Rebecca Simpson offers an alternative perspective on stillbirth and infant loss, focussing on the writings of two eighteenth century midwives. This is one of a series of essays addressing miscarriage, prematurity, stillbirth and neonatal loss, published by The Polyphony to coincide with Baby Loss Awareness week, which runs 9-15 October every year.
The voices of midwives are seldom heard in narratives of child loss, and even less so when examining historical cases of bereavement. There are very few surviving accounts of delivery and practice written by female midwives in the long-eighteenth century. Indeed, between the years of 1671, when Jane Sharpe published the first midwifery book written by a woman in English, and the end of the eighteenth century, only six texts were published. Furthermore, very few of these female practitioners included case-studies in their published texts, and thus the specific details of their interactions with their patients have been largely lost.
Within the examples that do survive, there are comparatively few case studies that detail the deaths of babies, or indeed maternal deaths, in comparison to the many accounts of successful deliveries. In a system where the successful delivery of a living child to a living mother is framed as the best outcome, the loss of a child during birth may be interpreted comparatively as a failure of practice. Furthermore, during the eighteenth century female midwives faced increasing competition from male accoucheurs, or man-midwives, who worked increasingly in day-to-day midwifery practice in a phenomenon termed by historians as ‘the rise of the man-midwife.’[1] Therefore female midwives who moved into the market of medical publication were acutely aware of their need to positively represent not only their own individual practice, but also the professional capabilities of female midwives as a whole. Naturally, when committing their cases to print, these midwives sought to present their most successful cases, and thus foetal or infant death is featured less prominently.
This article looks at examples of case-studies from the published works of two eighteenth-century midwives: Sarah Stone and Margaret Stephen, to offer initial insights into the attitudes of historical practitioners towards infant death. Stone was a provincial midwife, working for most of her career in Taunton, Somerset, before moving to Bristol.[2] A Complete Practice of Midwifery (1737) is largely constructed from the case-studies she gathered over the course of a career that spanned thirty years, and thus offers invaluable insights into midwifery practice at the beginning of the eighteenth century. In contrast, Margaret Stephen lived and worked in London and published Domestic Midwife; Or, The Best Means of Preventing Danger in Child-birth Considered (1795), at the end of the century. [3]
Stone presents herself as the most experienced and accomplished midwife in Taunton and the surrounding countryside, and a number of her cases detail her being called to a patient after other midwives have been unable to perform a delivery. This self-characterisation has led Stone to be accused of ‘fashion[ing] herself as a hero, whose labours, like those of Psyche rather than those of Hercules, involve a non-climactic series of patient, resolute cooperation.’[4] However, this behaviour is not unique to Stone; as outlined above, all of these female-authored texts are engaged in an activity of self-promotion, not only for the individual services of their authors, but for the cause of female midwifery practice as a whole. Stone’s position as the most experienced practitioner in her area is also notable because it meant she never had to subjugate her authority in the birth chamber to a male practitioner – in Taunton, as she relates in A Complete Practice, ‘there was no man-midwife.’[5] Therefore, in contrast to Stephen, who worked in London when there were far larger numbers of male practitioners, and whose case-study addresses their incompetence directly, the target of Stone’s criticism are ignorant female midwives.
The death of a child, either during delivery, or not long afterwards, occurs in a number of Stone’s case-studies in A Complete Practice. In only one of the cases, or ‘observations,’ is the child’s death presented as the unavoidable consequence of a difficult labour. In this example, ‘Observation XXIII,’ the foetus is extremely large and lying in a transverse position, and, although Stone is able to turn the child, and deliver the mother safely, the baby is stillborn.[6] Stone presents this birth as one of the most difficult of her career: ‘ I don’t remember above four such terrible Labours, in all my practice,’ and thus as an outlier amongst her many successful deliveries.[7] Observation XXIII is presented as an unavoidable tragedy where the midwife, despite her heroic efforts, is unable to prevent the course of nature. In contrast, the other cases leading to child death in A Complete Practice, as presented as the result of incompetence on the part of the original midwife.
In Stone’s other cases that result in child loss, and in Observation XIV to the deaths of both mother and child, deaths are attributed by Stone to the ignorance of the first attendant midwife or as a result of their unwillingness to hand-over the case to a more experience practitioner. Stone’s inclusion of these cases within A Complete Practice, provide her with an opportunity to demonstrate in print, the ways in which the cases were mismanaged, and provide instruction as to how the outcomes could have been avoided. Stone’s stated intention in her ‘Preface to the Reader’ is to ‘prove instructive to some Women Professors in the Art of Midwifery; and inform them in a right, safe and just practice of that Art: that they may be able to deliver in difficult Labours, as well as those who are not so.’[8] Stone’s desire to enable other midwives to deliver their patients safely is thus presented as the reason for the comparatively high number of child deaths that appear within her published case-studies, despite her overall success rate throughout her career.
This educational intent is a point of continuation between the work of Stone and Margaret Stephen. Stephen was staunch critic of the incursion of men into general midwifery practice, and Domestic Midwife is presented as an extension of Stephen’s work as a teacher of female midwives. As such she includes in the text a case study about child loss that she presents as a cautionary tale to her students. In Section V, which outlines techniques for dealing with ‘Preternatual labours, and the Art of Turning’, she relates a case in which her attempts to work collegially with a male practitioner results in her being wrongly blamed for the death of a child. [9]
Stephen describes a prolonged labour which causes the concerned family to summon an apothecary who also acts as a man-midwife (Stephen also refers to this practitioner as a ‘doctor’ but does not describe him as a physician.) Although Stephen does not judge either mother or child to be in danger, she cedes the case to the male practitioner and he performs a forceps extraction on the baby who is born with an umbilical pulse but is soon declared dead.
[…] upon wiping its head and face, I discovered a deep wound on the right temple, which appeared to me to be evidently the case of the child’s death, because it was in the direction of the temple vein; but as the doctor was young, and of course his character rather delicate, I endeavoured to veil this misfortune, by drawing the lips of the wound close together, and keeping my finger upon it, till the blood dried to keep it from opening. […] the doctor came to me, and whispered me to put a cap on it: he ran to the basket and brought me one. I took the hint, and pinned it close over the face to hide the cut […][10]
Stephen’s actions in concealing how the baby died from its parents certainly constitute a violation of modern medical ethics. Indeed, her behaviour in this case-study directly contravenes section 1.b of The International Code of Midwifery Ethics: ‘Midwives support the decisions of women/families to participate actively in decisions about their care.’( my emphasis)[11]
However, Stephen’s framing of this incident makes clear that her actions are intended to spare the family suffering, and to generously help protect the reputation of her young, male colleague. Stephen presents her own actions as collegial, and her handling of the birth prior to the male midwife’s attendance as responsible and measured. In contrast, the male doctor is depicted as ungratefully attempting to shift blame off himself, and onto his female colleague; informing the grief-stricken family that the child had died prior to birth, he blames Stephen’s handling of the case for the tragedy.
The doctor’s sentiments of generosity were very different from mine, for when, on his first visit, the parents regretted very much the child’s death; he said “ as to that, the child was “dead four hours before he was called;” this was a gross falsehood […][12]
This case study is interesting because it also contains a rare example of an eighteenth-century midwife commenting in print upon the emotional impact of child loss upon the bereaved family. Typically, the narratives of such case-studies maintain a clinical distance that excludes the inevitable emotional consequences of losing a child. However, Stephen’s actions in this case, though in violation of modern medical ethics, at the very least outline a consideration for the grief of the parents, as she washes and dresses ‘the poor infant’ so that it can be viewed by its parents without distressing them further.
Stephen’s presentation of this case is intended to serve as a cautionary tale to both midwives and mothers. She cautions midwives against ‘putting their patients at the mercy of young inexperienced men; for had this occurred in the early part of my practice, it might have hurt me very essentially.’[13] Stephen also advises mothers that the hiring of a man-midwife ‘is only necessary when difficulty occurs, and they should be men of known integrity and long practice; the idea that any man-midwife will do, is a mistaken notion indeed, and many have found it so to their cost.’[14] Her emphasis on the importance of integrity underscores the professional threat male practitioners pose, should they choose to blame female midwives for negative outcomes.
Evidence from the publications of eighteenth-century midwives suggests that practitioners maintained a clinical distance from those of their cases that resulted in the death of a child. Neither Stone, nor Stephen, relate their own emotional responses to these cases, and on only one occasion does a midwife allude to the grief of the bereaved family. The reason for this lies largely in the intended audience of these texts; both A Complete Practice and Domestic Midwife were intended for the readership of other midwives, all of whom would, at some point in their careers, encounter similar tragedies. These texts were intended, as Stone outlined in her preface, to enable midwives to prevent child loss, but also to accept that such deaths were an inevitable fact of life, and indeed, of birth.
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Rebecca Simpson is a PhD student at the Department of English and Related Literature and the Centre for Eighteenth Century Studies at the University of York. Her research focusses midwifery, pregnancy, and birth in the long-eighteenth century. She holds a Master’s degree in English Literary Studies from York and an MA in English Language and Literature from the University of Oxford. Rebecca is on Twitter as @rebellsimpson. https://york.academia.edu/RebeccaSimpson
References:
[1] See the following for a select few examples of texts on this subject. Adrian Wilson, The Making of Man-Midwifery: Childbirth in England, 1660-1770 (Cambridge, Massachusetts: Harvard University Press, 1995); Doreen Evendeen, The Midwives of Seventeenth-Century London (Cambridge: Cambridge University Press, 2000); Jean Donnison, Midwives and Medical Men: A History of Inter-Professional Rivalries and Women’s Rights (London: Heinemann Educational Books Ltd, 1977); Clare Hanson, A Cultural History of Pregnancy: Pregnancy, Medicine and Culture, 1750-2000 (Basingstoke: Palgrave Macmillan, 2004); Lisa Forman Cody, Birthing the Nation: Sex, Science and the Conception of Eighteenth-Century Britons (Oxford: Oxford University Press, 2005); Jenifer Buckley, Gender, Pregnancy and Power in Eighteenth-Century Literature: The Maternal Imagination, Palgrave Studies in Literature, Science and Medicine (Milton Keynes: Palgrave Macmillan, 2017).
[2] See the following for the most extensive biographical treatment of Stone: Robert Woods and Chris Galley, Mrs Stone & Dr Smellie: Eighteenth-Century Midwives and Their Patients (Liverpool: Liverpool University Press, 2014).
[3] Margaret Stephen, Domestic Midwife; or, The Best Means of Preventing Danger in Child-Birth Considered. (London, 1795).
[4] Isobel Grundy, ‘Sarah Stone: Enlightenment Midwife’, in Medicine in the Enlightenment, ed. Roy Porter (Atlanta, GA: Rodophi, 1995), 128–44. 131.
[5] Sarah Stone, A Complete Practice of Midwifery. Consisting Upwards of Forty Cases or Observations in That Valuable Art, Selected from Many Others, in the Course of a Very Extensive Practice. (London: Piccadilly, 1737). xiii-xiv
[6] Stone, 76–80.
[7] Stone, 79.
[8] Stone, ix.
[9] Stephen, Domestic Midwife. 1
[10] Stephen. 59-60
[11] International Confederation of Midwives, ‘International Code of Ethics for Midwives’, International Confederation of Midwives, 2008, https://www.internationalmidwives.org/assets/files/general-files/2019/10/eng-international-code-of-ethics-for-midwives.pdf. I
[12] Stephen. 60
[13] Stephen. 62
[14] Stephen. pp. 62-63
Bibliography:
Primary Sources
Fores, Samuel (as John Blunt). Man-Midwifery Dissected; Or, the Obstetric Family-Instructor. London. 1793
Smellie, William. A Sett of Anatomical Tables, with Explanations, and an Abridgment of the Practice of Midwifery; with a View to Illustrate a Treatise on That Subject, and Collection of Cases. 2nd ed. London, 1761
Sharpe, Jane. The Midwives Book, Or, The whole art of midwifry discovered.: Directing childbearing women how to behave themselves in their conception, breeding, bearing, and nursing of children in six books. London, 1671.
Stephen, Margaret. Domestic Midwife; or, The Best Means of Preventing Danger in Child-Birth Considered. London, 1795.
Stone, Sarah. A Complete Practice of Midwifery. Consisting Upwards of Forty Cases or Observations in That Valuable Art, Selected from Many Others, in the Course of a Very Extensive Practice. London: Piccadilly, 1737.
Secondary Sources
Buckley, Jenifer. Gender, Pregnancy and Power in Eighteenth-Century Literature: The Maternal Imagination. Palgrave Studies in Literature, Science and Medicine. Milton Keynes: Palgrave Macmillan, 2017.
Cody, Lisa Forman. Birthing the Nation: Sex, Science and the Conception of Eighteenth-Century Britons. Oxford: Oxford University Press, 2005.
Donnison, Jean. Midwives and Medical Men: A History of Inter-Professional Rivalries and Women’s Rights. London: Heinemann Educational Books Ltd, 1977.
Evendeen, Doreen. The Midwives of Seventeenth-Century London. Cambridge: Cambridge University Press, 2000.
Grundy, Isobel. ‘Sarah Stone: Enlightenment Midwife’. In Medicine in the Enlightenment, edited by Roy Porter, 128–44. Atlanta, GA: Rodophi, 1995.
Hanson, Clare. A Cultural History of Pregnancy: Pregnancy, Medicine and Culture, 1750-2000. Basingstoke: Palgrave Macmillan, 2004.
International Confederation of Midwives. ‘International Code of Ethics for Midwives’. International Confederation of Midwives, 2008. https://www.internationalmidwives.org/assets/files/general-files/2019/10/eng-international-code-of-ethics-for-midwives.pdf.
Wilson, Adrian. The Making of Man-Midwifery: Childbirth in England, 1660-1770. Cambridge, Massachusetts: Harvard University Press, 1995.
Woods, Robert, and Chris Galley. Mrs Stone & Dr Smellie: Eighteenth-Century Midwives and Their Patients. Liverpool: Liverpool University Press, 2014.
