‘Midwives, Men-midwives and Childbirth’

Lecture 6

Medicine, Disease and Society in Britain, 1750 - 1950

Lecture themes and outline

The ‘medicalisation’ of childbirth?

1. Traditional childbirthFear and ceremony

2. MidwivesRoles, training and characteristics

3. Midwives versus men-midwives

4. The growth of lying-in hospitals

5. Changes in the late C19 and early C20 century

General practitioners, registration

Diary of Isaac Archer re his wife Anne Peachey

‘My wife growing nearer her time was troubled with feares she should die; and I feared it too. She was much taken up, I saw, with such thoughts, and I was glad, because it was an occasion of seeking God,…’

His wife delivered a girl: ‘Her pains were sharpe, but short; and she bore them without sickness…and with great courage’.

Thus my heart was full of joy, thinking all over; and praying God for his mercy: but about 1 o clock my wife began to faint, through an overflow of blood, and was without sensible pulse, or colour; we gave her over, and she took leave of me…’ However, ‘God stayed the flow, and she began to revive’.

Anne bore 9 children over a 13 year period, 8 of whom died in infancy.

(Lane, Making of the English Patient)

Diary of Isaac Archer: 1677 and 1682 ‘...my wife was delivered 2 months before her reckoning, and of a

girle, which came wrong, and stuck so long with the head in the birth, that it was dead when fully borne, although alive at the time of travaile, and so next day ‘twas buried in Freckenham chancell, on the north side of the little boy, under a stone. My wife was in danger of miscarrying often, and was not well...especially a week before her delivery...perhaps I am not worthy of a son...The losse is the lesse because ‘twas a girle, though we could have wished the life of it’ (October 1677)

‘My wife was delivered of a little girle, fatter and larger than any yet, for she had her (health) well and a good stomach. She was in extremity from 1 to 4 in the morning...when, after great danger, God heard us, and she (was) delivered. I bless God that we have a living child.’(September 1682)

‘We were frighted in the morning with the sad newes of my little girle’s death. She was well the night before, and never sick in it’s life, only came out with heat, and had a cough, which yet was gone, and thrived to admiration. She had a tender hearted nurse, but we feare ‘twas overliad, as many that saw it did positively say’. (Dec 1682)

(Lane, Making of the English Patient)

Adrian Wilson, The Making of Man-Midwifery

• Collective female culture

• Period of lying in for 1 month

• Organised by women - ‘gossips’

• Midwife in charge

• Husband and all men excluded

• Lying-in chamber was sealed, air and light excluded

• Feasting and celebration foods – ‘caudle’

• Ended with churching ceremony - marking the return of the mother to public life

Who became midwives?

• Ranged from neighbours who occasionally helped at childbirth, to midwives who delivered babies regularly but not frequently and those who worked ‘professionally’ as midwives.

• Many ‘professional’ midwives scaled their fees according to what the patient could pay.

• Small midwife elite – wrote textbooks and had local, and national, reputations.

Examples of Midwives

In 1767 the obituary of a widow Mrs Mary Hopkins of Salisbury, declared her to be

‘a person well practised in the art of midwifery, and who, during the space of forty-five years last past, delivered upwards of 10,000 women, and with the greatest success, and is therefore greatly lamented by all who knew her’ (Adams’ Weekly Courant, 9 June 1767)

Sarah Stone

• Practised in Taunton, Somerset• Extensive practice with about 300 cases

a year. • Apprenticed to her mother for 6 years• Attended lectures on anatomy and

watched dissections • She became a consultant and was

called in by other midwives in difficult cases.

• Wrote A Compleat Practice of Midwifery (1737)

Sarah Stone’s Complete Practice of Midwifery, 1737

Bishop’s Licences - testimonial

We whose names are under written do hereby Certify that Nancy Littlewood,wife of Jeremiah Littlewood of the parish of Womborne in the County of Stafford and Diocese of Lichfield and Coventry is a person of sober life and Conversation and well known to us and that she is well skilled in the practice of midwifry and a person fit to be admitted and Licensed to practice that Art Witness our hands this Eighteenth day of June in the year of our Lord 1787.

J. Honeybourne Vicr of WombourneThos Parker, John Rogers (Church Wardens)

Walter Stubbs, Ann Tongue, Mary York, Mary Cartwright, Pru Hill (Lichfield Record Office, B/A/11/5)

Bishop’s Licenses

• Midwives were licensed by the bishop of their diocese.

• The midwife was to perform emergency baptism if the baby seemed likely to die.

• If the baby was still-born she had to ensure the mother had not killed it.

• The midwife was required to swear an oath not to use witchcraft, nor induce an abortion or deliver a child in secret.

Training

• Up until the late C19th there was no formal training or qualification in midwifery.

• Some midwives were trained by apprenticeship.

• More often skills was passed down from mother to daughter.

• Most training was practical, hands on – honed by practice and experience.

Attributes and Tasks• Expected to be kind, honest, gentle and not

gossips.• Midwives were not to hurt women.• Midwives were supposed to deal with normal

births and not use medicines or instruments.• It was also important for them organise the

birth and manage the lying-in.• Some midwives acted as a court witness in

cases of infanticide, rape and abortion.

I teach my own pupils the anatomy of the pelvis &c., and of the foetal skull, on preparations which I keep by me, with everything else relative to practice in nature at labours; also turning, and the use of the forceps and other obstetric instruments, on a machine which I believe few teachers can equal, together with the cases and proper seasons which justify such expedients; and I make them write whatever of my lectures may prove most useful to them in their future practice, for which they are as well qualified as men. I intend to continue my lectures as usual to women entering upon the practice of midwifery, until the men who tech that profession render them unnecessary, by giving their female pupils as extensive instructions as they give the males’.

Margaret Stephen, The Domestic Midwife or the best means of preventing danger in

childbirth considered (1795)

Rise of man-midwife•Fashion and forceps•Midwifery courses for male pupils•Lying-in hospitals•Famed man-midwives•E.g. William Smellie, William Hunter

‘That multitude of disciples of Dr Smellie, trained up at the feet of his artificial doll, or in short those self-constituted men-midwives made out of broken barbers, tailors or even pork butchers, for I know myself one of this last trade, who, after passing half his life stuffing sausages, is turned an intrepid physician and man-midwife.’

Elizabeth Nihell, A Man-Midwife or a Midwife? A Treatise on the Art of

Midwifery (1760).

Thomas Rowlandson, Midwife on her way to a labour, 1811

Lying-in Hospitals

• C18th = rise of lying-in hospitals – offered training to midwives and men-midwives.

• Run as charities – responding to fears poor women had limited access to care.

• Became dreaded sites of puerperal fever.• 1848 Ignaz Semmelweis became convinced

infection was spread by contact between people. Introduced hand-washing and cleansing instructions.

City of London Lying-in Hospital

Training and Registration

• 1840s: midwifery added to the medical curriculum

• 1850s: diplomas awarded by medical schools

• 1862: King’s College Hospital introduces midwifery training for nurses

• 1902: Midwife Registration Act

Medicalisation of Childbirth? Why did man-midwifery

appear so suddenly in this period?

• Birth described as increasingly risky for mothers – the need to intervene, make it a medical matter – birth only ‘normal’ in retrospect

• A new spirit of medical enquiry, especially in the fields of anatomy and physiology

• New technology (forceps, chloroform)• The rise of the surgeon-apothecary as the family

doctor• Marketplace competition• Fashion• Changing cultures• From home to hospital

Campaigns for proper training

• Female Medical Society and Midwives Association campaigned for proper training programmes.

• Midwives Act 1902 – certification became a requirement.

• 1905 Select Committee established a register of midwives, with a central body to approve training schools and admit qualified candidates.

Twentieth Century

4 features that made medicalisation ofchildbirth more apparent:• Male take over of childbirth becomes more

apparent.• Hospital deliveries increase – shift from home to

hospital.• Increasing intervention in childbirth – instruments

and anaesthetic.• Fear of childbirth finally disappears in the 1930s,

as maternal mortality falls. Infant mortality begins to delcline around turn of twentieth century.