Monday, 30 November -0001

The oldest profession in the world...and no it's not what you're thinking

Women have always helped each other give birth – and their stories of life, and death, are truly remarkable, says Sarah Chalmers…

Written by Sarah Chalmers
Without a trace of self-pity or angst, Hannah Jeffcott noted simply that Mrs Roberts's son had been delivered: 'Under Meats Getting Up Rooms'. At the time, 1870, the perfunctory description of one of the 3,290 births midwife Hannah attended warranted little elaboration.

Yet today, more than a century later, her reminiscences of a career spanning 32 years, ending in her 70s, offer an intriguing snapshot into life as an often overworked, usually unlicensed yet nonetheless essential midwife. The Getting Up Rooms she refers to would have been lace-finishing rooms, suggesting that Hannah had not even had time to leave her day job as a lace worker, before being called upon by a work colleague to deliver her baby.

In the 1800s, childbirth was not the medical procedure it is today and only the wealthy could afford doctors. Most of the female population relied on experienced mothers – sometimes called midwives, sometimes 'handywomen' – in the community to guide them through childbirth. These women were poorly paid and often accorded little status.

Hannah charged just two or three shillings per birth and had to supplement her midwifery takings with shifts in a lace factory. Others offered alternative therapies as a sideline to make ends meet. A Mrs Goodman advertised her services in a Nottingham trade directory of 1848 as 'midwife and dealer in leeches'.

Both women's stories are told in an exhibition at the Lakeside Arts Centre in Nottingham, running until 15 April, entitled Mothers And Midwives. The exhibition comes just as the nation is hooked on the BBC dramatisation of Jennifer Worth's memoirs, Call The Midwife.

baby-poster

From time immemorial women have helped one another in childbirth and when rural life declined and more and more people moved to towns and cities, the 'local woman' who helped deliver babies was categorised as a professional midwife, a skill often passed from mother to daughter. The Parliamentary Rolls of 1469 mention a yearly pension paid to the midwife of Elizabeth, Edward IV's queen.

By the 1700s the role received greater publicity, with the introduction of forceps and the move of men into this once female domain. Advances in science made rudimentary gynaecology a more interesting field for university-educated men to study and doctors found childbirth a way of securing future profi ts. 'If present at a birth it was a way of inveigling themselves into the whole family and hopefully becoming that family's GP,' says Dr Tania McIntosh, co-creator of the Lakeside exhibition and author of the forthcoming A Social History Of Maternity And Childbirth.

For the midwives, meanwhile, their work still focused almost entirely around labour – there was little or no antenatal or postnatal care. Even trying to predict when a child might be born was far from simple. For undernourished young women, and those who became pregnant quickly after the birth of another child, missed periods were not uncommon.

'Often women only realised they were pregnant when they felt the baby move,' says Dr McIntosh. Not only that, but science and a midwife's crude equipment could not even determine if an unborn infant was alive or dead – or indeed might be twins. In 1847 Hannah Jeffcott records an unexpected twin birth: 'two daughters to Mrs Mee, born an hour apart'.

But even with their limited scientific knowledge, the 19th-century midwife remained the fulcrum of her community, delivering three-quarters of all babies born.

hostpitalNottingham Hospital for Women, opened 1929

In 1881 three educated midwives, aided by philanthropist Louisa Hubbard, set up the Trained Midwives Registration Society – the forerunner of the Royal College Of Midwives – to formalise training and registration. Until then the profession had been licensed only by the church, and was derided by many men. An article of 1842 in The Lancet was typical of the public mood, stating: 'The women of England are wholly deficient both in the moral and physical organisation necessary for performing the duties of that most responsible office.' It took until 1902 and an act of parliament to introduce a national regulatory authority, The Central Midwives Board, and a three month training period.

The midwife's biggest challenge in the 20th century was the move away from home births to hospital. As more became understood about the process of childbirth, male doctors formed the view that hospital was a safer environment. Expectant mothers also favoured it.

'Midwives didn't carry any analgesia, so if you wanted pain relief you could only get it in a hospital. And in the days of large families and overcrowding, going there to give birth, where you remained for 10 days, free of charge after the advent of the National Health Service, was often the only break most women got from domestic drudgery,' says Dr McIntosh.

The other major advance was of course the ready availability of contraception, the Pill in particular. Jennifer Worth wrote that in the 1950s she had 80-100 deliveries a month on her books, but by 1963 that number had dropped to four or five a month. Over time, midwifery training also increased from a period of three months to three years to incorporate scientific advances and the practitioner's expanded role, which included antenatal and postnatal provision.

Today, fashions are turning full circle and groups like the National Childbirth Trust are campaigning for home births to be more readily available. Yet for all the changes the profession has undergone, midwives in Britain still deliver three-quarters of all babies born. And the crucial relationship between mother and midwife remains central to the very beginning of all life.

Mothers And Midwives is at Lakeside Arts Centre, Nottingham, until 15 April: www.lakesidearts.org.uk

Call The Midwife by Jennifer Worth is published by Orion, price £7.99.



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