Wednesday, March 01, 2006

C18th midwifery

While researching "Dangerous Waters" I discovered an intriguing new slant on the age-old debate of home births versus hospital delivery. An impersonal "conveyor-belt" atmosphere in some hospitals today is leading to more mothers opting for home births - provided they can find a midwife willing, able and sufficiently experienced. There was no such problem in the C17th. The midwife was a highly valued member of the community in her village or town. As well as learning the skills that would ensure mother and baby survived at birth, she also gained status as an expert witness in matters of rape, abortion and VD. Her clients were the wives of men from all walks of life, and for those midwives whose skills inspired confidence there was no shortage of work.

Then the mid-C18th saw the arrival of men-midwives. Combining charm with claims of greater skill, better education and access to new instruments, they quickly climbed from reluctant social acceptance to being the new "must-have" among the wives of men of substance. By 1800 they outnumbered traditional female midwives.

But this altered the concept of childbirth from a natural process presided over by women, to a medical situation controlled by men. The availability of new instruments inevitably meant them being used. Intervention as a precaution replaced time and patience.

A woman giving birth at home and attended by an experienced midwife trained in the use of herbs would be given raspberry leaf tea to assist her contractions and check any haemorrage during labour. Just before delivery, she would be washed with an antispetic lotion made from marigold flowers and goldenseal. If haemorrage did occur it was treated quickly with an astringent infusion of nettles.

During the same period, a woman delivering in hospital might be under the care of a doctor who had no interest in, or patience with, old wives remedies, condemning them as mumbo-jumbo and "unscientific." But that same obstetrician might have come to the bedside of the woman he was about to deliver straight from the mortuary where he had been dissecting a corpse without changing his coat or even washing his hands. These men buried their mistakes.

In 2006, hospitals boast dedicated maternity wings where women have far more choice in the manner of delivery. But while some opt for low light, soft music and sharing a birthing pool with a supportive partner, many are electing to give birth by caesarian section to avoid labour altogether. Indeed, why endure hours of pain and exhausting work if there's an alternative that requires 30 minutes, a neat row of stitches below the bikini line, and can be arranged to suit mother and surgeon's convenience?

We have come a long way in 300 years. Or have we? Hospitals are plagued with lethal infections. Spot checks reveal a worrying lack of basic hygiene. Perhaps a home birth, when a woman is cared for on a one-to-one basis by an experienced midwife, from labour through delivery and several days afterwards, has a lot to recommend it after all.

"Dangerous Waters" by Jane Jackson published 28th Feb by Robert Hale. Price £18.99


Carla said...

What an interesting parallel with modern changes in practice! Thank you for posting it.

Anonymous said...

Very interesting post, Jane. I wonder what the 18th century midwife would think of the modern fashion for a water birth?

Anonymous said...

>>We have come a long way in 300 years. Or have we? Hospitals are plagued with lethal infections. Spot checks reveal a worrying lack of basic hygiene. Perhaps a home birth, [...] has a lot to recommend it after all.<<

Well now we can have both - a home birth with the option of transferring to a hospital should the need arise. And despite the number of hospital infections, maternal and infant mortality rates are very, very, very low nowadays compared to what they used to be. I'd agree that birth can be, and often is, over-medicalised. But there are a lot of us who would be dead today were it not for surgical or other medical interventions.

How many women nowadays think to write their wills as their due date approaches? That would have been something women thought about far more frequently in the Middle Ages.