For most of human history midwives ruled the roost when it came to delivering children, as you may have read in my previous post on Regency midwives. Man-midwives or accoucheurs, as they were known in France, were called to a delivery only when there was a problem or special situation: for example, when a child required turning in the womb or in cases of flooding (hemorrhaging).1 Beginning in the 17th century, however, pregnant women — particularly aristocratic women, who were ever the fashionable trendsetters — began increasingly to call for a man-midwife to attend them. One key factor in the growing practice of man-midwifery during the 17th and 18th centuries was the forceps.2 Indeed, the forceps changed midwifery practice forever.
Chamberlen’s Invention
Chamberlen forceps, invented in the early 17th century (Source: Wikimedia Commons)
Obstetrical forceps are believed to have been invented by Peter Chamberlen (1560-1631), the elder son of a family of surgeons who fled to England from France in 1569 to escape religious violence. Dr. Chamberlen served as a surgeon to Queen Anne, wife of King James I, and a man-midwife to Queen Henrietta Maria, wife of King Charles I of England. His family’s success as medical practitioners in the Royal household has been attributed, in part, to the use of its “secret” instrument: the forceps. This innovative tool allowed a living child to be extracted from the womb in a difficult labor where the child might otherwise have been lost. To conceal the tool from the prying eyes of competitors it was carried in a gilded chest and removed only after the pregnant patient had been blindfolded.3
The forceps were not used widely until the 18th century when a description of the instrument was sold to a Dutch man-midwife, possibly by a nephew of Dr. Chamberlen.3 By 1735 various models of the Chamberlen forceps began to appear in England and Scotland. Where once men had been forbidden in the delivery room, the use of forceps gave medical men access to the rites and processes of a child’s delivery and to the most intimate parts of a woman’s body.4
Isaac Cruikshank’s satirical print: “A Man-Mid-Wife,” published in 1793 (Source: Wellcome Library, London)
Cruikshank’s View of the Man-Midwife
No discussion of man-midwives is complete without reference to Isaac Cruikshank’s satirical hand-colored etching. The caricature was drawn for a 1793 pamphlet written by Samuel William Fores, who did not favor the practice of man-midwifery. The etching shows a ridiculous melding of the personas of the man-midwife and the traditional midwife.
Notice the man-midwife is dressed as if going to his club to play cards with friends. He stands next to an over-large mortar and pestle on a floor made of cheap wooden planks. His right hand holds an instrument labelled a “lever.” Over his shoulder, other menacing-looking instruments used in his practice — the forceps, boring scissors, and blunt hook — hang from a cabinet shelf. In contrast, the midwife holds a small cup. She wears a mop cap and stands on a pretty, patterned carpet, her back to a fire burning in the grate. Her demeanor is reassuring and the setting looks homey and comfortable, as one might expect of a patient’s house, where most deliveries took place.5
The inscription beneath the drawing reads:
A Man-Mid-Wife, or a newly discover’d animal, not known in Buffon’s time; for a more full description of this Monster, see, an ingenious book, lately published, price 3/6, entitled, Man-Midwifery dissected, containing a Variety of well-authenticated cases, elucidating this animal’s Propensities to cruelty & indecency, sold by the publisher of this Print, who has presented the Author with the Above for a Frontsispiece to his Book4
The “Buffon” referred to in the etching’s caption was likely Georges-Louis Leclerc, Comte de Buffon (1707-1788), a French naturalist, mathematician, and author. It was said of him: “Truly, Buffon was the father of all thought in natural history in the second half of the 18th century.”
Midwives Favored Using the Hands
Obstetrical forceps similar to those used by Dr. William Smellie (Source: Wikimedia Commons)
There was considerable controversy over the use of forceps in the practice of midwifery. The 18th-century midwife Elizabeth Nihell, who published her thoughts on the subject in 1760, believed ardently in relying on nature to guide a woman through labor. She wrote: “Nature, if her expulsive efforts are but . . . gently and skillfully seconded by the hands alone, will do more, and with less pain than all the art of the instrumentarians, with their whole armory of deadly weapons. The original and best instrument . . . is the natural hand.”6
Nihell criticized Dr. William Smellie, the most famous man-midwife of his time, for altering the forceps. One such enhancement was wrapping the instrument in leather so that the gleam of metal blades would not shock his patients. She believed the leather added bulk and rough edges and might introduce an offensive smell or infection when used. In sympathy with Dr. Smellie’s advice to use new covers on the blades with each use, Nihell concluded: “It is the very best thing they can do, next to never using it at all.”6
Many Man-Midwives Favored the Forceps
Engraved portrait of Dr. William Smellie, famous man-midwife of the 18th century (Source: Wikimedia Commons)
Dr. William Smellie (1697-1763) was an enthusiastic supporter of forceps. He confessed to trying other instruments such as the fillet, but found he was usually obliged to return to the forceps, which “seldom failed to answer the purpose.” He wrote of their use in his treatise on midwifery:7
A more safe and certain expedient for this purpose [that is, extracting a child during a difficult birth] hath been invented, and of late brought to greater perfection in this than in any other kingdom, so that if we are called in before the child is dead, or the parts of the woman in danger of a mortification, both the foetus and mother may frequently be happily saved.
Dr. Thomas Denman was a prominent man-midwife of the Regency period (Source: Wikimedia Commons)
The prominent man-midwife Dr. Thomas Denman (1733-1815), who practiced during Jane Austen’s time, believed forceps should be used only when necessary, arguing that sometimes “the assistance of art, by whatever means it can be afforded,” was justifiable. He cautioned, however, that practitioners must be convinced of their necessity and be careful in their use, else they create a new evil or aggravate a situation. He considered it a duty to avoid using forceps, if possible, but when forceps were employed, he endeavored to use them without injuring either the mother or child.8 (Incidentally, some of the methods used during the delivery in my novel, Rosings Park, were based on Dr. Denman’s precepts.)
Other like-minded man-midwives echoed Dr. Denman’s advice. Dr. Hamilton, who published a book of midwifery cases in 1795, wrote: “The Physicians of the Hospital have laid it down as an invariable rule, that instrumental delivery ought not to be had recourse to, unless some urgent symptoms take place.”9 Dr. Hamilton worked as an assistant physician in the Edinburgh General Lying-in Hospital.
It is no surprise to learn that Elizabeth Nihell had no patience with Dr. Smellie, having once called him a “great horse God-mother of a he-midwife,”3 but I think she might have approved of the cautious, common sense approaches of Drs. Denman and Hamilton. Regardless, she and other like-minded 18th-century midwives could not turn the tide, and the use of forceps became commonplace as the practice of man-midwifery progressed.
Sources:
1Chapman, Edmund. A Treatise on the Improvement of Midwifery, Chiefly with regard to the Operation (London, 1735), pp. v-vi (PDF pp. 16-17).
2Wilson, Adrian. The Making of Man-Midwifery: Childbirth in England, 1660-1770. Cambridge, MA: Harvard University Press, 1995, pp. 1-8.
3Sheikh S, Ganesaratnam I, Jan H. The birth of forceps. J R Soc Med Short Rep. 2013;4:1-4. Available here.
4Laycock, Anna Katherine. Forceps. PBworks: English 330: Eighteenth Century Literature, University of Warwick, 2014-2015. Available here.
5Dittrich, Lisa R. Isaac Cruikshank: A Man Midwife. In: Art Annotations: Literature, Arts, and Medicine Database, NYU School of Medicine, 1999. Available here.
6Nihell, Elizabeth. A Treatise on the Art of Midwifery, setting forth Various Abuses therein, Especially as to the Practice with Instruments (London, 1760), pp. 418-419 (PDF pp. 449-450), 454 (PDF p. 485).
7McClintock, Alfred H. Smellie’s Treatise on the Theory and Practice of Midwifery, Vol. I (London, 1876), pp. 250-256 (PDF pp. 273-279).
8Denman, Thomas. An Introduction to the Practice of Midwifery (Brattleborough,VT, 1807), p. 240 (PDF p. 279).
9Hamilton, James. Select Cases in Midwifery; extracted from the Records of the Edinburgh General Lying-in Hospital (London, 1795), p. 44 (PDF p. 71).