Medicalisation of Childbirth: Traditional Practices, Midwives, and Lying-in Hospitals

1. ‘Mind, Body and Society’, Week 3‘Childbirth, Midwives and Medical Men, 1700-1900’, Hilary Marland

2. Lecture themes and outline The ‘medicalisation’ of childbirth? • Traditional childbirth Fear and ceremony (social childbirth) • Midwives Roles, training, characteristics and practice • Midwives versus men-midwives 4. The growth of lying-in hospitals • Changes in the late C19th and early C20th centuries

3. 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

4. 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)

5. 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)

6. 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

7. Lying-in room, 1616

8. 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.

9. 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)

10. 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)

11. Sarah Stone’s Complete Practice of Midwifery, 1737

12. 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)

13. 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 .

14. 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, or from other female relatives. • Most training was practical, hands on – honed by practice and experience. • Few had theoretical knowledge/book learning.

15. 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.

16. 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’.

17. Rise of man-midwife Midwifery courses for male pupils Lying-in hospitals Fashion and forceps

18. Rise of Man-midwife • Up to C18th-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 for male pupils – experience replaced by book learning • Lying-in hospitals – trained doctors and midwives • Famous men-midwives e.g. William Smellie and William Hunter

19. 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.’

20. 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. • Concerns about population decline – how to secure a large and healthy population. • However, maternal mortality rates high. Became dreaded sites of puerperal fever. • 1848 Ignaz Semmelweis became convinced infection was spread by contact (post-mortems to midwifery deliveries). Introduced hand-washing and cleansing instructions.

21. City of London Lying-in Hospital

22. 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.

23. 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.

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

25. 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/GP as the family doctor. • Marketplace competition – midwifery foothold to family practice • Fashion – status of ‘accoucheur’ • From home to hospital

26. 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 began to decline around turn of twentieth century. • Monty Python: The Meaning of Life - The Miracle of Birth (You Tube) – have a look before the seminar!