The Regency midwives Margaret Stephen and Martha Mears appear to have been hard-working, knowledgeable, and competent. (See my previous post on these famous midwives.) Margaret Stephen defined her craft as “the art of delivering women safely of their children, and preserving the children from injury” — an outcome equally desired by obstetricians today.1 Martha Mears believed pregnancy was a natural condition, not a state of indisposition or disease; she inspired her patients to rely on the power of nature to guide them through the delivery.2 Were these paragons typical of 18th-century midwives? Apparently not. Some midwives were ignorant and uneducated and did more harm than good in any number of horrible ways.

Thomas Rowlandson's satirical print titled "A Midwife going to Labour" (1811)

Thomas Rowlandson’s satirical print: A Midwife Going to a Labour, published in 1811. She’s carrying a lantern, a bag of supplies, and her trusty bottle of ale or wine or gin. Her appearance does not inspire confidence! (Source: Science Museum, London)

A Torn Cord

One man-midwife named Siebold reported a case in which a midwife had torn the cord or navel-string from the placenta, after which she replaced it in her patient’s vagina. When Siebold arrived, he took hold of the cord, which without the least resistance fell into his hand. “My God! doctor,” the midwife said, “you have broken the cord.”3 Who knows what words were traded after this exclamation, but I can imagine a rather heated discussion took place. And nothing is reported about whether the child lived or died. Although the Dr. or Mr. Siebold who described this incident is not identified, he might have been Adam Elias von Siebold, (1775-1828), a German gynecologist who authored several textbooks.

Overly Active Fingers

Title page to Sarah Stone's "small treatise" on midwifery, published in 1737

The title page to Sarah Stone’s treatise, published in London in 1737.

The early 18th-century midwife Sarah Stone had some 35 years of experience, attended more than 300 births a year, and deplored the ignorance of country midwives. On one occasion Stone was called to a tanner’s wife in Currey-Mallet, a village in Somerset, at about 11 o’clock at night. By the time she got there, what with the bad weather and worse roads, the child had been delivered. The country midwife told her all was well, at which words Stone took time to dry her clothes and recover her energy. When finally she inspected the child she was shocked to find one of its eyes had been put out and its whole face injured, so much so that no skin was left on it and the upper lip was “tore quite hollow from the jaw-bone, [and] was extremely swell’d, so that the child could make no use of it.” When questioned the country midwife explained that the mother had fallen down two days before her labor and injured the child. Stone’s retort probably brought no comfort:

I told her I was sensible the child came head foremost, but the face presented to the birth; and the damage the child received was from her fingers. She could not make any defence for herself. I found her extremely ignorant.4

Too Much Caudle

Common sense would dictate that neither the midwife nor her patient should imbibe too much warm caudle, ale, or cordials during the progress of labor. In fact, Dr. William Dease offered this advice: “When a woman is in labour the first attention . . . is to see that she is neither crowded with assistants, nor over heated by bed-cloths, nor plied too much with warm drinks.” 5 Caudles are a type of warm drink made by mixing a thin gruel of oatmeal with ale or wine, selected spices, and sugar; they were considered restorative during labor and after the delivery. (See my previous post on caudles.)

Mr. David Evans, a surgeon, reported a case of being called to assist an old midwife whose patient had been in labor of her first child for two or three days.6 His examination of the woman found the child’s head low in the pelvis; the os uteri (the cervix) thick and inflamed; and the vagina and vulva hot and dry. The woman’s pains had stopped; her pulse was quick and her tongue furred. She displayed “every symptom of excessive excitement.” It seems that when the old midwife realized a surgeon had been sent for, she spent her time during the wait for his arrival by keeping her patient well oiled with ale posset, gin and water, and the like, as a means of strengthening her labour pains. (A posset is a spiced drink of warmed sweetened milk with wine or ale.) In short, the poor pregnant woman was fairly drunk. The surgeon bled the patient, gave her weak fluids like gruel and tea, and kept the room cool. All the woman’s unpleasant symptoms diminished and the next day she delivered her child safely.

A Long-term Problem: Lack of Training of Midwives

The surgeon and practitioner of midwifery George Counsell stated his view of the problem in his book on the art of midwifery:

For it is a Truth too well known, that Mothers and their Children are daily, if not hourly, destroyed [such is the Practice of Midwifery in our Days] by ignorant Wretches . . . How much, then is it to be lamented, that no Care has yet been taken by any Law, to prevent these cruel and most fatal Proceedings!7

The problem, in part, was that throughout the 17th century and into the 18th century midwives were licensed by the Church of England. The license usually included the names of perhaps six or eight friends, neighbors, and clients who testified to the woman’s competence. Even though the conferring of licenses by the Church diminished during the 18th century, it remained the case that no law prevented unlicensed women from working as midwives and no register was kept of midwives. Any woman could practice midwifery, whether or not she had received any education or training in the profession.

Mr. Counsell, cited above, was complaining about the lack of midwife training in the 1750’s. In another 100 years — between 1857 and 1874 — training courses for midwives were started at four London lying-in hospitals. In still another 50 years the regulation and training of midwives became law: in 1902 the Midwives Act was passed. Finally, reform and common sense succeeded.8

On an Unrelated Topic . . .

Did you notice the similarity of the opening phrase in Counsell’s quote — “For it is a Truth too well known” — to Jane Austen’s famous opening line in Pride and Prejudice? If you care to read more about Austen’s famous first sentence, click here.

1Bosanquet, Anna. Margaret Stephen, protector of the profession. The Practising Midwife. 2009 (Dec);12(11):31-32. Available here.
2Bosanquet, Anna. Martha Mears, nature worshipper. The Practising Midwife. 2010 (Jan);13(1):34-36. Available here.
3Aveling, JH. English Midwives: Their History and Prospects (London, 1872), pp. 100-101 (PDF pp. 121-122), 125 (PDF p. 146).
4Bosanquet, Anna. Sarah Stone, the Enlightenment midwife. The Practising Midwife. 2009 (Oct);12(9):31-32. Available here.
5Dease, William. Observations in Midwifery, Particularly on the Different Methods of Assisting Women in Tedious and Difficult Labours (Dublin, 1783), p. 30 (PDF p. 53).
6Evans, David. A series of cases of bad practice in midwifery and surgery. In: Transactions of the Associated Apothecaries and Surgeon-Apothecaries of England and Wales, vol. I (London, 1823), pp. 204-205 (PDF p. 395-396).
7Counsell, George. The Art of Midwifry [sic]: or, the Midwife’s Sure Guide (London, 1752), pp. x-xi (PDF pp. 15-16).
8Forbes, Thomas R. The regulation of English midwives in the eighteenth and nineteenth centuries. Med Hist. 1971(Oct);15(4):352-362. Available here.