The Evolution of Midwifery

With a process as natural as childbirth, handy women and midwives were a common feature from the beginning of history. Even without medical training or basic knowledge of anatomy women were present at friends and families birth to help or hinder regardless of nation wide mortality. However from Medieval era there was little distinction between midwifery and witchcraft in dealing with conception, pregnancy and birth until the early twentieth century. Monumental medical discoveries and reforms formed during the nineteenth century began the upward track to lessening mother and child mortality. The term midwife essentially means ‘with-woman’, a person who would attend a woman in labour. For centuries midwifery was a woman’s world with male doctors only attending when there is an issue.

The ancient Greeks and Romans ensured there was not a distinction between male or female scholarship in childbirth. Yet still women had the majority of control in training to be midwives. There are plenty of male writing on the topic including Hippocrates’ et al. Hippocratic Gynaecea, essentially the ‘Diseases of Women’. Hippocrates along with the popular beliefs of the Romans thought that men were the rational half of the species. Women were susceptible to diseases, such as pregnancy, that caused them to be irrational. The Romans created an early professionalization of medicine meaning that births would be attended by a midwife, in the upper classes naturally. In antiquity the role of a midwife or physician earned the person civic rights and privileges within society in terms of money and status and often methods and practises were handed down through the family. Since medicine often coincided with religion, medical schools were held in temples and this had been wide-spread since the Ancient Egyptians. Hospitals in the modern sense did not exist so birth took place in the home of the expectant mother. Artemis was the goddess associated with labour so thanksgiving and offerings to her became the norm, before and after labour. Experimentation was common also since it was believed the womb could move and had to be shifted back during herbs. The womb was thought to be the source of several illnesses in women and there is extensive study around it. The midwife in antiquity followed an expectant mother throughout the pregnancy and was on hand for massages, tinctures and advice. Ancient midwives thought there were three stages in pregnancy: conception, pica (cravings) and labour. Caesarean sections were also practised and some are known to have been successful. This was thought to have been first achieved by the Roman Jewish society yet skill in this era declined during the rise of Christian Rome away from Pagan Rome. The mother would give birth on a birthing stool, a tradition that continued beyond antiquity into the Middle Ages.

Not much changed in how pregnancy was perceived between the Romans and the medieval people. Many doctors and nurses relied upon ancient documentation for childbirth and generally practised medicine. Unlike in antiquity were midwives were respected they achieved a lowering in status beyond the fall of the Roman Empire. Most were from the illiterate masses and did not attend a pregnant woman until she goes into confinement, if she were of the upper classes. The lower classes either had family attend the birth with only the grandmother and married female relatives in attendance, or a midwife that does not cost much to procure her services. The tools of the trade changed from herbal and natural remedies to instruments such as scissors and early scalpels. Medieval midwives carried on the tradition of anointing the pregnant women’s genitals before birth in case of a still-born ensuring the child’s passage to heaven; this comes from Greek pagan practises. There was no organization of midwives, they were trusted purely on the basis of their reputation. They could earn a fair amount if they attend multiple births of one family successfully or serve the royal family. On the other hand, payment was often only received on the condition of a live child, an issue due to the high mortality rates of medieval and early modern women and children. It was more common for a woman to die in childbed despite measures taken to ensure safety. In the upper classes a birthing chamber would be hung with biblical tapestries, the windows kept shut and fires kept alight even in heated summer months. A woman would always give birth at home. A woman would be told not to be active until she was churched as a pregnant woman was considered unclean. She could not leave the birthing chamber until a few months after the birth yet usually the child would have been removed to the nursery long before she left the chamber. It was during the medieval and early modern era that midwifery was held in close contact with witchcraft. As a midwife you would be expected to have knowledge on conception and tools used to get a women with child were often thought to be devils work, specifically if the child was born disfigured. Poor regulations and no consistent training of midwives continued through to the early twentieth century.

From 1900 onwards there was a move towards the medicalization of pregnancy. Many thought that there ought to be proper training and scholarship into childbirth considering the great medical leaps from the mid-eighteenth century. However this was not achieved until 1902 when the first Midwives Act was passed in government meaning that all women had to be attended by a properly trained midwife at birth. The act introduced the Central Board of Midwives, meaning midwives had to be sufficiently trained and certified to practise midwifery. This meant assessment throughout pregnancy; continuous training and regulations were placed for midwifery protocol. Much of the neonatal and antenatal discoveries were done at Edinburgh University. It was here that the first antenatal bed/ward was created nearly 10 years later after antenatal clinics were being opened across the country. Yet there was still the popularity of women giving birth in their homes until the 1960’s when a hospital birth was becoming increasingly common. Hospitals specifically designed for antenatal and neonatal clinics became popular before being submersed into general hospitals.

Midwifery changed quicker in the space of a hundred years then it did for several centuries. Many people wonder whether hospital births are better than home births. The debate and discussion on how best to have child is still ongoing, something that midwives are all keen to stay apart of.

If anyone is interested in midwifery I would recommend Jennifer Worth’s books or look at the Central Board for Midwives website for a full bibliography on the history of midwifery.

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