Call the Midwife

This exhibition explores the history midwifery from the sixteenth century to the sixties, illustrated with the birth stories of women with connections to Barking and Dagenham.

Early midwives

Women have helped each other in childbirth from time immemorial. During the sixteenth century, childbirth was still customarily a domestic event, attended by female friends, relatives and local women experienced in delivering children. Generally the midwife was the senior woman in the community, commonly a married woman or widow who had herself given birth. These women were mothers themselves and this experience legitimated their presence – having survived childbirth – they could provide both psychological and practical support to the woman in labour.

That birth was indeed a women-only affair found its reflection in language. Until the seventeenth century no word existed to signify a male birth attendant and the modern word ‘obstetrician’ (first used in English in 1828) comes from the Latin word for a midwife, ‘obstetrix’. Perhaps not that surprisingly, when used as an adjective from the seventeenth century onwards, ’obstetrical’ was normally a metaphor pertaining to men ‘delivering’ ideas, texts or lectures.

Case study: Lady Ann Fanshawe

At this time despite the best efforts of these early midwives, childbirth was dangerous for women. Maternal and infant deaths were common. Between 1645 and 1665, Lady Ann Fanshawe, wife of Sir Richard Fanshawe, gave birth to fourteen children, with only five of which survived into adulthood. She also miscarried a further six children. Ann was lucky to survive. In her memoirs, which she wrote to her only surviving son, Richard, she remembers all her children including the ones that she miscarried. Here she recalls the birth and sad death of her first son, who was called Harrison:

‘The beginning of March 1645, your father went to Bristol with his new master. And this was his first journey – I then lying-in of my first son Harrison Fanshawe, who was born on the 3 February last – he left me behind. As for it was the first time we had parted a day since we married, he was extremely afflicted even to tears, though passion was against his nature. But the sense of leaving me with a dying child, which did die two days after in a garrison town, extremely weak and very poor…’

She writes of a later experience of miscarrying triplets in 1600 just months after the death of her daughter Mary:

‘In the later end of this summer I miscarried, when I was near half gone with child, of three sons, two hours one after the other’.

She goes on to comment on what she thought was the reason of her miscarriage:

‘I then was in, and perpetual company that restored to us, of all qualities, some for kindness, and some for their own advantage. As that was a time of advantage…’

We know that she was attended in labour by her younger sister but cannot be certain about who else would have been with her. At this time women would rarely have given birth in bed, labour more commonly was brought to a climax in a birthing chair or took place on the straw strewn floor in front of the hearth. Complications during pregnancy and labour were treated with herbs. Lady Ann Fanshawe, like many women of this time it is clear that got through the ordeal of childbirth due to her trust in the will of God.

Rise of the Professional Midwives

The gradual development of towns and cities led to the specialisation of occupations, including midwifery, and with this the professional midwife. These professional women would acquire their skills over years as apprentices to older midwives and duties were incorporated into the oath she swore under the licensing system operated through the Church of England.

Sarah Stone, active from 1701 to 1737, epitomises the traditional nature of a profession that was to change in the 1700s. She was the daughter of a midwife, and the mother of a midwife, who learned her trade through skills being handed down and practical experience gained within families and among women. Unlike many contemporaries she also studied anatomy and attended female autopsies to improve her practical knowledge.

From 1703 her practice was based in Taunton, in the west of England. Stone was more skilled than the existing local midwives, and often dealt with the most difficult deliveries. Her reputation meant that within a few years she was attending around 300 births annually. Stone later moved to Bristol, where she further championed female midwives in the face of the growing influence of man-midwives. The culmination of this was her book, ‘A Complete Practice of Midwifery’, published in 1737. It detailed skills and techniques she had developed over decades dealing with the most challenging, and very often fatal, cases.

Stone was particularly outspoken about man-midwives. She felt female midwives could manage difficult cases on their own with the right training. And feared female midwives lost credit for their hard work when ‘the young men command all the praise’ by stepping in at the climax of the birth’. Her prediction that man-midwives would increasingly be the first port of call was, in time, proved correct.

Man-midwives

Male medical practitioners – as early as the second century AD – attended complicated births, especially when the child didn’t present head-first. Also it would be up to a surgeon to perform a Caesarian section after a mother’s death or to remove a dead foetus.  Male practitioners were thus associated with death or difficulty at births.

The man-midwife, as portrayed in this caricature by illustrator Isaac Cruikshank (for a 1793 pamphlet against man-midwifery), was a commentary on the fact that from around second half of the 17th century medical men—both physicians and surgeons—have been encroaching on an area of medicine traditionally controlled by women – normal childbirth. Moving beyond assisting only at difficult births, men started to argue that they make the best midwives. No matter what scientific explanations these ‘man-midwives’ provided to support their ways of delivering babies, the general public had its reservations. For many, a man assisting a birth progressing without complications was a freak of nature with ambiguous gender/sexuality.

Chamberlen forceps

However these doctors were aided by a path-breaking invention of the forceps, or rather its coming into mass use in the 18th century. The forceps were actually invented and used by the Chamberlen Brothers in the 17th century, the instrument was kept secret for almost 100 years.

The Chamberlens, Huguenot refugees from France, settled in England in 1569, and subsequent generations of male members of the family pursued medical careers focusing on midwifery. Central to their success was their obstetrical forceps. Peter Chamberlen (1560-1631) and his younger brother, also confusingly called Peter (1572-1626) went to extraordinary lengths to hide the invention and protect their lucrative trade. The brothers would arrive at a delivery carrying a huge engraved box, giving the false impression that large machinery was involved. The birthing room was then cleared save for the Chamberlens and the labouring woman, who was blindfolded.

The great-grandson of Peter the younger, Hugh Chamberlen (1664-1728), was the last to use the secret tools. He had no male heir, and it appears he revealed the secret as forceps of similar design came into use after his death in the 1730s.

In 1813, several pairs of forceps once belonging to Peter the elder, were found beneath a trap door in his old family home. His wife hid them after his death, an indication of the family’s determination to take the secret to their graves.

The mass use of instruments – allowed the extraction of a alive baby from the womb in difficult presentations – initially widened the gap between male and female practitioners as at first women, considered not technical savvy enough, were banned from using forceps.

However both experienced midwives and man-midwives took pride in using instruments as rarely as possible. For example, Scottish physician and obstetrician, William Hunter was cautioning against their indiscriminate use and took pride in his forceps being rusty. More opportunist man-midwives made forceps their trademark.

Laurence Sterne portrayed such practitioner, one Dr Burton of York, in the character of Dr Slop in his epic ‘The Life and Opinions of Tristram Shandy, Gentleman’ (1759-1767). In the coloured etching, Dr Slop, on applying his favourite instrument, breaks the bridge of a nose of a newborn baby Tristram, meeting with an outrage of chambermaid Susannah. This event influences the whole of Tristram’s life as one of his father’s pet theories was that a large and attractive nose is important to a man making his way in life.

Case Study: Mary Wollstonecraft

On 30 August 1797, Mary Wollstonecraft gave birth to her second daughter, Mary. Although the delivery seemed to go well initially, the placenta broke apart during the birth and became infected. This condition, known as puerperal fever, was a common and often fatal occurrence in the eighteenth century. After several days of agony, Wollstonecraft died of septicaemia on 10 September 1797.

Maternal deaths from puerperal fever were commonly the result of man-midwives, who were overzealous with their use of forceps, and other medical instruments. In addition they would often go from undertaking an autopsy on a dead body to the birthing chamber without washing their hands or changing their clothes unaware that they were increasing the chance of infection.

Nevertheless it became fashionable for families aspiring to higher social status to have male practitioners attend births. The substantially higher fee that doctors charged compared to midwives was an indication of a family’s wealth. Attending pregnant and labouring women was indeed lucrative for male doctors. In turn, female midwives gradually lost status and came to be portrayed as unenlightened, unhygienic and entwined with superstition and folklore.

Georgian and Regency Period

As men encroached on better paid midwifery practice, so the poorer rewards left to female midwives made the investment of time and money in learning their calling no longer worthwhile for many women and so their status declined further into the late Georgian and Regency Period. This is demonstrated by this caricature by Thomas Rowlandson ‘A midwife going to a labour’ dated 1811, which shows a corpulent midwife hurrying through a howling gale with her lantern in one hand – and her bottle of booze in the other.

Victorian Era

These trends continued into the Victorian Era. At the same time the terminology of childbirth changed to increased euphemism. Terms such as ‘in the family way’ and ‘confinement’ were increasingly used. Meanwhile surgery was transformed both technically and professionally with the advent of anesthesia. Anaesthetic, in the form of chloroform or ether, was first used to assist in a difficult delivery by a Scottish physician, James Simpson in 1847. In obstetrics, though, there was initially opposition to its use based on the biblical injunction that women should sorrow to bring forth children in atonement for Eve’s sin. This opposition was substantially demolished when Queen Victoria, had ‘blessed chloroform’ administered during the births of Prince Leopold in 1853.

Mortality rates following caesarean section remained high, with the infections septicemia and peritonitis accounting for a large percentage of post-operative deaths. The first recorded successful caesarean section in Britain took place in 1882.

Prior to the establishment of the germ theory of disease and the birth of modern bacteriology in the second half of the nineteenth century, surgeons still wore their street clothes to operate and washed their hands infrequently while passing from one patient to another. In the mid-1860s, the British surgeon Joseph Lister introduced an antiseptic method using carbolic acid, and many operators adopted some part of his antisepsis. Others, however, were concerned about its corrosiveness and experimented with various aseptic measures that emphasized cleanliness. By the end of the century antisepsis and asepsis gradually were making inroads into the problems of surgical infections.

Midwives Act 1902

Childbirth remained dangerous at the turn of the twentieth century, despite significant medical reform and technological developments of the eighteenth and nineteenth centuries. However this all began to change with the campaign to improve the statutory position of midwives, which gained momentum with the formation of the Midwives Institute in 1882, and resulted in the passing of the Midwives Acts of 1902 and 1936. These acts brought about the registration and certification. And perhaps most importantly of all this brought about improvements in the education of midwives.

Early twentieth century

As the century progressed, obstetricians began defining ‘normal’ standards for childbirth, with methodologies like the Friedman Curve. Deviations from normality were seen as reasons for medical intervention, and childbirth became an ideal sequence of events to be monitored and managed.

By the twenties and thirties, caring for labour and birthing women went from responding to problems as they arose to attempting to prevent problems through routine use of interventions as a way to control the course of pregnancy and labour. In Britain, the majority of births were still at home, attended by educated and certificated midwives during the first part of the twentieth century. Apart from when there were complications…

Case Study: Ethel Todd

Vivian Bevan Todd was employed by the Ford Motor Company in Dagenham. The lived with his wife, Ethel at No. 167 Second Avenue, Dagenham. On 19 June 1937, his wife gave birth to their daughter, Vanessa. Vivian describes in great detail the lead up and birth of his daughter in his diary, which is kept at the Archives and Local Studies Centre. Mrs Todd is quite unwell before the birth and was admitted to the East End Maternity Hospital near Aldgate, because of problems with her kidneys on 8 June. Vivian visits as much as he can:

‘Ethel looked beautiful and she was happy. Only heartburn made her wince at times – poor darling. The doctor pronounces her much improved and she is allowed much more variety in her diet. They will keep her in until the baby is born though – and the baby is not so small after all – her tummy is practically all baby!

The baby was induced on 18 June:

‘The doctor saw her today and decided that it would be better if baby was induced to make an early entry. And so my pet was told that they would do the necessary operation tomorrow to bring labour on. We’ve wanted our baby born but now this has come upon us. I at least am worried and frightened. And the thought of what my little girlie will go through tomorrow is like a blade turning in my vitals. It would be so much better if it could be natural!’

The baby was safely delivered the day after. Vivian declares:

‘I am certain that my sweetheart is no ordinary mortal. His wife stayed in hospital until 1 July. ‘Our home is home again!’ [and of course he goes on to day], ‘Vanessa is the prettiest baby I’ve ever seen, and my love and I worship her!’.

Second World War

With the onset of the Second World War, medical services available for the civilian population were considerably reduced, due to the withdrawal of many doctors and nurses for military service. At the same time there was an unprecedented increase in the number of babies being born, which exasperated the existing shortage of midwives. Midwives and maternity nurses were required to work not only long hours, but also sometimes in dangerous circumstances.

The following extracts  from an article entitled ‘Midwives and Flying Bombs’ that appeared in the Midwives Chronicle and Nursing Notes (September 1941), set the scene by providing a vivid impression of what it was like to have worked as a midwife in London at the height of the Blitz.

‘To the accompaniment of gunfire and several heavy explosions, falling plaster and a rocking house, the baby was born. As the debris continued to fall… She somehow got the mother safely and securely onto a mattress on the floor, and towed them along the corridor and down the stairs. While she was making the patient as comfortable as possible in the cupboard under the stairs a bomb fell very near, and the two top floors of the building were completely demolished’.

‘The midwife heard the ominous and familiar burr of a pilotless bomb just as the labour she was attending reached its final stages. The midwife thought fast. As the bomb fell, she placed a pillow over the mothers face, and used her tin hat to protect the oncoming baby from glass and plaster’.

One of our volunteers at Valence House was born in the Morrison Shelter at Collier Row, while her father was away serving in the RAF:

‘My mother goes to bed in the Morrison Shelter. She wakes up in the middle of the night and feels things happening. So she raises the alarm with a neighbour two houses down. The neighbour runs up the hill to get the midwife, who arrives on her bike. The midwife says ‘No. Go back to sleep’. Half an hour later things get more urgent. This time my mother crawls to the neighbours house. The neighbour runs back up the hill. And the midwife comes back on her bike. She arrives at the house to find my mother in final stages of labour. And it is too late for her to be moved. The midwife has to get into the shelter with my mother, which is where I was born… When I was little and would ask my mother were I came from, as you do, she would always answer ‘Under the table!’

Evacuation

As the bombs continued to fall, more and more pregnant women from inner city areas were evacuated to emergency maternity homes in country houses, hotels and boarding houses, as well as private billets. In Barking, many expectant mothers were sent to Tywford House in Bishop Stortford, and then when this was bombed in 1940 they went to a home at Battlers Green near Radlett on the outskirts of London. Meanwhile women from Dagenham were sent to private billets in reception areas organised by the London County Council.

These emergency maternity wards would have been extremely busy, with midwives nursing patients with severe medical conditions while at the same time conducting labours, deliveries and attending the needs of new mothers who at this time remained in bed for eight to ten days after they gave birth. These midwives also staffed the nursery and supervised the satisfactory establishment of lactation, as well as undertaking a considerable amount of domestic work, such as sterilising syringes, making dressings and washing sheets.

Post-war

Throughout the forties, fifties and sixties, midwives would have travelled by foot, bike or public transport. This meant that they would have had to have carried everything they required in a their midwifery briefcase, which would have included enamel bowls, a douche can, forceps for holding swabs or needles, a dilator to enlarge the cervical canal, absorbent cotton wool and gauze, a hypodermic syringe, a mucus catheter for use in cases where the child is asphyxiated, umbilical tape, sulphanilamide tablets and a device of measuring the pelvis of pregnant women.

After the second Midwives Act of 1936, midwives who received the proper training were allowed to administer inhalation analgesia (or gas and air) to their patients. Nurse Goodbun, who was a domiciliary midwife and maternity nurse for Dagenham Village, Rainham Road and the Rylands Estate from 1942 to 1958, was the first midwife in this area to be given a car by the local authority, which enabled her to transport this sort of apparatus.

Hospitalisation

Nevertheless the fact that this sort of pain relief was more readily available in hospital contributed to a substantial decrease in the number home births, and the hospitalisation of expectant mothers in the years immediately after the Second World War. The hospitalisation was also greatly influenced by the formation of the National Health Service in 1948. This trend continued throughout the rest of the twentieth century. Women expecting in Barking, would have given birth at Upney Maternity Hospital. Dagenham women might have been sent here or to the East End Maternity Hospital in Aldgate.

Antenatal and Postnatal Care

In addition to attending births, midwives are of course involved in the provision of antenatal and postnatal care. Indeed a midwife, like Nurse Goodbun, would have been a well known figure within the community.

Midwives would have visited women at home. Women would also have attended at antenatal and postnatal clinics that were set up by the local authorities during the early twentieth century. Around this time there were five of these clinics run by the Borough of Dagenham at Ashton Gardens, Chadwell Heath; Becontree Clinic, Becontre Avenue, Dagenham; The Leys Nursery, Ballards Road, Dagenham; Rush Green Clinic, 179, Dagenham Road, Rush Green; and York House, Frizlands Lane, Dagenham. There were a further two clinics in Barking, the Central Clinic and Woodward Clinic. These clinics would have provided tests, checks and health advice. Efforts were to encourage and support women breastfeeding were particularly stepped up.

Conclusion

For the first time in history, the majority of women gave birth in hospital in the Sixties. A baby book of the era sets the scene:

‘In the delivery room, white with bright lights, you will be taken from a hospital trolley to the delivery table. The nurses will be standing by with the doctor and with their gentle help and encouragement, aided by the science they have studied so long, your baby will be born’.

Away from the familiar surroundings of the home, women looked to a birthing partner for more moral support and men started to play an increasing role.

During the later part of the twentieth century rate of maternal mortality, stillbirth and neonatal death continued to fall across the United Kingdom. This wasn’t primarily due to the hospitalisation of childbirth, I would argue that it was also down to medical advances, improved economic circumstances of families and the changing roles of women, as well as the valiant efforts of campaigning women from the Midwives Institute, and practicing midwives from Sarah Stone to Minnie Goodbun.