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What Made a 17th-Century Midwife Good at Her Job?

A traditional midwife at work in a 17th-century engraving. (Public Domain)
A traditional midwife at work in a 17th-century engraving. (Public Domain)
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Percivall Willughby (1596–1685) despised the midwives of his time. In his 1670s book, Observations in Midwifery, he intended to ‘inform the ignorant common midwives’, whose brutal methods were responsible for so many deaths – according to him. Although his book wasn’t published until almost two centuries later, Willughby was writing in a period in which male practitioners were gradually taking over the role of midwives in Britain (or at least trying to). Many of his contemporaries wrote similar accounts, no doubt motivated by asserting their claim on the medical marketplace, although Willughby’s writing is particularly striking. According to him,

‘midwives will pull, stretch, or hale their [the mothers’] bodies, or use any violence to enforce the womb, in hopes of a speedier delivery. Such strugglings and doings make a difficult, painful, and long labour.’

But was any of that true? What made a 17th-century midwife good at her job? And can we trust men like Willughby?

A satyrical depiction of a man-midwife (late 18th century). (Wellcome Images)
A satyrical depiction of a man-midwife (late 18th century). (Wellcome Images)

Challenging Bias in 17th-Century Midwifery

Well, until fairly recently, most people did believe these accounts by male midwives. Traditional midwives were depicted as stereotypically ignorant, poor, superstitious, and unskilled. Perhaps the main reason for that is that the first historians of midwifery in Britain were physicians – not trained historians – who tended to take male medical practitioners of the past, such as WiIllughby, at their word. This, of course, also reflected the biases of these 19th-century writers, who struggled to see women (whether in the present or the past) as skilled and capable at what they considered ‘male activities’.

Fortunately, social historians have spent decades deconstructing this stereotype thanks to a wealth of primary sources, including records kept by the midwives themselves, their clients, and the licensing authorities. So, what made a 17th-century midwife good at her job?

The baby in the womb in Jane Sharp's 1671 'The Midwives Book'. (Public Domain)
The baby in the womb in Jane Sharp’s 1671 ‘The Midwives Book’. (Public Domain)

Ethical Standards for 17th-Century Midwives

Perhaps the best way to answer this question is to look at how midwives were licensed, which was the responsibility of the Church of England. Midwives swore oaths, which often included:

  • Making their services available to both rich and poor women (whom they often attended for free)
  • Reporting information on the father of the baby and suspected bastardy
  • Not engaging in witchcraft
  • Baptising infants who probably wouldn’t survive
  • Notifying the ecclesiastical authorities of any baptisms performed
  • Not ‘switching’ babies
  • Not procuring abortions
  • Maintaining patient confidentiality
  • Not using instruments or mutilating babies in the womb
  • Making sure that stillborn babies were buried properly
  • Cooperating with other midwives and instructing their deputies (apprentices)
  • Reporting midwives who didn’t conform to these guidelines

As you can see, these injunctions have much to do with professional ethics, both from a medical and religious perspective, but they also highlight the importance of helping fellow midwives, of cooperating in difficult deliveries as well as instructing the new generations of midwives. Midwives should be of ‘good character’ and practising Christians, active in their communities and parishes. Still, you might be thinking that none of these criteria seems to take skill into consideration.

The all-female world of childbirth depicted in a 17th-century engraving, 'The Lying-In'. (Wellcome Images)
The all-female world of childbirth depicted in a 17th-century engraving, ‘The Lying-In’. (Wellcome Images)

The Path to Becoming a 17th-Century Midwife

In 17th-century Britain, most midwives practised for long periods before obtaining their licenses. They usually started as a deputy to an older, more senior midwife, in order to gain experience. They attended deliveries and helped their mentors for years before working on their own, with these informal apprenticeships lasting from four to ten years. So, when midwives applied for their licenses, it wasn’t unusual for them to have decades of experience, especially since the licensing process was so expensive, and so they might need time to save for their application fees.. Besides gaining experience through practice, midwives were usually married women or widows, often with children themselves, which only added to their empirical, ‘bodily’ knowledge about childbirth and female health. (Read about the all-female early modern world of childbirth here.)

What is perhaps most telling about these midwives and their careers was the way their clients spoke about them. You see, besides being a ‘good Christian’, swearing to their oath, and undergoing informal apprenticeships, midwives were expected at their licensing to give evidence of their skill, which normally involved their clients testifying in their favour. Many women would come forth and praise their midwives to the licensing authorities, sometimes dozens of them, describing how many times they had been delivered and how capable the midwife was. Of course, the higher these clients were on the social scale – say, a gentlewoman – the more these testimonies would weigh in the midwife’s favour. They might include passages like these:

‘…she [the midwife] is not only helpful to the rich and those that can pay her but also to the poor’.
‘…she had the blessing to be a means for the safe delivery of others whose names are here subscribed and many others…’
‘[she has] good skill, experience and success in midwifery and has safely delivered several women in childbed with good success…’
A traditional midwife at work in a 17th-century engraving. (Public Domain)
A traditional midwife at work in a 17th-century engraving. (Public Domain)

Community Esteem and Expertise of 17th-Century Midwives

So, what made a 17th-century midwife ‘good’ was a mix of their good character, skill, piety, ethics, and involvement in their communities. Although the licensing system wasn’t perfect, it ensured standards of good conduct and practice as well as ascertained practical skills through clients’ testimonies and legitimised deputy midwives’ apprenticeships. Midwives were commonly well-known and respected in their communities, by people of all social groups. Besides their clients’ accounts of their skill, midwives were often called to testify as ‘experts’ in early modern courts, such as in the case of women ‘pleading the belly’ (declaring they were pregnant to avoid execution). (You can read more about the ‘Jury of Matrons’ here.) But midwives would also testify in bastardy cases or when someone was accused of rape, which indicates how they were perceived by their communities as medical ‘experts’.

Moreover, as midwives started to publish midwifery manuals, in no small measure to assert their authority over the world of pregnancy and childbirth, which they perceived as increasingly threatened by male practitioners, some midwives became widely known. That’s the case of Jane Sharp (1641-1671), the best-selling yet mysterious English author, and Louise Bourgeois or Boursier (1563-1636), the French royal midwife. In their writings, we get a glimpse of an early modern midwife’s life; they were aware of their responsibilities and committed to caring for women as part of a sisterhood.

An engraving of 'The expert and famous madam Louys Bourgeois midwife to the Queene of France'. (Public Domain)
An engraving of ‘The expert and famous madam Louys Bourgeois midwife to the Queene of France’. (Public Domain)

Resisting the Narrative: Reevaluating the Skills of 17th-Century Midwives

Despite what man-midwives like Percival Willughby wrote, 17th-century midwives were generally very skilled and experienced, as hundreds of testimonies, letters, and journals tell us (including some accounts by physicians themselves!). Most of them followed an informal apprenticeship and this all-female network allowed them to cooperate and learn from each other. It wasn’t rare for a midwife to call a colleague to help in a complicated delivery; this wasn’t seen as a failure, but rather how a midwife should proceed. Midwives weren’t poor, ignorant, and dangerous practitioners. Rather, they were known for their patience, skill, kindness, and, crucially, for their knowledge, which derived from practical experience.

Yet it is telling that this negative stereotype of midwives as ignorant and unskilled persisted. With the medicalisation of childbirth and the rise of male midwives and their tools, such as forceps, traditional midwives were gradually replaced, and male practitioners eager to cement their new role were quick to decry them. As for Victorian physicians interested in the history of medicine, they believed their predecessors’ accounts and didn’t question how capable midwives actually were and whether man-midwives might have had an economic interest in degrading them.

As a historian, it is difficult to ignore the mounting evidence of 17th-century midwives’ skill and professionalism. Personally, having met midwives and been safely delivered by one myself, it seems hard to believe their depiction of midwives as violent and brutal. Lastly – and ironically-, it is likely that much of Willughby’s knowledge about childbirth (as well as many other man-midwives’) came directly from the midwives they so disparaged in their writings, who often instructed them, such as Willughby’s own daughter. But that’s a matter for another day.

References:

Louise Bourgeois,  Observations diverses (Paris: 1609).

Jane Sharp, The Midwives Book (London: 1671).

Percival Willughby, Observations in Midwifery (Warwick: 1863).

Further Reading:

David Cressy, Birth, Marriage, and Death: Ritual, Religion, and the Life-Cycle in Tudor and Stuart England (Oxford: 1997).

Doreen Evenden, The Midwives of Seventeenth-Century London (Cambridge: 2000)

David Harley, ‘Ignorant Midwives – a persistent stereotype’, The Society for the History of Medicine Bulletin 28 (1981), pp. 6-9.

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A Grip on the History of Forceps in Medicine

The Chamberlen forceps in K. Das' Obstetric Forceps (1929). (Wikimedia Commons)
The Chamberlen forceps in K. Das' Obstetric Forceps (1929). (Wikimedia Commons)

Content Warning: Discussion of childbirth, obstetric violence, maternal and infant mortality.

On a cold winter evening in 1600, Peter Chamberlen the Younger found himself attending to a labouring woman on the outskirts of London. The mother-to-be had been in labour for over 48 hours, and the situation was dire. Despite his wealth of experience, Peter feared that both the mother and child might be lost. With time running out, he made the fateful decision to use a secret tool that he and his brother, Peter Chamberlen the Elder, had been developing: a pair of obstetrical forceps. Miraculously, the mother gave birth to a healthy baby boy, much to the relief and amazement of everyone present. Little did they know that this life-saving tool, hidden away in a locked box, would revolutionize childbirth and save countless lives in the centuries to come. Just to give you an idea, today in the UK around 7% of deliveries in the NHS involve the use of forceps.

At the same time, the history of forceps highlights the gradual transition of birth from a ‘natural’ to a ‘medical’ event, with physicians competing with midwives and taking over childbirth. The rise of forceps is very closely connected to the creation of the field of obstetrics. To make things even more interesting, for decades this tool was surrounded by secrecy, making us question who should have access to medical knowledge. So, let’s try to get a grip on the history of forceps.

Plate showing the birth of a baby using forceps from L'art des accouchemens, by Jean Louis Baudelocque Published, 1781. (Wellcome Images)
Plate showing the birth of a baby using forceps from L’art des accouchemens, by Jean Louis Baudelocque Published, 1781. (Wellcome Images)

The Origins of Forceps

The earliest known references to forceps can be traced back to the ancient Egyptians, Greeks, and Romans, with physicians like Hippocrates and Galen mentioning the use of forceps-like instruments in their writings. The word forceps itself comes from the Latin formus (hot) and capere (to grab). But these early tools were very rudimentary compared to the later, more anatomically refined designs that emerged in the early modern period.

The history of forceps became inextricably linked to the Chamberlen surgeons, especially the brothers mentioned above, Peter Chamberlen the Elder (1560-1631) and Peter Chamberlen the Younger (1572-1626). The Chamberlen family were French Huguenots who emigrated to England in 1569 and became prominent in their field. (Still, no one really knows which of them created the design for their famous forceps.) Peter the Elder served as a physician to Queen Anne, the wife of King James I, and later to Queen Henrietta Maria, the wife of King Charles I. His younger brother was appointed the royal physician to both King James I and King Charles I. But it was their newly designed forceps that cemented their fame.

A Family Secret

For over a century, the design of this tool was a closely guarded secret since the Chamberlen brothers realised how their forceps set them apart from other medical practitioners, be they midwives, physicians, or surgeons. Before forceps, the situation was difficult for babies who were stuck in the birth canal. Sometimes surgeons were called to remove them with hooks, often in pieces, in the hope of saving the mother.

When the Chamberlens were called to attend difficult births, the brothers brought their forceps in a large (and locked) box. No one was allowed to see the instrument, not even the person giving birth. The labouring mother was usually blindfolded, and all others present were removed from the room. As soon as the baby was born, the secret tool was hidden away in its box once more.

An engraving of Peter Chambelen the Third (son of Peter the Younger), with incorrect first name. (Wikimedia Commons)
An engraving of Peter Chambelen the Third (son of Peter the Younger), with incorrect first name. (Wikimedia Commons)

What made the Chamberlen forceps so unique was its unique, ‘gentler’ design: the blades were curved (imagine soup ladles), to conform to the baby’s head, minimising the risk of injury during the extraction. Crucially, the blades could be locked together at the handles with a spring, after being inserted separately, facilitating the delivery. Plus, being made of steel, their forceps were easy to clean.

The Chamberlens’ Detractors

Rumour had it that the Chamberlens had the highest success rates for delivering the baby safely and the mother surviving. Many women believed that they had higher chances of a safe birth with their help, which made the brothers highly sought-after and, unsurprisingly, deeply resented by their competitors. One of their critics even wrote a poem against them ending in:

‘To give you his character truly compleat
He’s Doctor, Projector, Man-Midwife, and Cheat.’

The Chamberlen brothers were members of the Guild of Barbers and Surgeons, who were never highly regarded by physicians since they hadn’t formally read medicine in Oxford or Cambridge. The Chamberlens were also not popular among midwives. In 1634, Peter had petitioned the king to create a Midwives Corporation which, of course, he intended to run. That did not go well with midwives.

The Chamberlen forceps in K. Das' Obstetric Forceps (1929). (Wikimedia Commons)
The Chamberlen forceps in K. Das’ Obstetric Forceps (1929). (Wikimedia Commons)

Forceps and Secrecy

It probably didn’t help the Chamberlens’ popularity that they refused to share their secrets with other medical practitioners. Keep in mind that this was a time before patents to protect their design and they would make no money from sharing it. Still, when you think about how many people could have been spared if they shared their secrets, it’s hard to sympathise with the Chamberlens. Hugh Chamberlen was unapologetic:

‘My fathers, brothers,and my self […] have, by God’s blessing, and our Industry, attain’d to, and long practis’d a Way to deliver Women in these cases without any Prejudice to them or their infants. […] I will not take apology for not publishing the Secret I mention we have to extract Children without Hooks. […] I do but inform that the fore-mention’d three Persons of our Family, and my Self, can Serve them in these Extremities, with greater Safety than others.’
Late 18th-century caricatures of 'man-midwives' with forceps. (Wellcome Images)
Late 18th-century caricatures of ‘man-midwives’ with forceps. (Wellcome Images)

Meaning that, if you wanted a safe delivery, you better hire a Chamberlen, which meant you had to live in London and be able to afford their fees. Otherwise… well, too bad for you!

Openness at Last

The secret design remained hidden within the Chamberlen family for generations. In 1670, Hugh Chamberlen travelled to Paris to sell the design to the French doctor Francois Mauriceau, one of the most well-known ‘man-midwives’ of the time. You might be wondering how come the Chamberlens were willing to share their design. Well, Mauriceau won a bet. Chamberlen needed to prove that a forceps delivery was quick and safe, otherwise, Mauriceau would have the right to buy the secret.

Mauriceau chose the woman on whose body they would decide their wager: she had rickets and a malformed pelvis. Both mother and baby died following a horrific delivery in which Chamberlen perforated the woman’s womb and Mauriceau attempted a caesarean section. We know next to nothing about her, the woman who died over a bet between two medical practitioners. In the end, the sale wasn’t made, and Chamberlen returned to England.

A forceps following the design of the man-midwife William Smellie, with leather over steel, mid-18th century. (Wikimedia Commons)
A forceps following the design of the man-midwife William Smellie, with leather over steel, mid-18th century. (Wikimedia Commons)

According to legend, he eventually moved to the Netherlands, where he sold the design to a local doctor. However, the story goes, this ‘forceps’ was only composed of one half, and was, of course, useless. Hugh Chamberlen’s son, also named Hugh, eventually allowed the design to be made public in England in the early eighteenth century. There is even a monument to him inside Westminster Abbey.

But where did the original forceps go? Well, it was hidden (probably by Peter Chamberlen) under the floorboards of his Essex home, where it was found in 1813, by the mother of the family then living there. By then, many competing designs had been created by other obstetricians.

After the Chamberlens

Forceps opened the door to a flood of innovations and ‘birth gadgets’, including the (to me, very silly) ‘self-operated forceps’. Can you imagine trying to use forceps on yourself while giving birth?!

Post-forceps, medical men were increasingly present in the birth room. The Chamberlens became known as ‘man-midwives’, helping popularise this concept. Other changes followed; midwives were used to attending people giving birth on birth stools or chairs, but physicians preferred their patients lying down so that they could use their tools more easily.

Hugh Chamberlen's monument in Westminster Abbey. (Credit: Westminster Abbey)
Hugh Chamberlen’s monument in Westminster Abbey. (Credit: Westminster Abbey)

Forceps became popular for many reasons, including that physicians believed that some elite women were ‘too fragile’ to push. However, their use was contentious from the beginning. Just take a look at this passage from a poem against forceps, penned by John Maubray, the author of the Female Physician:

[Forceps] Kill many more INFANTS than they save and ruin
Many more WOMEN than they deliver
[…] I would advise you to practice Butchery rather than MIDWIFERY…

Following the height of their popularity in the nineteenth and early twenty centuries, their use gradually faded, especially as caesarean sections became more widespread. Still, the history behind forceps begs one of the most crucial questions in the social history of knowledge: who should have access to knowledge? Crucially, it also asks the (always feminist) question: who should make decisions about our bodies?

References:

John Maubray, The Female Physician (London: James Holland,1724).

Francois Mauriceau, The Diseases of Women with Child, translated and annotated by Hugh Chamberlen (London: T. Cox and J. Clarke, 1793).

Further Reading:

A.    C. Banks, Birth Chairs, Midwives, and Medicine (Jackson: University Press of Mississippi, 1999).

K. Das, Obstetric Forceps: Its History and Evolution (Leeds: Medical Museum, 1993).

B. Hibbard, The Obstetrician’s Armamentarium (San Anselmo, CA: Norman, 2000).

R. H. Epstein, Get me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank (New York: Norton, 2010).

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Giving Birth in 17th-century England: A Tentative List

Portrait of a Woman in Red 1620 by Marcus Gheeraerts II (1620). Credit: Tate
Portrait of a Woman in Red 1620 by Marcus Gheeraerts II (1620). Credit: Tate

What to do, what to buy, what to organise, what to cook, what to read… I made so many lists when I was pregnant that it would take a new list to organise them all! Expectant parents are bombarded today with information about how to prepare for the arrival of a baby. Yet childbirth itself has never been more medicalised and arguably out of families’ control. But what about the past, before social media, Amazon wish lists, and insipid hospital food? Here’s a list of how to prepare for a new baby in 17th-century England.

Caveats: I have considered an ‘average’ English family, composed of a married woman and man of middling social status (think of the husband as a yeoman or merchant). The things listed here would usually follow this order, but each community and family had specific practices. Like all lists, this is non-comprehensive but should give you an idea of what life was like for new parents at this period.

1. Confirming the Pregnancy and Spreading the News

Unlike today, a missed period was not usually thought to automatically indicate pregnancy. It wasn’t until quickening that pregnancy was confirmed (when foetal movement could be first felt). From then on, people could announce the news. Some mothers might prepare in case childbirth didn’t go smoothly, although that wasn’t very common. (You can read more about writing to the unborn child here.)

Portrait of a Woman in Red 1620 by Marcus Gheeraerts II (1620). Credit: Tate
Portrait of a Woman in Red 1620 by Marcus Gheeraerts II (1620). Credit: Tate

2. Engaging a Midwife

Most people lived close enough to a midwife to have her help in the delivery. For the ones living in cities, there was a choice of practitioners. Friends’ recommendations, price, and reputation were all considered when a midwife was hired.

3. Hiring a Nurse

A temporary nurse would be hired to help around the house for the month following the delivery. She would help take care of the baby and mother, but her main role was to perform the domestic duties left unfulfilled by the one who had just given birth.

Frontispiece of Tis Merrie When Gossips Meet, by Samuel Rowlands 1602. Credit: Google Books.
Frontispiece of Tis Merrie When Gossips Meet, by Samuel Rowlands 1602. Credit: Google Books.

4. Inviting the Gossips

In the final months of the pregnancy, the expectant mother would issue invitations to her female relatives, neighbours, and friends, to attend her birth as her ‘gossips’, or ‘god-sibs’ (siblings in God). The women she chose would help her and the midwife, by making food, keeping company, and supporting her during the birth. The mother could expect at least half a dozen gossips.

5. Preparing the Birth Chamber

As the birth approached, the family would make sure to have the essential items for the delivery: candles, extra linen, a straw pallet bed, maybe a birth stool or chair, swaddling bands for the newborn baby, food and drink for everyone involved in the birth, herbal medicines, and (hopefully) the midwife’s fee. Before the Reformation, relics could be used, as well as rosaries, crucifixes, prayer books, and birth girdles with images of the Virgin Mary or St Margaret. (You can read about an amazing 15th-century birth girdle here.) The expectant mother would also seek the blessing of her local priest for a safe delivery.

Detail from the frontispiece of Jacob Rueff’s De conceptu et generatione hominis (1580). Credit: Wellcome Images.
Detail from the frontispiece of Jacob Rueff’s De conceptu et generatione hominis (1580). Credit: Wellcome Images.

6. Summoning the Midwife and Gossips

When labour began, the husband, perhaps helped by a servant, would go from door to door calling the gossips and midwife to come to attend his wife during the delivery. (This was later called ‘nidgeting’.)

7. Enclosing the Mother

If she wasn’t already in confinement, the gossips and midwife would move the labouring woman to a separate space from men as soon as they arrived. This was usually already set up, at least in part. Windows would be shut and covered by curtains or makeshift fabrics, to keep the daylight and the air out. Keyholes would be blocked so that no air came through them either. Candles would be lit as well as a fire. A birthing stool would be available (often brought by the midwife) for the use of the labouring woman.

8. Nourishing the Mother

The gossips would make sure that the person giving birth received nourishment (often under the midwife’s advice). They would offer her warm drinks made of wine, especially caudle, which contained sugar, spices, and eggs. (Check out this 14th-century recipe for caudle!)

9. Delivering the Baby

Midwives’ techniques varied greatly, but they were usually highly experienced. They might examine the woman to see how the birth was progressing and suggest which position would work best for the delivery. They could also manually remove the placenta after the birth if so needed. If the baby was unresponsive, the midwife would probably be the one to revive it. The midwife or a gossip would tie and cut the umbilical cord.

Richly Swaddled babies in The Cholmondeley Ladies (c.1600–10), by an unknown artist. Credit: Tate
Richly Swaddled babies in The Cholmondeley Ladies (c.1600–10), by an unknown artist. Credit: Tate

10. Cleaning and Swaddling the Baby

One of the gossips would probably be responsible for washing and swaddling the infant. Swaddling was deemed essential for babies in this period, to make sure their limbs grew correctly. It was also thought to keep babies calm and to make life easier for the one taking care of them, as it helped babies sleep.

11. Showing the Baby to the Mother and Breastfeeding

After the baby was ready, the mother would finally be able to see it. Breastfeeding would be encouraged unless the family was wealthy enough to hire a wet nurse. In that case, she would probably have been engaged earlier, around the same time as the nurse. Breast milk could be used to treat abscesses in the mother following childbirth, as well as eye or skin conditions in the newborn baby. (I wrote about breastmilk as medicine here.)

A Lying-in Chamber (1583). Credit: Wellcome Images.
A Lying-in Chamber (1583). Credit: Wellcome Images.

12. Lying-In

After the delivery, the mother’s lying-in period would begin. This would last for around 3 to 5 weeks and be comprised of three phases.

  1. In the first stage, she would be in her bed, and the room would remain darkened. The mother’s vulva would be washed with herbal solutions, but her sheets usually wouldn’t be changed. She would not perform any household duties. A nurse, hired for the lying-in period, would help around the house.
  2. In the second stage of lying in, she would be able to sit up and move around the room, and her bedclothes would be replaced. This was when close female friends would usually visit her. It was a time of female sociability and bonding. Caudle would be offered to visitors as well.
  3. In the final stage of her lying-in, the mother would be able to move around the house, but not leave it. More visitors would drop by, including men. Light household duties could now likely be performed by the mother.

Significantly, it was usually the person who had given birth who decided when to move from one stage of lying-in to the next.

13. Baptism

During the lying-in period, the baby would usually be baptised, without the parents’ presence. The godparents (usually three people) would act in their place, and the baby would be welcomed to the community.

A woodcut of a baptism, in A Booke of Christian Prayers by Richard Day (1581). Credit: V&A
A woodcut of a baptism, in A Booke of Christian Prayers by Richard Day (1581). Credit: V&A

14. Tipping the Midwife

At or right after the baptism, the godparents and gossips would usually tip the midwife for the safe delivery of the child. The father of the child would typically have paid and tipped the midwife after the birth.

15. Resuming Sexual Activity

It was inadvisable for sex to take place until the lying-in period was completed. Once the month was over, however, husband and wife could go back to sleeping together. (Of course, it’s impossible to know how much this injunction was followed.)

Presentation in the Temple, by Hans Memling (c. 1470). This episode is at the origin of the churching ritual.
Presentation in the Temple, by Hans Memling (c. 1470). This episode is at the origin of the churching ritual.

16. Churching

After her lying-in period was complete, the mother should only go outside the house after having been ‘churched’. (She usually wore a veil on the way to church to go around this unpractical norm.) Escorted by her gossips, the mother would go to church and kneel in a specific area separate from others, often called a ‘childbed pew’. During the service, the woman would thank God for her safe delivery. Specific Psalms would be said (116, 121, or 127), as well as the Lord’s Prayer (Kyrie Eleison). She would then make offerings to the priest and clerks and would be welcomed back to the community. This ceremony was much contested during the Reformation – but that’s a topic for another day!

Giving birth in 17th-century England was a process of separation, transformation, and reincorporation full of specific customs. Gender was a crucial aspect of these practices: the woman giving birth was separated from men and surrounded only by those of her sex and finally, reintegrated into society. Significantly, this was a female collective ritual, that inverted the usual power dynamics within families. In a patriarchal society such as 17th-century England, that was no small feat. This female world assured that, after birth, the mother’s body belonged to her, not her husband, at least for a while. She wouldn’t fulfil her domestic or sexual duties. This is why I find the female culture of childbirth so fascinating: it is a form of resistance, a fight for autonomy – even if short-lived.

(If you’re interested in this subject, I had a lovely talk with the wonderful doula Carly Lokrheim last year comparing past and present childbirth. You can watch it on YouTube.)

Further Reading:

David Cressy, Birth, Marriage, and Death: Ritual, Religion, and the Life-Cycle in Tudor and Stuart England (Oxford: Oxford University Press, 1997).

Amy Licence, In Bed with the Tudors: The Sex lives of a dynasty from Elizabeth of York to Elizabeth I (Gloucestershire: Amberley Publishing, 2012).

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‘Let Nature Take its Course’: In Defence of ‘Gentle’ Midwifery

Louise Bourgeois’ portrait (Wellcome Images)
Louise Bourgeois’ portrait (Wellcome Images)

In the 16th and 17th centuries, a delivery room could be a noisy place. Childbirth was a social event, and birthing chambers were often full of women (friends, relatives, servants, midwives…), celebrating and helping the one giving birth. However, whenever I picture this scene, I remember how important it was to me that my birthing environment be calm and quiet.

Today, there is much discussion about the effects a tranquil environment can have on the person giving birth. The French royal midwife Louise Bourgeois (1563-1636) agreed. To her, one of the main tasks of the midwife was to make sure that before and after childbirth, the room was calm and relaxing, gently serving the one giving birth:

‘Your only task is to do things properly, and serve those who call you in, following their wishes […] A midwife’s gentleness produces better results than harshness’. (Instruction à ma fille II, 23)

Louise Bourgeois’ portrait (Wellcome Images)
Louise Bourgeois’ portrait (Wellcome Images)

Louise Bourgeois believed midwives should be patient, cautious, and reassuring. Most of her treatments were gentle, and she only intervened in extreme cases: ‘I advise letting nature take its course’ (Observations diverses, II, 49).

Her approach was unhurried, without unnecessary or distressing interventions or regular internal examinations to check how the labour was progressing. Midwives should help the one giving birth manage it by providing moral support and allowing them to choose how it would unfold. For instance, she believed the best way to give birth was lying on a bed. However, Bourgeois wrote that

‘I have often noticed that one of the most important things for a woman in labour is finding the best position for her comfort and that of the child’. (Observations, I, 97)

Therefore, according to Bourgeois, the midwife should be flexible. People who wanted to move, walk around, and climb stairs should be respected; moreover, depending on their constitution, Bourgeois would suggest more vertical positions for delivery (such as kneeling, on a birthing chair, standing up), or horizontal ones (such as on a bed). But she was against forcing anything:

… ‘this discomfort [childbirth] is so extreme that the one suffering should be accommodated a little. I am often sorry to see women being forced by mother or relatives […] so that it makes their condition twice as bad’. (Observations, I, 98)

An early modern birth stool (Wellcome Images).
An early modern birth stool (Wellcome Images).

As the midwife to queen Marie de Medici, Bourgeois delivered her six children, including the future king Louis XIII, bringing this mindset to the French court. She was a highly educated and ambitious midwife who wrote multiple medical books when it was very rare for women to be published. Bourgeois was the first midwife to write about her ‘art’ in print.

This was no small feat. In Bourgeois’ time, university physicians, surgeons, midwives, and other medical practitioners competed in the medical marketplace for patients, who could change providers if they were not satisfied with the service. While most births were attended by women (including a midwife), surgeons might be called in particularly complicated cases. Bourgeois advocated for mutual respect between midwives and other medical practitioners, who had different kinds of expertise. Bourgeois herself delivered more than 2000 babies, performed minor surgeries, and was present at autopsies, working alongside physicians. She was confident about manually extracting a retained placenta and a child through a podalic version but argued that ‘handling’ the person giving birth should be the exception – not the norm.

Queen Marie de Medici and the Dauphin, future King Louis XIII (Musée des Beaux-Arts de Blois.)
Queen Marie de Medici and the Dauphin, future King Louis XIII (Musée des Beaux-Arts de Blois.)

Reading her instructions to aspiring midwives, it is clear how Louise Bourgeois was a departure from other midwifery manuals of the time. Contemporary authors such as Eucharius Rösslin, Ambroise Paré, and Jacques Guillemeau all favoured constant activity on the midwife’s part. They advised frequently checking the child’s progress, lubricating the birth canal, and pressing the belly to help the baby be born.

We should be careful not to make generalisations, however. For instance, some male writers advocated breaking the waters if the birth was not happening by itself, while others did not. What they did have in common was an expectation that midwives should ‘supervise’ the one giving birth, ‘order’ them and manipulate their bodies. They also shared a sense that midwives were ‘imprudent’, ‘obstinate’ people who needed to be themselves guided by medical men.

Louise Bourgeois’ portrait in a copy of the midwifery manual The Compleat Midwife’s Practice (1656), written by four English midwives. Credit: Dominic Winter Auctions.
Louise Bourgeois’ portrait in a copy of the midwifery manual The Compleat Midwife’s Practice (1656), written by four English midwives. Credit: Dominic Winter Auctions.

Louise Bourgeois had read medical texts and was married to a barber-surgeon; moreover, she wrote within the humoral theory framework of the time. Yet her work was a break from tradition. She occupied a liminal space, close to learned medical practitioners, yet apart from them because of her gender and field of expertise. This is evident in her case histories, which showcase both the midwife’s vulnerability and the limitations of male practitioners. Her ambivalent relationship to medical men is symbolic of midwifery’s shift in this period, which saw a gradual medicalisation (and indeed ‘masculinisation’ of childbirth). Bourgeois respected other practitioners (even if she criticised them) and expected to be valued as well:

‘I have had the honour of delivering all the Queen’s children, and I was not contradicted by the King nor her, nor by any physicians or ladies’ (Observations, II, 51).

Bourgeois likely exaggerated to make her point that midwives’ knowledge should be acknowledged. According to her,

‘… to know the secrets of women’s conditions, it is crucial to have worked with midwives and to have been present at multiple deliveries, as your great Master and legislator Hippocrates did, [since he] on the point of women’s conditions consulted midwives and relied on their judgement’ (Apologie, 19).

Louise Bourgeois’ Recueil de Secrets, illustrated by the artist Louise Bourgeois (MoMa)
Louise Bourgeois’ Recueil de Secrets, illustrated by the artist Louise Bourgeois (MoMa)

There is a clear sense of the increasing encroachment of medical men into midwifery, and Bourgeois protested this marginalisation of midwives. To her, childbirth should continue to be a social event requiring support rather than a medical one requiring treatment.

Untitled, from Louise Bourgeois’ Recueil de Secrets, illustrated by Louise Bourgeois (MoMa)
Untitled, from Louise Bourgeois’ Recueil de Secrets, illustrated by Louise Bourgeois (MoMa)

Louise Bourgeois was not a typical 17th-century midwife. She received 900 livres for her deliveries at court (18 times what average midwives received for the same service). While she was not a ‘regular’ midwife, her ambivalence about medical men was not an isolated case. Bourgeois strove to belong to learned circles while demanding midwives’ knowledge be respected and recognised. To her, the relationship between a midwife and her client should be based on trust. But that did not only mean that the patient should trust the midwife, but also that both should trust nature and respect the ‘natural’ way childbirth unfolds. Bourgeois was not shy about intervening, when necessary, but those instances were rare and not the way deliveries usually happened. Therefore, the midwife’s primary role was to support the one giving birth while nature took over, which involved offering nourishment, reassurance, and making sure the birth room was calm. Times have surely changed but she still strikes me as someone I would be happy to have by my side while giving birth!

*All French translations are my own.

References:

Louise Bourgeois,  Observations diverses (Paris: 1609).

Louise Bourgeois, Instruction a ma fille (Paris: 1617).

Louise Bourgeois, Apologie de Louyse Bourgeois (Paris: 1627).

Louise Bourgeois, Recueil des Secrets (Paris: 1635).

Jacques Guillemeau, De l’Heureux accouchement des femmes (Paris: 1609).

Ambroise Paré, Deux Livres de chirurgie (Paris: 1573).

Eucharius Rösslin, Der Rosengarten (Strasbourg: 1513).

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‘…but the Art of Midwifry chiefly concern us’!

In her 1671 midwifery manual, the English midwife Jane Sharp defined the art of midwifery as ‘doubtless one of the most useful and necessary of all Arts, for the being and well-being of Mankind’. A midwife should combine theoretical and practical knowledge, even if the former was harder to obtain in a world where women could not attend universities and their anatomy lectures.

The baby in utero, Jane Sharp’s The Midwives Book: or the Whole Art of Midwifery Discovered, 1671 (Wellcome Images).

However, ‘farther knowledge may be gain’d by a long and diligent practice, and be communicated to others of our own sex’. According to Jane Sharp, experience defined a midwife as skilled; the lack of theoretical knowledge could be remedied by books such as her own.

Seventeenth-century midwives were privy to the all-female world of childbirth and ‘secrets of women’. Yet they also had an essential social role in religious rituals, such as ‘churching’ – when a woman was welcomed back into church life after her lying-in period postpartum. They were often called as expert witnesses in trials as well, especially those in which sexual matters were at stake. Midwifery was also one of the few professions open to women who wanted to earn a living and be independent.

While not much is known about Jane Sharp, her faith in midwives (her ‘Sisters’, as she calls them in the dedicatory epistle) is strikingly different from how most other contemporary midwifery manuals depicted midwives. To her, midwives were smart, hard-working people who did their best to keep women and babies safe during the hazards of childbirth. They would also care for the mother and child before and after the delivery. Midwives were undoubtedly essential members of society.

Seeing the photos of the March with Midwives held in many cities throughout the UK on 21 November, it is baffling to think that midwives and birth activists still must fight for midwives to be treated with the respect they deserve. After all, the art of midwifery chiefly concerns us, as Jane Sharp wrote.

@midwivesmarch #MarchWithMidwives

Reference: Jane Sharp, The Midwives Book. Or the Whole Art of Midwifery Discovered (London: Simon Miller, 1671).

Midwives and campaigners by Lincoln Cathedral. Photo: Steve Smailes for The Lincolnite
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