Any pregnant woman during the Regency period would have known what a man-midwife meant when he asked: Are you prepared to take a pain? To “take a pain” was a popular expression meaning to submit to an examination per vaginam (“via the vagina”). I found this gem in Dr. Thomas Denman’s book on the practice of midwifery. He believed the phrase reflected women’s opinion of the procedure.1 Taking a pain had two aspects: the proper position for the examination and what might be gleaned from it.
Dr. Thomas Denman was a prominent man-midwife of the Regency period (Source: Wikimedia Commons)
The Usual Position for Taking a Pain
The position for the per vaginam examination differed by country. In some countries, a woman sat in a chair or on a stool; in others she knelt by the bedside or laid on the bed. Some women submitted to an examination while standing fully clothed, as shown in the image below. In England in 1807, it was customary for a pregnant woman to lie down on a couch or bed, on her left side, with her knees bent and drawn up toward the abdomen. Dr. Denman considered this “the most convenient, as well as decent” position.1 Dr. Samuel Bard, President of the College of Physicians and Surgeons in the University of the State of New York in 1819, advised the same position, but also suggested placing a small pillow between the woman’s legs and throwing a light covering over her.2
Internal Examination of a possibly pregnant woman, c. 1800 (Jane Austen’s World blog)
How the Examination Should be Conducted
Dr. Denman warned that it is “an invariable rule, never to propose an examination per vaginam but as a matter of absolute necessity, and in the presence of some attending person.” At all times the practitioner must use the “utmost care and tenderness,” with a great regard for the patient’s modesty.1 This warning likely stemmed from the suspicion many people had of man-midwives and their motives for delivering children.
What Might Be Learned from An Examination
The purpose of the examination per vaginam was to determine whether the uterus was diseased in any way; whether a woman was pregnant or how far along she was in her pregnancy; whether she was in labor or how far advanced in labor she was; whether the presentation of the child was “natural” (that is, whether the head presented); and whether the woman’s pelvis was normal or deformed. If the child’s head presented and labor was completed within 24 hours with no artificial assistance—that is, without the use of forceps or other instruments—the labor was considered natural. If any part of the child’s body other than the head presented, the labor was preternatural. If labor endured longer than 24 hours, it was considered difficult; if labor required the use of instruments, it was labeled anomalous.1
A group of young, fashionable doctors, 1823 (Image V0011717) (Wellcome Library, London) Copyrighted work, Creative Commons Attribution only licence CC BY 4.0
Dr. Denman advised his students to refrain from conducting an examination per vaginam early in a woman’s pregnancy because it was “extremely difficult, if not impossible, to determine by examination” whether a woman was with child. He believed it was better to wait until the practitioner could speak with “precision and confidence” about the pregnancy.1 He would be astonished no doubt by today’s popular method of buying a home urine test kit to identify a pregnancy without the help of an obstetrician.
The Importance of Touching
Dr. Bard believed the method of touching was important, for two lives depended on doing it properly. “Let him [the man-midwife], therefore, never throw away his opportunities by carelessness or inattention; but on every occasion of introducing the finger, coolly reflect on what he is about.”2 I believe even the outspoken midwife Elizabeth Nihell, who held most man-midwives in contempt, would have approved of his philosophy.
Sources:
1Denman, Thomas. An Introduction to the Practice of Midwifery (London, 1807), pp. 152-153 (PDF pp. 191-192).
2Bard, Samuel. Compendium of the Theory and Practice of Midwifery, Containing Practical Instructions for the Management of Women, during Pregnancy, in Labour, and in Child-Bed (New York, 1819), pp. 181 (PDF p. 194), 216 (PDF p. 229).