Medicine, Disease and Society in Britain, 1750 - 1950
‘Midwives, Men-midwives and
Childbirth’
Lecture 6
Lecture themes and outline
The ‘medicalisation’ of childbirth?
1.
2.
Traditional childbirth
Fear and ceremony
Midwives
Roles, 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 Wombourne
Thos 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.
Margaret Stephen, The Domestic Midwife or the best
means of preventing danger in childbirth considered
(1795)
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’.
Rise of manmidwife
•Fashion and
forceps
•Midwifery courses
for male pupils
•Lying-in hospitals
•Famed manmidwives
•E.g. William
Smellie, William
Hunter
Elizabeth Nihell, A Man-Midwife or a Midwife?
A Treatise on the Art of Midwifery (1760).
‘That multitude of disciples of Dr Smellie, trained up
at the feet of his artificial doll, or in short those selfconstituted 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.’
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 of
childbirth 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.