From Cradle to Grave
Childbirth and Maternity
Lecture Outline
1. Traditional’ childbirth – fear and
ceremony (social childbirth)
2. Maternal mortality
3. Midwives - roles, training,
characteristics and practice,
qualification
4. Lying-in hospitals to
hospitalisation
5. Changes in the 19th and 20th
century– GP practice,
registration of midwives
6. Medicalisation of child birth:
hospitals, personnel and
technology of childbirth
Fear!
• Death in childbirth (mothers and
babies)
• High stillbirth rate, high infant
mortality, high maternal death
rate.
• Childbirth could be lengthy, painful,
complicated.
• impact of rickets, poor diet,
instrumental births, childbirth
fever, bad medical attendance.
• While infant mortality fell from
around 1900, maternal mortality
high until 1930s/1940s.
Maternal mortality
• Causes: puerperal sepsis (post-partum fever) (40%),
toxaemia (20%), haemorrhage (20%)
• Deaths from puerperal sepsis and septic abortion rose
between 1900-1934
• Maternal morality rate (MMR):
–
–
–
–
1900 - 42 per 10,000 births
1930 – 44
1940 – 26
1950 - 8.7
• How was fall explained?
– Sulphonomides – reduced infection, mid-1930s.
– War – blood transfusion and obstetric flying squad
– Ergometrine 1942 reduced deaths from haemorrhage
Alice Gregory (ed.), The Midwife: Her Book
(London, 1923)
‘I have twice seen the desolation of a working
man’s home when the mother is suddenly taken
from her young children, and I never want to see
it again. She went up to her room in good health
perhaps twelve hours before, and she will never
come down again until her body is carried to the
grave.’
• 1920-29 - 25,000 women died in Britain from
childbirth-related causes
Poverty and pregnancy
• Poor women’s pregnancies - money struggles
and health problems.
• Many continued to work hard throughout
pregnancy.
• General Lying-in Hospital early C20th - One
patient ‘half-starved’ and another had ‘not had
good food during her pregnancy’ (see Ellen
Ross, Love and Toil).
• Women’s Co-operative Guild letters.
• Maud Pember Reeves 1912 - ‘motherhood is
hanging over them like a curse’.
Margaret Llewelyn Davies (ed.), Maternity. Letters
from Working Women (London, 1915)
‘Three months before the baby came, I
was practically an invalid…. Of course, I
had chloroform; indeed I had it with all my
seven children, except two, as I have
always such long and terrible labours… I
am never able to get up under three
weeks after confinement, as I always start
to flood directly I make any movement… to
me [childbirth] is a time of horror from
beginning to end’.
Who became midwives?
• Neighbours who occasionally helped, to women who
delivered babies fairly regularly to those who worked
‘professionally’ as midwives.
• Many ‘professional’ midwives scaled their fees according
to what the patient could pay – often delivered for
doctors
• Many took on other roles – nursing and laying out the
dead.
• Many also helped in the household.
• Mixture of abilities – some skilled and experienced,
some not.
• Most worked in women’s homes.
Training
• Until the late 19th century no formal training or
qualification in midwifery in Britain (on continent
midwifery training and schools were set up and
midwives licensed by towns from early modern
period).
• Some midwives were trained by apprenticeship.
• Skills were passed down from mother to daughter
or other female relative.
• Most training was practical, hands on – honed by
practice and experience.
• A few had more theoretical knowledge and book
learning.
Attributes and Tasks
• Ideal midwife - kind, honest, gentle and not gossips.
• Midwives were supposed to limit themselves to normal
births and were not use medicines or instruments – to
‘wait on nature’.
• They were not to be associated with birth control or
abortion.
• It was also important for them organize the birth and
manage the lying-in. The social aspects of birth. A
Women’s sphere?
• Some midwives acted as a court witness in cases of
infanticide, rape and abortion – also task to persuade
mothers of illegitimate children to name father.
‘Traditional’ childbirth
• Collective female culture (social
rather than medical?) Midwife in
charge.
• Organised by women – but this
changed in many households in
19th century as male doctors took
over
• Period of lying in for 1 month after
the birth
• Ended with churching ceremony
– marking the return of the
mother to public life – still
practised in East End in early 20th
century.
Lying-in Hospitals to Maternity Hospitals
• 18th century rise of lying-in hospitals – offered training to
midwives and man-midwives.
• Run as charities – poor women had limited access to
care, concerns about population. Many in London.
• Became dreaded sites of puerperal fever – feared by
many.
• 1848 Ignaz Semmelweis and infection control.
• Poor Law also provided maternity care – of sorts – to
pauper women
• By 1920s and 1930s private nursing homes increasingly
popular with middle and upper classes. Poor women
also keen to have birth in hospital, though conditions
often bad.
Male obstetric practitioners
3 groups involved:
• Man-midwife 18thC – increased in
number (fashion and forceps)
• Rise of GP, especially during 19thC –
who took on more and more obstetric
work
• Rise of specialism of obstetrics (and
gynaecology). New concerns about
risks of childbirth (diseases of women).
Though ostensibly worked with difficult
cases also engaged themselves in
normal obstetrics.
Training and Registration
Doctors:
• 1840s midwifery added to the medical curriculum
• 1850s diplomas awarded by medical schools
• Licence in Midwifery (LM) acquired by many
general practitioners – midwifery ‘a foothold’ of
general practice
Midwives:
• 1862 King’s College Hospital introduces
midwifery training for nurses, gradually training
schemes introduced
• Late 19th intense lobbying for registration and
recognition of profession
• 1902 Midwife Registration Act
Medicalization of Childbirth?
Why did male practice take hold?
• Birth described as increasingly risky for
mothers – made a medical matter with high
levels of intervention – birth only ‘normal’ in
retrospect.
• A new spirit of medical enquiry, especially in
the fields of anatomy and physiology,
emphasis on formal training – new forms of
‘expertise’.
• New technologies – forceps 18th century,
anaesthesia (chloroform) 19th century.
• The rise of the surgeon-apothecary as the
family doctor .
• Marketplace competition – midwifery lucrative.
• Shift from home to hospital.
• Changes in ‘culture’ of childbirth.
Campaigns for training midwives
• Female Medical Society and Midwives Association
campaigned for proper training programmes l.C19th
• Midwives Act 1902 – certification became a requirement.
Managed largely by doctors. Central Midwives Board
established. Unqualified midwives – bona fides – given a
few years to acquire a licence.
• 1905 Select Committee established a register of
midwives, with a central body to approve training schools
and admit qualified candidates.
• 1936 Midwives Act local councils charged with providing
adequate, salaried domiciliary service. Relief for
midwives but most women then had to pay the local
authority for midwifery care.
• 1948 NHS introduces free midwifery services
1940s antenatal class
Maternity Ward, The Royal Free
Hospital, London (19133)
Rise of hospital births
• Hospital has become synonymous with ‘safe’ birth – provided
justification for move to hospital but little evidence to show
hospital safer.
– 1900 most births at home with midwife.
– 1930s birth at home with midwife or GP standard
– 1950s trend towards hospital set in.
– 1960 33% of women in England and Wales gave birth at
home – 13% 1970 and by 1992 1 %
• 1970 Peel Report declared hospital the proper place to give
birth – around same time women began to assert their right
to a home delivery. Ironic?
Technology and birth
• Hospital associated with more interventions –
increased use of analgesics and anaesthesia
in 20th century.
• Pain relief also demanded by women. National
Birthday Trust Fund set up in 1928 – aimed at
‘safer motherhood’ through better midwifery
services and promoted anaesthesia in hospital
and also pain relief at home.
• After 1936 midwives allowed to use gas and
air at home, but not chloroform.
Counter movements
• Grantly Dick-Read, obstetrician and
pioneer of natural childbirth –
Natural Childbirth (1933),
Childbirth without Fear (1942).
• National Childbirth Trust – more
natural approaches.
• Radical Midwives organisations.
• Sheila Kitzinger – advocated an
active role for women in birth,
breathing techniques.
• 1985 Wendy Savage Case.
Twentieth century
3 factors that made the ‘medicalization’ of childbirth more
apparent:
1. Men take over of childbirth – Female midwives lose autonomy.
2. Hospital deliveries increase – shift from home to hospital,
especially after WWII.
3. Increasing intervention and use of technologies in childbirth –
instruments and anesthetics.
Changes
• Fear of childbirth diminishes in the 1930s, as maternal
mortality falls. 1948 free service.
• Consumption of childbirth / the ‘good’ birth.
• BUT still problems – overstretched services and many women
give birth in poverty; impact of immigration; many mothers over
40 so ‘high risk’.
Mother and child in maternity ward, 1962