam and alfentanil were used as IV sedation. In the general-anesthesia group, intubation anesthesia was accomplished with alfentanil and propofol; atracurium was used for muscle relaxation. RESULTS: In the local-anesthesia group, operation time was shorter, perioperative discomfort was modest, and the costs of equipment were lower than in the general-anesthesia group. There was less postoperative abdominal pain and less need of analgesics, and the patients were more awake in the evening. The rise in heart rate and blood pressure were higher in the local-anesthesia group, and external oxygen was necessary to avoid apnea. Anesthetic surveillance was therefore mandatory. CONCLUSIONS: Local analgesia was highly acceptable to the majority of patients as well as to the gynecologists. The operation time was less, postoperative recovery was quicker, and the women were less bothered by abdominal pain and sore throat. There was a substantial reduction in anesthesia costs. Anesthetic surveillance during surgery was necessary.