Chapter 2 A history of the midwifery profession in the United Kingdom
After reading this chapter, you should be able to appreciate:
The office of midwife: a female domain
What manner of women were midwives?
These midwives, however, were in a minority. Inevitably the rest attended only the poor (the majority of the population), many living in rural, perhaps isolated, places. Such women would learn their midwifery through their own and their neighbours’ birthing experiences, undertaking the work by virtue of their seniority or the large number of children they had borne (McMath 1694; Siegemundin 1690, preface). Their work might entail travelling long distances on foot to outlying habitations, for a few pence or a small payment in kind. Many such women took up the work from necessity, eking out a poor living with sick nursing and laying out the dead, as did their successors until the early 20th century.
‘In the straw’
Generally, birth took place at home, poorer women typically delivering in the communal room, before the hearth, the floor covered with straw which would later be burnt. Usually the birth chamber was darkened, windows and doors sealed, with a fire kept burning for several days. These precautions were taken lest the woman took ‘cold’ (developed the possibly lethal ‘childbed fever’), and in more superstitious households for fear that malevolent spirits might gain entrance, harming mother or infant (Gélis 1996:97, Thomas 1973:728–732). Care was taken, too, that the afterbirth and its attachments (all credited with powerful magical properties) were disposed of safely, lest they be used in spells to harm the family. These beliefs were still current in remote parts of Europe in the early 20th century.
The second stage of labour usually took place, as for millennia, with the woman in an upright or semi-upright position (Kuntner 1988). In rich households a birth chair might be used, but more commonly the parturient sat on a woman’s lap. Some women knelt or stood, leaning against a support; some adopted a half-sitting, half-lying posture, with a solid object to push their feet against during contractions, while others delivered on all fours (Blenkinsop 1863:8,10,73, Gélis 1996:21–36). As labour progressed, the woman would instinctively change position, ‘as shall seeme commodious and necessarye to the partie’, as the Byrth put it, urging the midwife to comfort her with refreshments and encourage her with ‘swete wurdes’ (see Fig. 2.1). Following delivery, the mother would be put to bed to ‘lie in’ – rich women for up to a month, the poor for days at most. The infant would be washed, then swaddled to ‘straighten’ its limbs, and if circumstances permitted, an all-woman celebration of this female life event would ensue.
The midwife, the church and the law
Governing the midwife
Probably the first system of compulsory midwife licensing in Europe was instituted in the city of Regensberg in Bavaria in 1452, a system gradually emulated in other European cities. Applicants for a licence were commonly examined by a panel of physicians, who, innocent of practical midwifery, based their examination on classical texts. Generally, midwives were required to send for a physician or surgeon in difficult cases, and in Strasbourg, midwives were prohibited from using hooks or sharp instruments on pain of corporal punishment. Many cities appointed midwives to serve the poor, supplementing their remuneration with payment in kind and providing financial aid in old age or disability (Gélis 1988:25, Wiesener 1993:78–84).
Advent of the man-midwife
Maternal mortality
Interestingly, Willughby also links such interference with the woman ‘taking cold’ (Blenkinsop 1863:6), a likely reference to ‘puerperal’ fever, not so named, but recognized under ‘fevers’ and ‘agues’ occurring after childbearing. Following ancient humoral theory, the condition was ascribed to a bodily ‘humours’ imbalance (Jonas 1540: xxxiii, Sharp 1671:243–250) and was probably then, as later, the chief single cause of maternal death. Not until the late 18th century was it publicly proposed that this deadly malady might be carried to the woman on the attendants’ clothing or unwashed hands (Gordon 1795:98–99), a view not completely accepted, even in medical circles, until the 1940s.
’Towards a complete new system of midwifery’
By the mid-18th century, male practitioners, disdaining the familiar ‘man-midwife’, began to adopt the French term ‘accoucheur’, as conveying greater status. Their approaches to delivery varied, however. Some still dilated the cervix and the labia vulvae, practices continuing among the more ignorant at the century’s close (Clarke 1793:21). Some extracted the placenta immediately after delivery by introducing the hand into the uterus, while others roundly condemned this (Smellie 1752–64:238–239). The general trend, however, was towards less intervention. This development stemmed from the new realization that it was not exertions by the child but uterine muscular action that provided the necessary expulsive force (ibid. 202). Significantly, Smellie (since regarded as the ‘father of British obstetrics’) concluded from his vast experience that, out of 1000 parturients, 990 would be safely delivered ‘without any other than common assistance’ (ibid. 195–196).