Kill or Cure: Lecture 11
Childbirth, Midwives and Medical Men,
1700-1900
Lecture themes and outline
The ‘medicalisation’ of childbirth?
1. Traditional childbirth
Fear and ceremony (social childbirth)
2. Midwives
Roles, training, characteristics and practice
3. Midwives versus men-midwives
4. The growth of lying-in hospitals
5. Changes in the late C19 and early C20 centuries
Fear
• Death in childbirth – of mothers and babies
• Childbirth could be lengthy and painful
(impact of rickets, instrumental birth,
childbirth fever)
• Maternal mortality c.1% but cumulative risk of
dying in childbirth 6-7%
• Women made preparations for death when
pregnant
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.
(Joan 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)
Early modern childbirth – and ceremony of childbirth
• Collective female culture
• Period of lying in of 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
Lying-in room, 1616
Who became midwives?
• Ranged from neighbours who occasionally
helped at childbirth, to midwives who
delivered babies fairly regularly and those
who worked ‘professionally’ as midwives.
• Many‘professional’midwives scaled their
fees according to what the patient could pay.
• In continental Europe midwives employed by
town authorities.
• 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
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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 – testimonials/networks
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)
Bishops’ 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, and was obliged to
urge mother to declare name of father in
cases of illegitimacy .
Training
• Up until the late C19th there was no formal
training or qualification in midwifery in UK (cf.
continental Europe).
• 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.
• Few had theoretical knowledge/book
learning.
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 witnesses 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 teach that
profession render them unnecessary, by giving their female
pupils as extensive instructions as they give the males’.
Rise of manmidwife
• Midwifery
courses for
male pupils
• Lying-in
hospitals
• Fashion and
forceps
Rise of Man-midwife
• Up to 18th-century childbirth a female sphere so
what changed?
• Fashion and forceps (Chamberlen forceps 1673) –
science enters the birthing room, social kudos of
employing accoucheur or male birth attendant
• Midwifery courses of male pupils – experience
replaced by book learning
• Lying-in hospitals – trained doctors and midwives
• Famous men-midwives e.g. William Smellie and
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 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.’
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/aimed to preserve lives of
mothers and babies. Some for single mothers.
• However, maternal mortality rates high. 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
Midwife training extended during 19thC – in
workhouses and voluntary hospitals, initially only
several months training courses
1840s midwifery added to the curriculum in
medical schools
1850s diplomas awarded by medical schools
1862 King’s College Hospital introduces midwifery
training for nurses
1902: Midwife Registration Act – introduced
licencing, phased out ‘bona fide’ midwives,
regulated by doctors
Campaigns for improved training
• Female Medical Society (1862) and Midwives
Association (1872) 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.
Thomas Rowlandson, Midwife on her way to a
labour, 1811
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 and anaesthesia: James Young
Simpson 1847, John Snow 1853 administrated chloroform to
Queen Victoria)
• The rise of the surgeon-apothecary as the family doctor
• Marketplace competition
• Fashion
• From home to hospital
Twentieth Century
4 features that made medicalisation of
childbirth more apparent:
• Doctors take over of childbirth becomes more apparent.
• Hospital deliveries increase – shift from home to hospital,
especially after WW2.
• Increasing intervention in childbirth – instruments and
anaesthetics.
• Fear of childbirth finally disappears in the 1930s, as maternal
mortality falls. Infant mortality begins to decline around turn
of twentieth century.
• Monty Python: The Meaning of Life - The Miracle of Birth
(You Tube)