For most of human history the act of giving birth was women’s work. Midwives governed all aspects of the process, from arranging the space where the mother gave birth — the lying-in chamber — to taking charge of the delivery, tying-off the infant’s umbilical cord, and monitoring the mother’s health after the delivery. As the childbirth unfolded, midwives probed, touched, advised, and supported their pregnant patients, their vigilance being assisted by the close female friends of the mother — the “gossips,” as they were called. When necessary, midwives used clysters (enemas), purges, plasters, poultices, ointments, and herbal infusions to make their patients comfortable.1 (See my previous post titled “A Tedious Regency Labor: Hog’s Lard and Laudanum.”)
They toiled in service to their patients. Sarah Stone of Piccadilly, for example, was an early 18th-century midwife who traveled long distances, at any time of the day or night, over bad roads and in foul weather, often attending more than one pregnant woman during a 24-hour period. She attended roughly 300 births a year.2 As a rule medical men were called to an infant’s birth only when a serious problem arose — that is, until the 18th century, when a new type of practitioner, the man-midwife or accoucheur, began to subvert — slowly but inexorably — the role of midwives in childbirth.3

The classic look of the confident, capable 18th-century British midwife: Elizabeth Nihell (1723-1776) (Image from Wikipedia)
Regency Midwives
During the 18th century only four midwives published formal works of their ideas on the theory and practice of midwifery: Sarah Stone, Elizabeth Nihell (whose image is shown at right), Margaret Stephen, and Martha Mears. The latter two can properly be labelled Regency midwives, since both published their treatises in the 1790’s.
Margaret Stephen
Margaret Stephen worked as a London midwife for more than 30 years, ran a school of midwifery for women, and attended Queen Charlotte, wife of King George III, during her confinements. She had been trained by a pupil of the illustrious Dr. William Smellie, who used obstetrical machines to train future man-midwives. Stephen duplicated her teacher’s practice by using an obstetrical machine to train her pupils. (Her machine might have looked like the Italian obstetric phantom or manikin shown below.) She also taught the use of forceps to turn a child in the womb.4

18th-century Italian obstetric phantom made of wood and leather (Source: Wellcome Images)

Full view of the 18th-century Italian obstetric phantom shown at left (Source: Wellcome Images)
Despite praising some of her honorable male practitioners, Stephen believed midwifery should be a profession run by women only, and she accused man-midwives of interfering with the interests and training of female midwives:
Nothing can be more cruel, unjust, and ungenerous than the aspersions thrown . . . on the character and conduct of the women in that profession.5
Stephen’s treatise, Domestic Midwife, or, the Best Means of Preventing Danger in Child-Birth, Considered,6 was published in 1795 as a pocket-book for midwifery students; it was small enough to be carried in a pocket and consulted by a forgetful pupil to refresh her memory.5 It was not intended to be a comprehensive tome on midwifery practice, which might explain the bad review it received in The Critical Review, or, Annals of Literature of 1797: “To her patients the perusal of such a book would be detrimental, and to her pupils (if she has any) useless.”7 Ouch! Some 75 years later, however, Dr. Aveling described it as “perhaps the best upon the subject that has been written by any woman in our own language,” which Stephen would have found gratifying had she been living at the time.8
Anna Bosanquet, a Senior Lecturer in Midwifery at Kingston University/St. George’s University of London, wrote the following about this Regency midwife: “Margaret Stephen was one of the most inspiring midwifery educators who . . . was dedicated to the cause of keeping midwifery in the hands of women.”5 Stephen considered midwifery, like nursing, to be a worthy occupation for women.
Martha Mears
Martha Mears self-published her treatise in 1797 in London: The Pupil of Nature; Or Candid Advice to the Fair Sex.9 Her book consisted of 10 essays on topics as diverse as the “sensibility” of the womb and its “precious deposit” — by which she meant the fetus — the influence of the mind on the body, and the importance of a cooling diet, a little exercise, and fresh air on health. (Her advice: avoid all putrid exhalations!) She did not encourage domestic quackery (that is, the taking of medicines), but offered numerous herbal and dietary treatments for retching, voiding urine, fainting fits, and other ailments experienced during pregnancy.
She described herself as a “humble handmaid of nature” and passionately advocated against any unnecessary medical intervention, which is a little surprising considering she studied the works of the most eminent man-midwives of the time: John Leake, William Smellie, and Thomas Denman. “Much as I respect their their talents,” she wrote, “they themselves have taught me to feel a still higher reverence for nature.”
Her aim was to help pregnant women master their fears and learn to rely on the powers of nature. Reviewing Mears’s book and practice, Anna Bosanquet lauds this 18th-century midwife for her poetic description of pregnancy and her belief that women should rejoice in their procreative powers.10
Trouble on the Horizon
Although midwives were considered “formidable women possessed of exceptional authority,” their power was diminishing.1,3 As the 18th century advanced toward the 19th, man-midwives were making steady inroads into the profession. They used forceps and other instruments when necessary; generally chose medical intervention over Nature; and believed in the formal education, training, and regulation of obstetric professionals. Whether midwives were happy or not with the incursion of men into their traditionally female sphere, the practice of midwifery in the 18th century was changing, perhaps forever.
Sources:
1Cressy, David. Birth, Marriage, and Death: Ritual, Religion, and the Life Cycle in Tudor and Stuart England. Oxford: Oxford University Press, 1999, pp. 61-62.
2Bosanquet, Anna. Sarah Stone, the Enlightenment midwife. The Practising Midwife. 2009 (Oct);12(9):31-32. Available here.
3Wilson, Adrian. The Making of Man-midwifery: Childbirth in England, 1660-1770. Cambridge, MA: Harvard University Press, 1995, pp. 1-8, 47.
4Mangham, Andrew and Depledge, Greta, eds. The Female Body in Medicine and Literature. Liverpool: Liverpool University Press, 2013, p. 82.
5Bosanquet, Anna. Margaret Stephen, protector of the profession. The Practising Midwife. 2009 (Dec);12(11):31-32. Available here.
6Stephen, Margaret. Domestic Midwife, or, the Best Means of Preventing Danger in Child-Birth, Considered (London, 1795).
7Anon. The Critical Review, or, Annals of Literature, Tobias Smollett, ed., vol. 20, 1797, p. 351 (PDF p. 366).
8Aveling, J.H. English Midwives (London, 1872), p. 127 (PDF p. 147).
9Mears, Martha. The Pupil of Nature; or Candid Advice to the Fair Sex (London, 1797).
10Bosanquet, Anna. Martha Mears, nature worshipper. The Practising Midwife. 2010 (Jan);13(1):34-36. Available here.