Monday, January 4, 2010
History of Childbirth
While Childbirth itself hasn’t really changed over the years, those who care for women in childbirth and the techniques used has undergone many changes. There are significant differences between how male accoucheurs and midwives handled birth. One of them is that male accoucheurs were trained in the use of forceps. By the Regency period, the vast majority of midwives only used their hands. Midwives generally supported old traditions of giving birth (female friends and relatives being present at the birth, stopping up doors and windows, darkening the room, the drinking of caudle) and men were beginning the move away from these rituals and many of them went on at length about "dirty and ignorant midwives". There was a gradually escalating conflict between male-dominated medical institutions and the tradition of midwifery that started before the Regency period and extended to the Twilight Sleep of the early 20th century. Originally there were arguments that it was indelicate for men to preside at a birth, eventually it was argued that it was indelicate for women to do so. Whatever!
By the Regency, most women of the aristocracy and even the gentry were using a male accoucheur rather than a midwife. Women who were of lower classes or very old-fashioned might still use a midwife. The very wealthy sometimes had an accoucheur live with them in the weeks before the due date (the Duchess of Devonshire did so) or they went to London to give birth. They also employed a month nurse whose job it was to take care of the mother before and after the birth. Month nurses often knew how to deliver the baby in case the accoucheur couldn't get there in time.
An excellent book on this subject is IN THE FAMILY WAY by Judith Schneid Lewis.
The ladies in IN THE FAMILY WAY are all either royal or from aristocratic families (many well-known names like Lady Jersey and Princess Charlotte). Adrian Wilson's book indicates well-to-do tradesmen were starting to hire male doctors for their wives, following the trend started by the aristocracy. Remember, these ladies are ones about which a great deal is known because they were prominent, educated, and leaders in Society. These are ladies who would go the more expensive route. Your average middle class and gentry class lady would not have a doctor, especially not in the country. Doctors with skills were rare in the country, and most women were still uncomfortable with a man not their husband touching them so intimately.
The issue of cleanliness applied especially to hospital births. Most women gave birth at home before the 20th century but there were teaching hospitals and maternity wards for the poor. Until the advent of proper antiseptics, puerperal fever claimed many lives. Even those doctors who washed between cases (and a few were smart enough to advocate this) found it was not 100% effective. Midwives who carried a smaller case load were less likely to spread disease because they were more likely to have washed before seeing the next patient.
Even in Russia, they were using doctors amongst aristocrats. But these were few and far between in reality, so one can't conclude from a handful--relatively speaking--of women using doctors instead, that all women used doctors instead. Hospitals were not healthy for births. Doctors went from autopsies to deliveries without washing.
Language about childbirth was changing during the Regency, with "accoucheur" superseding "man-midwife" about the same time "in the family way" and "confinement" were replacing "breeding" and "lying-in". But midwives were still called midwives.
Giving birth is a natural act and, unless something goes wrong, women were able to manage this, even by herself. There are women even today who give birth unassisted, even some who do it on purpose. _http://www.unassistedchildbirth.com/_ (http://www.unassistedchildbirth.com/) although I, for one, was glad to have plenty of help!
A special room was designated for the birth that was not necessarily the bedchamber. The mother-to-be often had lots of visitors (female relatives and friends) during the birth and during the month or so period afterward might receive a bunch more, so the room might be chosen to suit that purpose. But some couples preferred to do things more privately in the country.
Birthing chairs they were popular with midwives but not with the male accoucheurs who were becoming fashionable by the late eighteenth century. My sources indicate aristocratic women were tending to go with male doctors by this period. They advocated birth in bed but Dr. Charles White also designed a "Lady's Ease Chair" that is semi-reclining. While giving birth to my six children, I have to say, semi reclining sure seemed to work better than flat on my back!
Midwives often had birthing chairs but some families owned chairs that were handed down between generations--presumably falling into disuse when male doctors advocated birth in bed. For more information regarding the midwife/birth chair I recommend Birth Chairs, Midwives and Medicine by Amanda Carson Banks. Lots of good pictures there.
For more information, I recommend http://www.elenagreene.com/childbirth.html. there are some rough sketches of birth chairs along with some notes and a bibliography on the history of childbirth.