Gertie F. Marx

Gertie F. Marx (born February 13, 1912, Frankfurt, Germany—died January 25, 2004, Bronx, New York, U.S.) German-born American physician, known as the mother of obstetric anesthesia for her leading role in developing obstetric anesthesiology as a specialty. She pioneered the use of epidural injections to ease women’s pain during childbirth, and she was the founding editor of Obstetric Anesthesia Digest, a quarterly journal summarizing world literature on the subject. (Her last article published there was in 1991.) In spite of fierce opposition from the most conservative social and religious quarters, Marx succeeded in transforming obstetric anesthesia.

Marx enrolled at the Medical School of the University of Frankfurt in 1931. As a Jew, she became alarmed at Adolf Hitler’s rise to power, and she persuaded her whole family to leave Germany and move to Switzerland. After graduating with an M.D. from the University of Bern in 1937, Marx went to the United States, where she began her postgraduate training at the Beth Israel Hospital in New York City. Although her class in medical school had been 40 percent female, conditions for women were different in the United States, and she was the only female intern at Beth Israel. Marx eventually became the director of obstetric anesthesia at the hospital, a position she held until 1955. In that year, she transferred to the anesthesiology department at Albert Einstein College of Medicine in the Bronx.

In both institutions, Marx focused on relieving the pain of childbirth. This commitment made her many enemies. She argued that epidural anesthesia considerably reduced the pain that women experienced while giving birth. In addition to reducing pain, it was a much safer form of anesthesia for both mother and baby than general sedation, which caused respiratory depression as well sometimes as aspiration pneumonia (a condition caused by the introduction of material into the airways or lungs) in the baby that could lead to death. Some opponents claimed that epidural anesthesia slowed delivery and thus provoked an increase in cesarean sections. Others, citing the Bible (specifically Genesis 3:16), went so far as to argue that childbirth was intended to be painful. Many opposed Marx simply because she was a woman, and women physicians were neither common nor welcomed in those days. Nevertheless, her argument about the safety of the procedure proved true.

Marx’s other significant contributions included the advocacy of acute hydration to prevent abnormally low blood pressure after spinal anesthesia; her studies of aorto-caval compression, another complication of late pregnancy caused by the pressure of the fetus on particular blood vessels when a woman is supine; and her support of the use of regional anesthesia for emergency cesarean section. As a tribute to her work, one company named a line of needles developed specifically for use in obstetric anesthesia as well as amniocentesis for her.

Marx received numerous honours and awards for her contributions to anesthesiology, including the Distinguished Service Award from the American Society of Anesthesiology in 1988 and from the American Society of Regional Anesthesia in 1990. Queen Elizabeth II of England also presented her with a medal from the Royal College of Anaesthetists in 1993.