Making of man-midwifery

Before 1740, give or take a few years, midwifery in England was still, as it had been for centuries, almost entirely a female affair attended by the midwife, and by friends and neighbors, with the exclusion of men. With few exceptions, medical practitioners were called to a birth only in a dire emergency such as the late stages of an obstructed delivery.

In little more than a generation after 1740 the management of childbirth was completely transformed by “the making of man-midwifery.” ¹ A large and rapidly increasing number of women were attended by a medical practitioner rather than a midwife for normal as well as complicated labors, lying-in hospitals and outpatient lying-in charities were established, and courses of instruction in midwifery were widely available to students, and often oversubscribed. Accompanying these changes were enormous advances in the understanding of the anatomy and physiology of childbirth and the nature of obstetric complications.

By the 1770s, “man-midwifery” was firmly established (albeit with reservations or opposition in some quarters) as a part of medical practice. The elite men-midwives or “accoucheurs” who held appointments at London lying-in hospitals were the teachers and the authors of most works on midwifery. Because midwifery is a manual activity involving the use of instruments and operative measures, one would assume that they were surgeons. There were indeed some surgeon-accoucheurs, but the leading surgeons in the mid-eighteenth century, who were busy becoming “pure” surgeons and severing their past connection with the barbers, deliberately rejected man-midwifery, which they saw as an occupation associated with the surgeon-apothecaries from whom they wanted to distance themselves. Because the surgeons were unwilling to practice a branch of medicine that they believed would lower their status, the majority of elite accoucheurs in the eighteenth and nineteenth centuries—the equivalent of consultant obstetricians today—were physicians, and usually members of the Royal College of Physicians.

But man-midwifery was not confined to the elite. By the 1770s it seems that a majority of the surgeon-apothecaries of the towns and villages throughout provincial England had taken to man-midwifery like ducks to water, and actually described themselves as “surgeon-apothecary and man-midwife.”

This, in outline, was the making of man-midwifery. It was a medical revolution if ever there was one, and what is so astonishing is the rapidity and extent of change. At the beginning of the eighteenth century very little was known about the mechanism of normal labor, and still less about the nature of complicated labors. Further, what was known was confined to a few writers—such as François Mauriceau (1637–1709) in Paris, Paul Portal (d. 1703) in Montpellier, Hendrik van Deventer (1652–1729) in The Hague, and Percival Willughby, who worked in Derby, England, during the second half of the seventeenth century. By the 1790s at the latest, the mechanism of normal labor and the nature of all the common complications had been accurately described. Through teaching and the publication of comprehensive texts by men like William Smellie (1697–1763), who is said to have taught more than nine hundred male practitioners in a period of ten years (p. 124), William Hunter (1718–83), and Thomas Denman (1733–1815) it is fair to assume that such knowledge was not confined to the few but was widely dispersed through all ranks of medical practitioners.

The processes by which midwifery was transformed make the eighteenth century the most exciting period in the history of childbirth and one of the hardest to explain. A few historians have looked at bits of this period, but as far as England is concerned, Adrian Wilson is the first to provide us with a wide-ranging and comprehensive analysis of the social, political, and cultural factors involved in the making of man-midwifery, backed up by a sound knowledge of clinical detail.

In the opening sections on the management of childbirth before the 1740s, Wilson suggests that there...