English midwives' responses to the medicalisation of childbirth (1671-1795)

This paper principally concerns the examination of four English midwifery treatises written by midwives between 1671 and 1795. It focuses on their responses to the medicalisation of childbirth and, in particular, their concerns about medical negligence and their views on the value of anatomical knowledge to the development and defence of their practice. They wrote during a period of mounting tension between midwives and men midwives, when even the most inexperienced men automatically assumed authority over traditional midwives. The texts reveal the authors' concerns about the harm being caused to women and infants by the indiscriminate use of birth instruments. Examples in the primary sources suggest that the practice of both types of midwife ranged from excellent to lethal. However, the midwife-authors perceived men midwives as a threat: unjustly denigrating traditional practice and rapidly carving niches for themselves in midwifery by attending wealthy and influential families, using their birth instruments to intervene and deliver women, sometimes on dubious grounds, and by publishing substantive texts which further promoted their usefulness to society. Foreseeing a medical takeover, the midwife-authors aimed to encourage midwives to be more effective in managing minor difficulties themselves, to avoid families calling in medical aid unnecessarily. They also highlighted the need for more formal education for midwives including basic anatomical knowledge, so they might better defend their practice against a medical attack in a laudable manner. Although the context of practice is quite different today, it will be briefly argued that some of the concerns of the midwife-authors practising in the 18th Century resonate with contemporary concerns about aspects of medicalisation and their insidious effects on women and infants, such as the rising caesarean section rate (Churchill et al., 2006). (C) 2010 Elsevier Ltd. All rights reserved.