Joseph DeLee

Early career After completing an internship and a trip abroad for postgraduate studies, DeLee was ready to set up a medical practice by the age of 25.

DeLee opened Chicago Lying-in Hospital in 1899. The hospital provided a larger space than the Maxwell Street Clinic and it focused on providing obstetrical care and training of doctors and nurses. In late 1899, the Chicago Tribune described one of the hospital's innovations, the first portable incubator.

Though he was an obstetrician rather than a pediatrician, DeLee became the greatest advocate of the infant incubator in the U.S. At that time, obstetricians dealt with the problems of the premature baby after birth, where pediatricians were likely to only see the survivors of prematurity many days later. The pediatricians – influenced by their experiences taking care of other types of malnourished children – thought it was essential for the babies to be exposed to sunlight. For most pediatricians, it seemed counterintuitive to enclose the babies in a box. By 1901, DeLee had built an entire incubator transport service staffed with specially trained nurses, but costs were high and maternity hospitals still did not attract many private patients. The funds ran out on the incubator station in 1908.

Introduction of "prophylactic forceps" In the early twentieth century, DeLee observed that obstetric complications and deaths were so common that he "often wondered whether nature did not intend women should be used up in the process of reproduction, in a manner analogous to that of the salmon, which dies after spawning. Perhaps laceration, prolapse and all the evils are, in fact, natural to labor and in fact normal... If you adopt this view, I have no ground to stand on, but, if you believe that a woman after delivery should be as healthy, as well as anatomically perfect as she was before, and that the child should be undamaged, then you will have to agree with me that labor is pathogenic, because experience has proved such ideal results exceedingly rare."

In 1915, at the annual meeting of the American Association for the Study and Prevention of Infant Mortality, DeLee spoke out against the use of midwives for childbirth. DeLee said that midwives stunted the progress of the obstetrical profession and said that he refused to take part in the education of a provider that lowered the standards of the profession. If obstetrics were seen as dignified work that could draw more than the menial fees charged by midwives, DeLee said, many young physicians would be willing to deliver the patients that were then under the care of midwives.

At a meeting of the American Gynecological Society in 1920, DeLee sparked controversy when he presented a paper advocating for the use of a systematic approach to childbirth for physicians, including the use of forceps and episiotomy even in women who had no labor complications. DeLee reasoned that the episiotomy prevented perineal tears which could cause complications like uterine prolapse and vesicovaginal fistula. He said that the early use of forceps would avoid pressure from the pelvic bones against a baby's head, thus preventing complications like epilepsy and cerebral palsy; DeLee said that fatal complications occurred in 4–5% of labors managed with the traditional conservative approach. Though DeLee said that such interventions should only be carried out by a well-equipped physician specialist, John Whitridge Williams and other prominent obstetricians criticized DeLee sharply. They felt that DeLee was being too aggressive by removing a baby before complications occurred; DeLee's colleagues preferred to be conservative and to manage complications as they arose. A young woman named Beatrice Edna Tucker came to Lying-In to complete her residency in 1929. DeLee was also the inventor of a catheter used to suction an infant's airway; the DeLee suction trap is still used after the delivery of a baby. He was one of the earliest physicians to advocate for the lower segment cesarean section.

In 1933, DeLee noted that while hospital births were increasingly popular, maternal complications and deaths were increasing. He identified infection as a major problem in hospital maternity wards. DeLee called for hospitals to construct maternity wards in separate buildings with their own staff members and laundry. Such proposals were met with great criticism by influential physicians such as J. Whitridge Williams, who said that DeLee's precautions represented "a degree of caution that approaches 'infectio-phobia'." He was the first physician to call for the use of face masks in midwifery practice.

When DeLee's critics cited the costs of his proposals such as separate buildings and maternity staffs, DeLee replied, "Nothing compares in value with human life."

Later life and legacy DeLee was employed with Northwestern University until 1929, when he aligned with the University of Chicago. DeLee authored several editions of Principles and Practice of Obstetrics, which was described as "unequalled in text and illustration."

William S. Kroger, who DeLee successfully revived as a newborn in 1906, graduated from medical school in 1930 and served a residency under DeLee in obstetrics, gynecology and neuroendocrinology.

In 1934, the University of Chicago recognized DeLee with its Rosenberger Medal, which is awarded for excellence in research, invention, authorship or other distinctions that benefit humanity. DeLee became an emeritus professor at the University of Chicago in 1935. He died at his Chicago home in April 1942, and was buried at Rosehill Cemetery. Author Harold Speert wrote, "Despite his wide professional acclaim, DeLee remained a lonely unhappy man, plagued by excessive sensitivity and by the compulsive tendencies of the perfectionist he was." The board of directors for the Chicago Lying-in Hospital awards the Joseph Bolivar DeLee Humanitarian Award annually to an individual who has made significant contributions to the care of women and children. DeLee's nephew, Sol DeLee, was a Las Vegas obstetrician who wrote several editions of the book Safeguarding Motherhood from the 1940s to 1980s.

During the baby boom, DeLee's prophylactic forceps approach found new life. Busy physicians were often eager to adopt this systematic approach to anesthetized delivery because its efficiency allowed them to care for more patients. The use of episiotomies also continued to increase throughout DeLee's career and after his death. By the 1970s, 90% of delivering women received an episiotomy. A 1983 study did not support good outcomes with this practice, and by the year 2000, only 20 percent of U.S. deliveries involved an episiotomy.

DeLee has been remembered in published literature as one of two "titans of modern obstetrics". He has been credited with making important advancements in obstetrical care, and he has been criticized for encouraging the liberal use of medications and surgical procedures during childbirth – interventions that carried their own risks – even in cases where childbirth could have proceeded uneventfully.