Introduction
In sixteenth and seventeenth century Britain and Europe birth was seen as an expected normal, although challenging, and often fearful part of a woman’s life. Birth was considered the domain of women; most births were social events, attended by family members, friends and neighbours, and traditional midwives, in the woman’s home.220 There is evidence for male input into gynaecological illness and complicated obstetrics as men were not totally excluded from the treatment of women even in ancient and medieval times,221 but childbirth, particularly ‘normal’ childbirth, remained almost completely in the hands of women.222
Birth attendants used rituals and practices that were not usually based on scientific knowledge but rather on domestic practice, cultural and religious thought and local superstition, combined with midwifery knowledge usually gained by midwives observing other midwives’ practices, and by simply attending many births.223 This chapter identifies, and using the theoretical model, analyses the birthing practices of Europe and Britain that the early settlers would have been familiar with prior to embarking for Aotearoa New Zealand. This knowledge was brought to Aotearoa New Zealand by the settlers, and became part of the foundational birthing knowledge and practice of Aotearoa New Zealand.
Traditional Practice
French traditional practice in birthing the placenta, still in use in the nineteenth century, is described by Gelis, “Not until the first cry was the cord cut”.224 He then outlines the process that
220 A. Banks, Birth Chairs, Midwives, and Medicine, University Press of Mississippi, Jackson, 1999; J. Gelis, History of Childbirth; J. Towler, J. Bramall, Midwives in History and Society; J. Donnison, Midwives and Medical Men.
221 M. Green, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-‐Modern Gynaecology, Oxford University Press, Oxford, 2008.
222 M. Green, Women’s Healthcare in the Medieval West.
223 A. Wilson, The Making of Man-‐midwifery: Childbirth in England 1660 – 1770, UCL Press, London, 1995. 223 J. Gelis, History of Childbirth.
was used to treat the cord and bind it to the baby’s body, and how the baby would be taken to the hearth to keep it warm while the midwife returned to help the mother expel the placenta.225 The commonest method was to tie the umbilical cord to the woman’s thigh to prevent it from going up inside her, and wait.226 If necessary, methods such as getting the mother to sneeze, vomit, blow hard, or abdominal massage were used. Neither cord traction nor manual removal of the placenta was a common practice.227 After the birth the placenta was checked to see that it was complete:
Satisfied she would set it aside, and make sure that the mother was well and that the lochia was flowing normally, then she would turn back to the child.228
Wilson comments that although swaddling the baby completed the birth, it was only the beginning of the childbirth ritual that was the month of ‘lying-‐in’. He describes the ‘lying-‐in chamber’ as being totally enclosed, physically and symbolically. Light was excluded by curtains, air by blocking even the keyholes, candles and often a fire were used for light and warmth, while the ‘caudle’ of warm ale or wine, was prepared with sugar and spices by the supporting women, or ‘gossips’. Men were excluded or restricted. Wilson speculates that ‘lying in’ was a method of preventing women from exploitation and of emphasising their need for recovery from birth and being excused from their usual duties.229 The woman was expected to remain in bed for anything from three to fourteen days, sometimes taking over some of her lighter duties gradually over the last fortnight before the month was up, when she could be ‘churched’ and could rejoin society.230
Midwifery and the Written Word
Caxton’s fifteenth century invention of the printing press was a major factor in the changes that were to overtake midwifery practice in Britain. ‘The Byrthe of Mankynde’ or (later) The Birth of
225 J. Gelis, History of Childbirth.
226 A practice known to be still in use by traditional midwives in mid-‐twentieth century Tonga, personal communication, Violani Wills, RGON, RM, 2009.
227 J. Gelis, History of Childbirth. 228 J. Gelis, History of Childbirth, p. 173. 229 A. Wilson, The Making of Man-‐midwifery.
230 ‘Churching’ was a religious ceremony for the woman that included thanksgiving for safe deliverance. Wilson states that 90 percent of women chose to be churched. There may also have been an element of being ‘cleansed’ after the birth.
Mankind was very popular and was reprinted several times over the next centuries.231 Reynald’s 1654 4th edition discusses “How the Secundine or Second Birth shalbe forced to issue forth, if it come not freely of his own kind”, discussing that:
also sometime it cometh to pass, that the Secundine, which is wont to come together with the birth, remain and tarrie behind, and follow not, and that for divers causes.232
The statement that the secundine should come “freely of his own kind” and that it usually accompanies the birth, suggests a perception of nothing being done to physically expedite the secundine’s birth at that time, although it is argued that at least in Europe many midwives (of both genders) were very ready to intervene in ways that were detrimental to women’s safety.233
Jean Towler, a midwife, wrote about the position of midwives in British society, describing the British midwives of the sixteenth century:
The majority of midwives were still illiterate, and although they may have been skilled at normal delivery of healthy women, they had no ‘training’ for the variety of obstetric and paediatric complications with which they had to deal, generally alone. [….] her only source of help was from a limited number of barber-‐surgeons who were called in as a last resort.234
Traditional midwives were still the norm in Europe in the eighteenth and early nineteenth centuries. In Britain the midwifery knowledge of the eighteenth century was handed down from woman to woman as, unlike Europe, Britain offered little education for midwives until the early nineteenth century, and medical schools teaching scientific ‘midwifery’ were usually not accessible for women practitioners.235 Most traditional midwives learned their trade in apprentice-‐ type situations from other midwives, like Sarah Stone, an early eighteenth century midwife, who was apprenticed for six years to her midwife mother.236
231 J. Ballantyne, The Byrthe of Mankind, in P. Wilson, Ed., Childbirth.
232 T. Reynald, The Birth of Mankind, Hood, Reyer and Timlins, London, 1654, p. 113. 233 V. De Brouwere, The Comparative Study of Maternal Mortality over Time. 234 J. Towler, Midwives in History and Society, p. 43.
235 A. Wilson, The Making of Man-‐midwifery;; J. Carter, T. Duriez, With Child; Birth through the Ages, Mainstream Publishing, Edinburgh, 1986; J. Donnison, Midwives and Medical Men.
Sir Richard Manningham set a precedent for female students when he offered instruction at a short-‐lived ‘charitable infirmary’ in London in 1739.237 By 1773 women midwives were also receiving instruction at the Rotunda Hospital in Dublin,238 but, particularly in rural areas, there was a lot of ignorance, among both female and male midwives. Donnison, who examined the relationships between women midwives and men midwives, wrote:
There was… no guarantee that any man setting up as a man-‐midwife, whether medically qualified or not, really understood his business, any more than there was for the women in this work. Without doubt male practice at its worse was as bad as that of the most ignorant midwife.239
British Traditional Midwifery Practice
Seventeenth century British midwifery practice is exemplified in the first British midwifery textbook, a practice manual written in 1671 by the English midwife, Jane Sharp, who published a practical book of midwifery informed by previous European writings.240 Sharp acknowledged that many English seventeenth century midwives were uneducated and without anatomical knowledge.241 She stated that she had “often sate down sad”242 when contemplating what women endured at the hands of midwives with little, if any training or knowledge of anatomy. Because of this she spent much time in her book describing male and female anatomy and physiology.
Describing the blood vessels in the umbilical cord and within the umbilicus at some length, she explained the contemporary view that the blood vessels join those of the mother in the womb. Recognizing that the twisting of the umbilical cord helped protect it from compression, she wrote detailed informative instructions on how and when the cord should be cut following the birth of the baby. Cutting the cord was viewed as helpful as it “keeps the blood and spirits in.” How and when it was done was a measure of a skilled midwife. The time to do it was “so soon as the Child
237 J. Carter, T. Duriez, With Child.
238 O. Browne, The Rotunda Hospital 1745-‐ 1945, E & S Livingstone, Edinburgh, 1947. 239 J. Donnison, Midwives and Medical Men, p. 12.
240 E. Hobby, Ed., The Midwives Book. 241 J. Towler, Midwives in History and Society.
242 J. Sharp, in E. Hobby Ed. The Midwives Book, p. 164; Hobby has simplified some of archaic spelling to make the book more readable.
is born”243 but Sharp acknowledged that the cord is important so the mother can give the baby blood and recommended that the midwife assess whether the baby is strong or weak immediately it was born. If the baby was weak “you must gently put back part of the vital and natural blood into the childs [sic] body by the Navel, for that will refresh a weak child”.244 Sharp had seen this technique revive babies that had seemed to be stillborn.245
Sharp discussed the difference of opinion between midwives and “Physicians” regarding where the cord must be cut (quoting various writers’ opinions and some superstitions linking the length of the cord to the length and size of men’s and women’s reproductive organs). How to “bind the Navel-‐string with a strong ligature” and cut it with something sharp so that it was neat, but not too close to the ligature so that it did not “unloose”246 was explained. Sharp recommended covering the cord stump with a little lint or cotton to keep it warm and discussed some topical applications that could be used. She then gave advice on what to do if the secundine did not come:
Women are in great danger if not more, after the young is born, but beasts are not; the Caule or inward chamber of the womb the child did lye in, stayeth ofttimes long after the child is born, which should presently follow it, and when it so happens, if it begins especially to corrupt as it will soon do, it causes grievous pains and sometimes death, wherefore make haste to drive it forth, but be sure the means you use be very gentle, for the woman is now grown weak and her womb is quick of feeling but the secundine is dead, let the quick then cast forth the dead.
Midwives long nails may do mischief, I grant delays are dangerous, for if it be retain’d until it corrupt, it will cause Feavers, Imposthumes, [Abscesses], Convulsions and such like; know this, that what brings away the birth, will also do good to cast forth the afterbirth; then comfort the woman, let her snuff up a little white Hellebore [winter rose] in powder to make her sneese; but put the woman to as little trouble as you can, for she hath endured pain enough already. 247
Sharp suggested non interventionist techniques to expel the secundine, and betrayed her concerns about the woman’s wellbeing, by asking the midwife to “be very gentle […] comfort the
243 J. Sharp, in E. Hobby Ed. The Midwives Book, p. 102. 244 J. Sharp, in E. Hobby Ed. The Midwives Book, p. 102.
245 Comparison could be made with Midwife Dawn Holland’s experience on p. 233. 246 J. Sharp, in E. Hobby Ed. The Midwives Book, p. 102.
woman […] she hath endured pain enough already”, and warning that “long nails may cause mischief” which they certainly could if used to peel the placenta from the wall of the uterus in a manual removal of the placenta.248
There is no mention of Sharp herself using the technique of manual removal of the placenta, nor the technique of cord traction, and in her discussion about the risks of retained placenta she, interestingly, did not mention haemorrhage, although she did talk about the potential for infection. In book V she discusses the woman’s “purgations” (lochia) and again later, in a list of childbirth complications that can occur, but in relation to bleeding in association with infection rather than primary haemorrhage associated with the birth.249 She considered that retained placenta in “beasts” did not endanger them – but commented that it was different for women.250 Stone’s text consists of case studies with reflective and critical comment and was printed in 1737. It reflects some of the changes taking place in midwifery practices. Stone criticised male practice, asserting that:
almost every young Man, who hath served his Apprenticeship to a Barber-‐Surgeon, immediately sets up for a Man-‐Midwife; altho’ as ignorant, and, indeed, much ignoranter, than the meanest Woman of the Profession.251
Stone described incidences of extremely short umbilical cords [15cm] and their consequences, explaining how to safely deliver the baby. She also recognised and treated uterine inversion. She noted that some women seemed to be at risk of the condition, not necessarily because the practitioner had pulled too hard on the umbilical cord. It seems that putting some tension on the cord was recognised as a legitimate means of birthing the placenta but Stone did not describe her
248 There is a risk of perforating the wall of the uterus during any manual removal of the placenta which would be exacerbated if the operator had long fingernails.
249 J. Sharp, in E. Hobby (Ed.), The Midwives Book, p. 167.
250 Which, of course, raises the question of why is it dangerous for women but was not thought to be as dangerous for animals? This question would seem, even now, in the age of antibiotics, to be worthy of exploration
normal practice, although she did describe manual removal of the placenta in a woman ‘flooding’ after the loss of a twenty-‐two week pregnancy.252
European Midwifery Practice
Late seventeenth and eighteenth century continental European midwifery practice is portrayed in Marland’s annotated translation of the memoirs of the Frisian midwife Catharina Schrader.253 Working as a midwife over many years, mostly in the Friesland town of Dokkum in the Netherlands, Schrader attended her last birth at the age of eighty-‐eight, in 1745. Her work as a midwife from January 1693 until the last birth in February 1745 is described in her memoirs, with added information from the notebooks she used to record the births and the financial aspects of her business. Catharina Schrader’s first husband was a barber-‐surgeon and it seems that from him she learnt various techniques in gynaecological and midwifery care. She differed from many of her colleagues in her ability to use instruments and to treat complicated cases; therefore her practice probably does not mirror that of all her contemporaries as she was often called on for help when the women were in ‘extremis’, which refutes the idea that no midwives were able or allowed to use instruments, at least in Europe.254
Schrader’s births were analysed, and show that at a time when men-‐midwives and surgeons aggressively managed the removal of the placenta, Catharina Schrader did not follow their example. Her notebook yields sixty-‐four cases of manual removal of the placenta, two per cent of the births she attended, even though she attended a high proportion of abnormal births. Kloosterman concludes that in about four per cent of the 3060 births attended by Schrader there were some manual manipulations recorded; leaving ninety-‐five per cent of the births she attended as spontaneous. In his analysis of maternal mortality amongst Schrader’s clientele he concludes that in five cases death “has to be attributed to a severe haemorrhage”, including two deaths from partially retained placentae following the birth of twins, two following total placenta praevia, and one from “loss of blood, together with shock by exhaustion, pain, and neglect”. In
252 S. Stone, A Complete Practice of Midwifery. 253 H. Marland, Mother and Child were Saved. 254H. Marland, Mother and Child were Saved.
this instance Schrader was called only when the woman was at death’s door.255 These are very respectable statistics, especially when we consider that she had skills that caused her to be called upon when other midwives had given up, so the acuity of the cases that she attended could have been closer to that of a surgeon rather than of another midwife.
Man-‐midwifery
There were man-‐midwives, who, although interventionist at times, were supportive of nature. Sir Percivall Willughby “Gentleman”, (1596 – 1685) wrote:
The midwife’s dutie, in a natural birth, is no more than to attend, and wait on, nature, and to receive the child; and, (if need require) to help fetch the afterbirth [...] The afterbirth oft cometh of itself, yet it is not amisse to assist nature for the producing of it. […] There be some midwives, that never offer to fetch the afterbirth, but suffer nature to expell it, and their women have done well.256
Sir Percivall Willughby257 was an example of a seventeenth century barber-‐surgeon turned man-‐ midwife, who began practising midwifery at a time when a surgeon was called after a long labour to remove a dead baby so that the mother would live. According to Wilson,258 this phase, which lasted until about 1720, was not true ‘man-‐midwifery’ as the surgeons usually only saw complicated births. True ‘man-‐midwifery’ came into being with the use of instruments such as the forceps, the fillet, and later, the vectis, methods that could be used to deliver live, rather than dead babies.
At first men were supplementary to the female midwives, who were still seen as the appropriate birth attendants at normal births. But after the 1750s, man-‐midwives such as William Hunter, John Denman and others, sought to be seen differently, as men who attended births “in lieu of a