Battle Passionné: Midwife vs Man-Midwife

Two parties waged a passionate battle throughout the Regency period and long afterward over the admittance of men to the practice of midwifery. On one side stood the midwives, who promoted patience and a reliance on Nature during delivery. On the opposing side were man-midwives or accoucheurs, who received training in anatomy, physiology, medicine and sometimes midwifery; they favored the use of forceps. The battle was long and vigorous.¹

In This Corner: Midwives

Midwives fought against male control in the delivery room. They held a strong position over delivery rights and argued that it had been traditional for centuries, if not all of human history, to call for a midwife. Furthermore, midwives were available to attend deliveries, particularly in rural villages, and their services were affordable.¹ Elizabeth Nihell, an 18th-century midwife who was very outspoken in defense of her sex, wrote: “But if they [man-midwives] so falsely exalt their own learning above the ignorance of women; they have their reason for it. They seek to drive out of practice those who stand in the way of their private interest.”² Acquiring aristocratic and other wealthy patients was surely one private interest at stake here. Indeed, Sir Anthony Carlisle, a President of the College of Surgeons, wrote as much in a letter to Sir Robert Peel: “Man-midwifery is the covert way to medical fortunes.”³

The question of immodesty also arose. Nihell accepted that women were considered “the peculiar property of a husband” and recognized the husband’s exclusive access to the “reserved parts” of his wife’s body. She chastised man-midwives for wanting “mercenarily or wantonly” to invade that sacred property. Although Nihell was somewhat placated to read of Dr. William Smellie’s admonition to his students “to act and speak with the utmost delicacy of decorum, and never violate the trust reposed” in them, she did not place much faith in his code, given the natural animal energy existing between the sexes.² In truth, there were numerous instances where accusations of adultery or seduction resulted in suits against man-midwives,³ and lecherous desires were thought to drive some men to work in midwifery. In the 1830’s the College of Surgeons indicated that erotic motives were the real reason why men chose to work as man-midwives.⁴

In This Corner: Man-Midwives

Man-midwives argued that their female counterparts were untrained and, hence, dangerous. “In a word, a midwife is an animal, who has nothing of the woman left, but the weakness of her understanding, [and] the wretched prejudices of old doting women . . .”⁵  Although some midwives were dangerous and ignorant, a few others, like Margaret Stephen, were competent, having been trained by man-midwives themselves.

This debate about training was significant, for male practitioners were required to be trained and licensed. The Royal College of Physicians of London (founded in 1518), The Company of Barber-Surgeons (1540), and The Worshipful Society of Apothecaries (1617) all set standards of practice and governed the professional conduct of their members.¹ Of course, training in man-midwifery was not always successful or sufficient. Country surgeons and apothecaries, for instance, were sometimes driven to take up the practice of man-midwifery, with the result that poor women might be delivered by apprentice boys less than 16 years of age.³ Not surprisingly, ignorant man-midwives could kill and maim as thoroughly as their ignorant female counterparts.

The Great Social Evil

The man-midwife or accoucheur — that Great Social Evil, as he was labeled³ — was scorned professionally and ridiculed publicly for decades. The surgeon Sir Anthony Carlisle, mentioned previously, believed midwifery was a belittling, undignified profession for a man, since it required him to assume the office of a nurse or an old woman. In the 1830’s the College of Physicians stated that no one engaged in the practice of midwifery could become a Fellow of the College because midwifery was “manual” labor that discredited any university-educated man.⁴ The College of Surgeons objected to man-midwives because their presence in the delivery room might terrorize the infant at its moment of birth.⁴

Years after the Regency period ended in 1830, when King George IV died, several books denigrating the work of man-midwives were published. Here is a sampling of comments made by Dr. John Stevens in 1849 and W. Talley, a solicitor, in 1864:

• Man-midwifery is a “deep, silent, secret source of adultery and cruelty — a silent, secret piece of well-dressed vice.”⁶
• Man-midwifery is an “unnatural practice” — a man-midwife is a “strange man in black with his iron fangs.”⁶
• “There are societies for the prevention of cruelty to animals, but not for the prevention of cruelty [by man-midwives] to women!”⁶
• Man-midwifery “is a violation of the ways of nature.”³
• Man-midwifery is a “degrading practice” and “a positive affront to nature.”³

Today’s Pregnant Woman Has A Choice

Over the course of the 18th and 19th centuries man-midwives slowly supplanted the lowly midwife in the delivery room. Given enough time, determination and dedication, the man-midwife or accoucheur — who in 1828 began to be called an obstetrician¹ — eventually acquired a respectable image. They established an Obstetric Society in 1825, which later became the Obstetrical Society of London, which merged in 1907 with other societies to form the Royal Society of Medicine.

Today’s pregnant woman can choose a woman or a man to attend her, and various professionals of both sexes are licensed to deliver infants. In the United States, for example, a woman might choose an obstetrician-gynecologist, a family physician, a certified nurse-midwife, or a direct-entry midwife. (Yes! There are male midwives, although not many of them.⁸) Fortunately for today’s specialist, no hint of immorality or indecency attaches to the professional who delivers women of their children.⁷

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Sources:
¹Forbes, Thomas R. The regulation of English midwives in the eighteenth and nineteenth centuries. Med Hist. 1971(Oct);15(4):352-362. Available here.
²Nihell, Elizabeth. A Treatise on the Art of Midwifery, setting forth Various Abuses therein, Especially as to the Practice with Instruments (London, 1760), pp. vi, 223-224 (PDF pp. 17, 256-257).
³Talley, W. Man-Midwifery and the Results; with a Letter Addressed by the Late Sir Anthony Carlisle to the Late Sir Robert Peel, through the Leading Journal of England (London, 1864), pp. 3-4 (PDF pp. 18-19).
⁴Loudon, Irvine. Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950. Oxford: Oxford University Press, 1993, pp. 188-190.
⁵Lapeyre, Louis. An Enquiry into the Merits of These Two Important Questions (London, 1772), pp. 35, 37 (PDF pp. 34, 36.)
⁶Stevens, John. Man-Midwifery Exposed, or the Danger and Immorality of Employing Men in Midwifery Proved; and the Remedy for the Evil Found (London, 1849), pp. i, 3, 17 (PDF pp. 8, 10, 13, 28).
⁷American College of Nurse-Midwives. Midwifery: evidence-based practice: a summary of research on midwifery practice in the United States, 2012 (revised). Available here.
⁸Pilkenton, Deanna, and Schorn, Mavis N. Midwifery: a career for men in nursing. Men in Nursing. 2008(Feb):29-33. Available here.