In 1912, Dr John Shields Fairbairn, a leading consultant obstetrician at St Thomas Maternity Hospital, London, commenced a program to revolutionise the medical approach to child delivery. He aimed to replace the 19th century medical practice of heavily medicating women during labor and the common use of force to deliver. To implement his vision of providing pregnant women with education and natural physical health for childbirth and recovery, Fairbairn chose midwife and physiotherapist Minnie Randell (1875–1974) to lead the newly founded St Thomas School of Physiotherapy, which served as the project’s education and training centre.

To create the method, Randell sought inspiration from Swede Per Herik Ling’s philosophy and exercises of preventative medicine. Her repertoire included full-body movement exercises in the lying, sitting, and standing positions. The objectives of the pre-natal exercises were ‘to improve the physical and mental well being of the patient – encourage a cheerful and confident outlook towards her confinement and so to help herself effectively during labour’. Pre-natal training included education, stretching, relaxing, and deep breathing with many free arm movements to improve circulation. The daily home exercises were designed to improve muscle tone, increase flexibility, and control of movement. The post-natal exercises were designed to improve the condition of relaxed muscles, in particular the abdominal muscles, so that the figure is restored to normal after confinement.

As a reflection of the women’s suffrage movement, Randell encouraged female students to use their knowledge and healthy physical ability to gain self-empowerment and help others to do the same. She encouraged women to teach spouses to perform and to teach the exercises calmly and confidently; to reinforce the teamwork between parents and to be of practical assistance during childbirth.

Fairbairn also recruited obstetrician Kathleen Olga Vaughan, who in 1912 had just returned from several years of women’s health medical service in India. In the sub-continent, Vaughan was amazed that mostly affluent women suffered physically and mentally from childbirth, while poor women typically gave birth with relative ease. She explained that the active indigenous Indian lifestyle and regular exercises that maintain a functional pelvic anatomy were abandoned by the affluent. Vaughan also observed that traditional Indian women, who covered their entire body with garments, were at risk of medical dangers including osteopenia due to sunlight deprivation.

By the 1930s, the method was flourishing and the St Thomas faculty was reinforced with two of Randell’s distinguished physiotherapy graduates: Australian hockey star Barbara Mortimer Thomas (1910–1940), who served as main instructor, and English dancer and choreographer Margaret Morris (1891–1980), who already used remedial exercises in her dance teaching. Exercising to the beat of classical music, the dance moves and grace typical of the St Thomas Method exercises are attributed to Morris.

Publications, establishment recognition, and public support followed. In 1932, Fairbairn was elected President of the Royal College of Obstetricians and Gynaecologists. In 1936, Morris (in collaboration with Randell) published ‘Maternity and Post-Operative Exercises,’ that illustrated exercises for pregnant and puerperal women and those who had been operated on. The book emphasised breathing, relaxation, conscious training of the pelvic floor muscles, and re-establishing good posture.  A year later, Morris published ‘Basic Physical Training’ for the general public, dedicated to ‘all those who, realising the inter-dependence of mental and physical well-being, are working to raise the standard of health.’  In 1939, Randell published her seminal textbook ‘Training for Childbirth – From the Mothers Point of View’ which described her philosophy in detail with related anatomy and pathology and exercise descriptions and instructions. This was followed up in 1949 with ‘Fearless Childbirth’, a practical manual for mothers-to-be.

In 1937, Randell’s number-two Thomas was sent to Australia to lecture on the St Thomas Project, teach the exercises, and assist local physiotherapists with the program’s implementation. As a result of the visit, the St Thomas method was implemented in maternity hospitals in Sydney and Melbourne; the exercises were used by physiotherapists on an individual basis and Thomas was remembered as a pioneer of Australian antenatal physiotherapy.  In London, the Medical Officer of Thorpe Coombe Maternity Hospital approved and implemented the St Thomas method in 1940. They also produced a film called ‘Training for Childbirth – and After’, where Thomas demonstrated the exercises illustrated in the book. There was also interest from the USA, but this option did not materialise.

The St Thomas method did not survive World War II, besides the mentioned indications of use in Australia a decade later, and Randell’s work has since been forgotten. Various factors might attribute to this, including the tragic loss in 1940 when two bombs hit St Thomas hospital killing four physiotherapists including Thomas; and the promotion of rival London obstetric group, led by obstetrician Grantly Dick-Read and physiotherapist Helen Heardman, with the concept of natural childbirth. This movement gained favour with the healthcare establishments, chartered physiotherapists and the general public at the ultimate expense of the St Thomas Project.

Randell left St Thomas physiotherapy school in 1945, just before the Chartered Society of Physiotherapy imposed a new syllabus.  She received the royal title of OBE and extended her career interest with a focus on gynecological cases; in 1948, she co-founded the Obstetric Association of Chartered Physiotherapists, was awarded an honorary fellowship of the Chartered Society of Physiotherapists and was later remembered as the pioneer of modern women’s health physiotherapy.

References:

Hoffman J and Gabel CP. (2016). The origins of western mind-body exercise. Physical Therapy Reviews. Taylor and Francis.  Accessed online at https://www.researchgate.net/publication/300089303_The_origins_of_Western_mind-body_exercise_methods on 6 January 2025.