Iona Tytler, studying for an MSc in Gender History at the University of Glasgow, discusses the issues surrounding the medicalisation of childbirth in the eighteenth century.
This was a turning point in medical history which had repercussions on the profession of midwifery and those for whom it provided a livelihood. These issues are: displacement of female midwives, the impact of this change on female midwives, and the societal discussion which took place of the ‘man-midwife.’
William Hunter’s pioneering work ‘The Anatomy of the Human Gravid Uterus’ was published in 1774 and detailed the human uterus at various stages of pregnancy. (GB 247 MS Hunter 658 (Az.1.4)
The item pictured above is one of eleven life-sized plaster casts held by The Hunterian (GLAHM: 125628 – 125636), the casts having been made of dissections of women who died in the final stages of pregnancy.
Hunter’s work was recognised as revolutionary in medical research at the time, as it allowed obstetricians a greater insight into the human body, and historian Samantha Williams argues that it made ‘the invisible world of life visible.’ (Williams, p.86)
William Hunter and the ‘revolution in obstetrics’
The publishing of Hunter’s work came at the time of a great advancement in the spread of medical knowledge surrounding birth and the female body, alongside developments in the medical techniques, and a large number of male students being trained in higher education to bring together these knowledge and techniques. (Williams, p.86)
Consequently, Hunter’s publication was part of a bigger picture, termed as a ‘revolution in obstetrics’- male midwives were becoming more involved in childbirth, and subsequently driving out the traditional female midwife. (Wilson, p.343) New ideas circulated that men were more equipped to cope with childbirth due to their access to higher education, and their involvement in charitable work such as lying-in hospitals. (Wilson, p.343)
The medicalisation of childbirth lead to the displacement of female midwives who were previously commonplace in the eighteenth- century birthing scene. Traditionally, there were many women present at the birth, both in the form of midwives and other female witnesses known as ‘gossips.’ (Wilson, p.344)
It is noted that these female midwives were widely recognised as essential to the birth until the middle of the eighteenth century, having had adequate training, and were trusted. (Fife, p.185) Male midwives were usually only called upon if there were complications with the delivery, but as the eighteenth century went on, they came to be seen as essential to the birth. (Lloyd, p.645, p.657)
But why this sudden break with tradition?
Class, science and technology
This is historically assessed to be due to the large population growth of the era being coupled with the elevation in the social status of the male midwife, which occurred due to their access to higher education but also the pioneering new studies of the female body proffered by William Hunter alongside his brother John. (Fife, p.186)
Being able to afford to hire a male midwife became associated with an individual’s social standing and was used as a class marker, with historian Sheena Sommers highlighting the contrast between the ‘smooth, polite and confident’ male midwife and the ‘traditional, lower class, and uncouth women.’ (Sommers, p.91)
In terms of the new medical knowledge, there came the advent of forceps and their use in birth, which increased the popularity of the male midwives who used them. Male midwives and their forceps had gone from being perceived as an object of terror that implied that there had been complications with the birth, to a symbol of ‘hope’ in difficult births to avoid these complications. (Sommers, p.90, p.91)
It is interesting to note that William Hunter himself cautioned against “excessive” use of forceps. Historian Adrian Wilson argues that their less frequent use helped Hunter’s case, as he was seen as having the superior education of a male midwife, but the comforting presence of a female midwife. (Wilson, p.180)
The Hunterian holds three sets of forceps from Hunter’s original bequest. One such example, W.Hunters 5″, GLAHM: 122961 is seen here and is on display in the Medical History display in the museum. However, the new technology grew to be accepted and was used widely in male midwifery, having garnered a new status.
Male midwives as ‘counsellors and advisors’
It is important to note that midwifery as a practice changed from being primarily concerned with the emotions and feelings of the mothers themselves, to being seen as an elite sphere of education, examination and scientific study, which women were prohibited from on the grounds of their gender. (Williams, p.86)
Although the role which female midwives played in providing an emotional bond between them and the mother was important, male midwives could almost upstage this with their ability to offer emotional support as a ‘stand-in for a husband’ during the birth. (Cody, p.192) This is highlighted in the writings of Hunter himself, where he described that he had been ‘their counsellor and advisor in the moments of their greatest distress,’ and clearly filled this role. (Cody, p.192)
Lastly, an argument put against the use of female midwives in an increasingly medicalised profession was that they were too fragile and sensitive in order to be exposed to this new knowledge, that they had an inability to separate fact and fiction, and that they assessed situations wrongly as their ‘passions led them astray.’ (Sommers, p.95)
It is argued that male midwives were coming to view expectant mothers solely as bodies and objects for medical triumph, that this was exemplified in their writings where there was a lack of discussion of details surrounding the mother or child themselves, but a great deal of information about the birthing process. (Fife, p.186)
Much like the plaster cast of the Gravid Uterus, both the pregnant women and the female midwives were being reduced to the confines of their body and the meanings which their gender held in the society of the time.
This turning of the tide against female midwifery led to a multitude of changes for the stance of their work. Female midwifes encountered a change in their image as they went from being the trusted birthing partner to suffering accusations of ignorance, and that any successes they had in delivering were just luck. (Evenden, p.75, 76)
This change of image was also seen in the print of the time, being the subject of caricatures such as one by popular cartoonist Rowlandson, where they were seen as ‘drunken, blowsy old hags,’ and these ideas of ignorance were once again highlighted. (Berridge, p.185) Also, there was a noted change in their level of employment.
Female midwifes were now having to work for less money, succinctly put by Cody as being reduced to ‘wage labourers under the control of male philanthropists, parish magistrates and doctors.’ (Cody, p.184) Educated midwives were now facing increasing hostility and hardship due to having to compete with the growth of men in the practice, alongside the fact that the expectant mothers who could afford to hire the male midwives who charged considerably more, would, and they would travel for the chance to be treated by them. (Cody, p.190)
It is even seen that many midwives had to take on extra work in order to generate a wage, such as ‘washing and charing.’ (Berridge, p.185) Importantly, female midwives did have a voice in this situation, and they were writing about this reduction in the status of their work.
Changing status of midwives
In their writings they were aware of the problem of richer expectant mothers seeking the male midwife to deliver their child, and that they were blocked from this employment due to the higher education that they could not access. (Allotey, p.534) William Hunter himself recognised that female midwives should be treated with respect, but only mentioned that ‘old and experienced nurses’ should be on the receiving end of this. (Wilson, p.177)
Further to this, when Hunter was teaching lectures to young male midwives, he referred to male midwives simply as ‘midwives,’ and female midwives as ‘women operators,’ which led to them being othered, and separated from the profession. (Wilson, p.175) Female midwives did not have access to the same support networks or education as the men who were training, and were reduced in status at a time when anatomical teaching was seen as the only valid source of knowledge. (Allotey, p.537)
Despite the clear high status attributed to the male midwives at this time, there is also evidence of societal backlash in being a man in this job, with Hunter himself being described as taking great pleasure in being a ‘despised male midwife.’ (University of Glasgow Special Collections) Complaints about their work did appear in newspapers and pamphlets which were widely circulated, with the idea being that this was not work for men, and that by completing it, they were encroaching on the female body, being ‘sexually intrusive.’ (Cody, p.184)
Some even went as far to highlight it as the ‘symptom of a diseased civilisation,’ with one critic Dr John Stevens categorising male midwifery as a ‘noxious weed.’ (Sommers, p.94) A clear visual mocking of male midwives that took place was in the cartoon included in Samuel William Fores’ treatise ‘Man Midwifery Dissected,’ drawn by Isaac Cruikshanks and published in 1793, which depicts the male midwife as straddling two worlds, showing the contrast between the medicalised world of forceps and the idea of a traditional home birth. (British Library)
Despite this stance of some in society at the time, it has been recognised that Scottish male midwives were helping to win over those in England about the positive contributions that these male midwives were making in society, helping bridge the divide between England and Scotland after the union of 1707 through their medical and charity work. (Cody, p.197)
On a personal level, Hunter was known for his positive work with women, in a way which almost harks back to the emotional connection female midwives had with their expectant mothers, highlighting a bond of trust. He helped a woman conceal a fake miscarriage from her husband, and was sympathetic towards unmarried mothers, having recommended the pregnant daughter of a well-known peer a foundling hospital, and was part of the campaign against infanticide. At the time, mothers could still be tried for stillborn births. (Wilson, p.180)
Uncovering hidden pasts
Overall, this was clearly a time of upheaval, for both the medical community and for gendered notions of care. The increasing medicalisation pushed women out of roles, and this negatively impacted their livelihood. Male medical knowledge came to be prioritised over the traditional female knowledge, when women were physically barred from achieving education of the same standard.
There was societal disapproval of both male and female midwives, as female midwives were seen as uninformed due to the link of their role in birth with emotions, but in male care emotions were not widely considered at all, with this medicalisation being linked with the view of expectant mothers primarily as objects of medical attention and experiment.
However, an important aspect is also the positive associations between men and midwifery, and the wider societal implications which these had. With the illustrations in Hunter’s work ‘The Anatomy of the Human Gravid Uterus’ and the related plaster casts being so relevant to this masculinisation and medicalisation of midwifery, it highlights that museum objects often have a hidden past to be uncovered.
The Gravid Uterus is a symbol of pioneering medical discovery, but also highlights a deeper issue of gendered attitudes in society at this time.
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