Midwifery and childbirth: a historical A–Z guide

As BBC One's Call the Midwife returns for a new series, Nige Tassell charts the history of childbirth for BBC History Revealed – from bump to birth and beyond

Midwives and babies in the sun

A… is for Agnodice

Although some classical scholars debate she ever existed, Agnodice is widely remembered as a pioneering midwife. According to legend, she was born into a wealthy Athenian family in the 4th century BC and, keen to help reduce the high rates of mortality in childbirth, decided to study medicine – a career from which women were prohibited. In order to study and work as a physician, Agnodice had to dress as a man and, it’s said, had to physically reveal herself as a woman to gain the trust of pregnant patients. She allegedly became the most in-demand physician in ancient Athens, despite court action being brought against her by the medical profession.

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Pinoeering midwife Agnodice
Agnodice is remembered as a pioneering midwife (Photo by Alamy)

B… is for Breckinridge

Mary Breckinridge was born into a wealthy family in Memphis in 1881. Following the premature deaths of her two children, she devoted herself to nursing. In 1923, she travelled to London to train as a midwife. After graduation, she toured the Highlands and Islands of Scotland to understand more about the needs of rural communities when it came to childbirth. Back in the US, Breckinridge founded the Kentucky Committee for Mothers and Babies in 1925 (later the Frontier Nursing Service), an institution dedicated to training midwives and providing midwife support to underserved rural communities.

C… is for Chloroform

In 1847, James Young Simpson, professor of midwifery at Edinburgh University, first administered chloroform to one of his patients, a Mrs Carstairs. So grateful was she for the intervention that she named her daughter Anaesthesia. The breakthrough even made the front page of The Scotsman. While chloroform’s introduction was initially far from universally accepted by the medical fraternity, six years later Queen Victoria was administered the compound as she gave birth to her eighth child. The treatment now came by royal appointment.

D… is for Draper

At breakfast time on 12 August 1762, at St James’s Palace in London, the son and heir of George III and his wife Charlotte of Mecklenburg-Strelitz came into the world. But the arrival of the new Prince of Wales was unusual. The Queen had not wanted the attentions of the celebrated surgeon William Hunter. Instead, remaining at the palace in case of complications, Hunter is said to have stood aside in favour of an ordinary midwife – one Mrs Draper. It was she who is thought to have delivered the future George IV.

E… is for Ether

While James Young Simpson pioneered the use of anaesthesia on the eastern side of the Atlantic, his counterpart to the west was Walter Channing, professor of midwifery and medical jurisprudence at Harvard. His favoured anaesthetic was the clear liquid known as ether. Observing that there was no reason that a woman should “submit to a suffering which is [as] unnecessary as it is… cruel”, Channing was the author of the 1848 Treatise On Etherization In Childbirth, which included testimony from 45 other physicians, who confirmed the absence of negative consequences in all the births in which they had administered ether.

Ether inhaler
Ether was first used as an anaesthetic in Boston in the 19th century (Photo by Getty)

F… is for Floreta d’Ays

Floreta d’Ays was a Jewish midwife who worked in Marseille in the early 15th century. In 1403, after a woman in her care died from a post-partum haemorrhage, d’Ays became the first midwife to be tried for medical malpractice. She had, in fact, been attempting to extract the placenta manually. However, because the new mother, a Christian, had not survived, d’Ays was accused of deliberately causing her death. Most of the testimony in court was from Christian women, with d’Ays given little opportunity to explain the science behind the procedure. She also declared that any confession of malpractice had been achieved through the use of torture. The final outcome of the case is not known.

G… is for Genesis

One of the earliest references to midwifery can be found in the Old Testament, specifically in Genesis 35:17 when Rachel, wife of Jacob, is encountering difficulties during the birth of her second son: “And it came to pass, when she was in hard labour, that the midwife said unto her, ‘Fear not Rachel, it is another boy.’”

H… is for Herophilus

Known as ‘the father of anatomy’, the Greek physician Herophilus made a substantial contribution to the study of pregnancy and childbirth. His third-century BC treatise, Midwifery, was an attempt to give doctors and midwives a greater understanding of their vocations. It not only highlighted the possible reasons for a difficult birth, but also explained the processes of conception and identified the various stages of pregnancy.

I… is for Ixchel

Ixchel was the Mayan goddess of midwifery and fertility
Ixchel, shown in the Mayan book known as the Dresden Codex (Photo by Alamy)

Ixchel was the Mayan goddess of midwifery and fertility. Mayan midwives differed from those elsewhere in the world in that it was believed that pursuing midwifery wasn’t a matter of selecting a job, but rather a calling from God, often received through a series of dreams. Mayan midwives were expected to spend a great deal of time with their patients, often to the detriment of their own marriage – they were also required to abstain from sex throughout the time they were attending births and performing ceremonies.

J… is for Jane Sharp

Jane Sharp was the first Englishwoman to publish a book on midwifery. Until then, most knowledge of the subject was gleaned from male-written texts. Sharp’s best-known book, The Midwives Book, Or The Whole Art Of Midwifry, Discovered, was an instant bestseller on publication in 1671 and was successful, wrote historian Jenna Townend in 2013, in “readdressing the gender imbalance, in terms of both authorship and perspective, that had blighted the science for much of the preceding two centuries”.

K… is for Knowledge

Although interest in midwifery among medical students in Britain rose throughout the 18th century, it wasn’t a mandatory element of a degree in medicine. Indeed, until Scotland made it a compulsory field of study in 1833 – English universities followed suit in 1866 – it was possible to be a practising physician without having received any instruction in the ways
of childbirth.

L… is for Lying-In Hospitals

A lying-in hospital was where women – usually poor and/or unmarried – who were unable to have their child at home went for delivery and for post-partum care. During the 15th century, St Thomas’ Hospital in London had lying-in wards, as did numerous workhouses. The 18th and 19th centuries saw the construction of several dedicated lying-in hospitals across the capital. These included Queen Charlotte’s Hospital in Hammersmith, which was primarily established to serve “wives for poor industrious tradesmen or distressed house-keepers”, as well as the wives of soldiers and sailors.

M… is for Male Midwives

Male midwife Colin Bestead
Midwife Colin Bestead, pictured at King George V Memorial Hospital in 1976 (Photo by Getty)

Midwifery was an almost exclusively female role until accoucheurs – male midwives – became fashionable in 17th-century France, leading to a much greater involvement of male medical practitioners in childbirth. Quite often, these accoucheurs – such as the celebrated François Mauriceau – were also licensed as surgeons. As such, they were permitted to use forceps and anaesthetics, unlike their female counterparts.

N… is for Nuns

BBC One’s Call the Midwife is based on the mostly autobiographical accounts of district nurse Jennifer Worth, who worked as a midwife in London’s East End in the 1950s. The nuns who feature in the series are inspired by a real-life nursing order – the Community of St John the Divine. Founded in 1848 as a ‘nursing sisterhood’, the community of nuns worked alongside Florence Nightingale and, after 1948, with midwives and doctors of the new National Health Service, caring for families in some of the poorest parts of London. The order moved to Birmingham in 1976.

O… is for Obstetrics

Obstetrics is a branch of medicine that is distinct from, although at times overlapping with, midwifery. The two disciplines haven’t always enjoyed the smoothest of relationships, with the rise of obstetrics over the past two or three centuries – fuelled by scientific and technological advances – casting midwifery somewhat into shadow. Broadly speaking, history shows a direct correlation between the advent of obstetrics and the level of male medical practitioners working within childbirth, with midwifery often viewed as somehow unscientific.

P… is for Puritans

A witch is burnt at the stake
In the Middle Ages, midwives risked being labelled as witches and burnt at the stake (Photo by Getty)

In 1648, Margaret Jones, a Puritan midwife, became the first woman to be executed for witchcraft in the Massachusetts Bay Colony. One of the charges against her, reported the journal of Governor John Winthrop, was that: “She practising physic, and her medicines being such things as, by her own confession, were harmless… yet had extraordinary violent effect.” The link between midwifery and witchcraft was already long-established. The infamous Malleus Maleficarum, a 15th-century book about witches, claimed midwives were the most dangerous kind of witch. Midwives were said to be women whose purpose was to steal stillborn children, who may actually have been murdered by the midwives, for use in satanic rituals.

Q… is for Queen Ulrika Eleonora

In the 17th century, the Danish-born Queen of Sweden became dismayed by the high mortality rates of both mothers and new-born babies in her adopted country. In 1685, inspired by her own experience with midwife Catherine Wendt, Ulrika drew up plans for a midwifery school which, aside from practical training, offered theoretical learning – at the time, midwife instruction usually occurred ‘on the job’. Although it took quarter of a century for it to be opened, the school laid down the roots of Sweden’s strong midwifery tradition, ultimately contributing to reduced mortality figures.

R… is for Regensburg

The Bavarian city of Regensburg is believed to be where the licensing of midwives was first instituted and made compulsory, a practice that soon spread across Western Europe. From 1452, any woman in Regensburg wishing to become a midwife had to appear xquestioning. However, with their medical training avoiding gynaecology and childbirth, these physicians often weren’t exactly the best-qualified people for their task.

S… is for Soranus of Ephesus

The birth chair, originally designed by Soranus of Ephesus
A parturition or birth chair, the design of which was pioneered by Soranus of Ephesus (Photo by Getty)

Largely through his seminal work Gynecology, the second-century physician Soranus made an enormous contribution to the study of midwifery. Indeed, he was a major influence on the practice of childbirth right up until the Middle Ages. As well as introducing the use of the birth chair, the Romans placed great significance on the immediate assessment of a just-born child. Gynecology also sets out the necessary characteristics of a midwife: “[She should be] respectable and generally not unduly handicapped as regards her senses, sound of limb, robust and, according to some people, endowed with long, slim fingers and short nails at her fingertip.”

T… is for Twilight Sleep

It might sound the most natural thing, but twilight sleep was actually an injection of morphine and scopolamine that together aimed to ease the experience of childbirth. The morphine relieved the pain, while the amnesiac scopolamine erased the memory of giving birth. It was first administered in 1902 by an Austrian physician, Richard von Steinbüchel. Initially at least, educated and upper-class women welcomed use of the procedure.

U… is for Ultrasound

‘The investigation of abdominal masses by pulsed ultrasound’, a paper published in The Lancet in 1958, revolutionised pre-natal care. Authors Ian Donald, John McVicar and Tom Brown were pioneered using ultrasound within gynaecology and the paper included the first ultrasound pictures of a foetus.

V… is for Vesalius

Andreas Vesalius was a Flemish anatomist whose dissections of human cadavers produced discoveries that greatly enhanced knowledge of the female reproductive organs, and thus helped to advance midwifery. For instance, in his most famous work – De Humani Corporis Fabrica Or On The Fabric Of The Human Body, published in 1543 – he debunked prevailing thought that the human uterus was divided into two sections.

W… is for Westcar Papyrus

Named after the British antiquarian Henry Westcar, who acquired it during his travels in Egypt in the 1820s, the Westcar Papyrus is an ancient text, thought to date from c1700 BC, that tells five miraculous stories. These reveal that midwifery was a recognised occupation at the time – and a reputable one too.

X… is for Xenophobia

During the first few decades of the 20th century, anti-midwife rhetoric grew louder in the US as the obstetric profession sought to undermine the role of the traditional, ‘unscientific’ midwife. With immigrants making up a large proportion of midwives (in 1924, 86.3 per cent of Minnesota midwives had been born outside the US), historian Sheryl Nestel observed in her 2007 book, Obstructed Labour: Race and Gender in the Re-Emergence of Midwifery, that the anti-midwifery debate of the time “relied heavily on racist and xenophobic themes”. That infant mortality rates were comparatively high during this particular time of economic hardship only fuelled this sentiment.

Y… is for Young

Thomas Young
Thomas Young, English Polymath (Photo by Alamy)

Professor Thomas Young of Edinburgh University was the first to give public lectures on midwifery. In a 1779 lecture series, he explained: “Midwifery, though formerly very much neglected, is certainly an art of the greatest importance.” However, he also mentioned “the ignorance of those who practised it [midwifery] in the days when it was in the hands of women”.

Z… is for Zepherina Smith

A social reformer, Smith greatly advanced the education and training of midwives, especially those serving the poorer quarters of English society. After returning to England in 1871 from nursing duties in France during the Franco-Prussian War, Smith (née Veitch) trained and served as a midwife until she got married. Thereafter, she dedicated herself to improving midwifery standards, notably as president of the Midwives’ Institute, later known as the Royal College of Midwives.

The new series of Call the Midwife is scheduled for January 2020, and a Christmas special will air on Christmas Day

Nige Tassell is a freelance journalist and author specialising in history

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This content first appeared in the January 2020 issue of BBC History Revealed, on sale 27 December 2019