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Simpson, Semmelweis, and Transformational Change

Grant, Gilbert J. MD; Grant, Abraham H. MD; Lockwood, Charles J. MD

doi: 10.1097/01.AOG.0000168452.10067.27
Current Commentary

The first anesthetic for childbirth and the first recognition of the importance of hand hygiene in obstetrics coincidentally occurred within 5 months of one another in 1847. More than 150 years later, one would have thought that these milestone events would have been fully integrated into practice. However, individuals resist transformational change, which is defined as a fundamental alteration in their beliefs, attitude, and behavior, even when they are confronted with incontrovertible facts. This resistance to change may explain why, in 2005, a large percentage of health care providers still do not practice acceptable hand hygiene, and the pain of childbirth continues to be extolled by some as a necessary part of womanhood, just as pharmacologic pain relief is discouraged.

More than 150 years after anesthesia for childbirth was introduced, and the importance of hand hygiene was recognized, many have yet to internalize these advances.

Department of Anesthesiology, New York University School of Medicine, New York, New York; Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan; and Department of Obstetrics Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.

Corresponding author: Gilbert J Grant, MD, Department of Anesthesiology, New York University Medical Center, 550 First Avenue, New York 10016; e-mail:

© 2005 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.