The Perceptions of Pregnancy blog, like the Researchers’ Network, aims to reach beyond boundaries and borders, and to facilitate an international and interdisciplinary conversation on pregnancy and its associated bodily and emotional experiences from the medieval to the modern. Today’s post on complaints against midwives in the nineteenth century is contributed by historian Megan Webber.

On the afternoon of 31 December 1804 —as an old year died away— Elizabeth Edwards struggled to bring forth new life into her humble London lodgings. Respectable but poor, Mrs. Edwards was a beneficiary of an outpatient maternity charity, the Lying-In Charity. This entitled her to the assistance of a charity midwife and, with the onset of her labour pains, she sent her husband running for Mrs. Turnley. When Mr. Edwards got to the midwife’s house, he found that she was busy, but she assured him that “she would come presently.” She did not arrive soon enough, however, and Mr. Edwards was dispatched a second time. Mrs. Turnley made her appearance soon afterwards and delivered a baby within an hour. The Edwards family later complained to the charity that Mrs. Turnley had been “much in liquor” and had injured the new mother.[1]

As its full name suggests, the Lying-In Charity for Attending and Delivering Poor Married Women at Their Own Habitations was established in 1757 to provide domiciliary care to expectant mothers.[2] It was the first and largest of London’s outpatient maternity charities. By 1804, its district encompassed much of the metropolis and its staff consisted of twenty-six midwives and four physicians.[3] Mrs. Edwards was one of 4335 women the charity claimed to have delivered in 1804.[4]

A committee of male governors managed the charity. Proceedings of the committee’s monthly board meetings were recorded in minute books, now kept in the archives of the Royal College of Obstetricians and Gynecologists. Each patient attended two board meetings. The first occasion was when she applied for assistance a month before delivery. If her application was successful, she was assigned to a midwife who would attend her during childbirth and make several postpartum visits. Physicians intervened only if complications arose. After childbirth, the patient made her second appearance before the governors to “give thanks” for benefits received. The “giving thanks” ceremony was more than a display of gratitude; it also offered patients the chance to air their grievances. Numerous complaints recorded in the minutes provide fascinating insight into the experiences of charity midwives and patients in early nineteenth-century London.

Many of the complaints suggest there was some truth behind contemporary criticisms of midwives as unskilled, drunk, and unfeeling.[5] Mrs. Turnley fit this description. In 1816, she was accused of “using very prophane Language” when summoned to a birth. She arrived drunk and stayed with the labouring woman for only half-an-hour before she allegedly “shoved [the woman’s] Landlady backwards… went out… and fell down in the street.”[6] Mrs. Turnley was the subject of no fewer than seven complaints between 1804 and her dismissal in 1818. A majority of complaints to the Lying-In Charity involved a minority of midwives. While a handful of midwives was disciplined repeatedly, some midwives never came under scrutiny, indicating that they provided a good service.

Midwives had heavy workloads. If the charity’s 4335 deliveries in 1804 are averaged out amongst the twenty-six midwives, each midwife was responsible for 167 patients. This figure does not take into account the fact that many midwives worked for several outpatient charities concurrently, in addition to taking private patients. Mary Tungate, a midwife employed by four charities, estimated in 1826 that she had up to 200 or more cases every year.[7] To put this into some perspective, in 2011, the Royal College of Midwives recommended a ratio of one midwife for every twenty-eight births (see: www.bbc.co.uk/news/uk-14239022). It is little wonder that families frequently protested that midwives had been unavailable, late, or rushed because they had been attending other patients.

Charity patients competed against private patients for midwives’ attention. Midwives often preferred the latter because they paid better and involved less paperwork than charity cases. Taking advantage of emergency situations, some midwifes demanded “gratuities” from charity patients before they would assist (strictly prohibited under charity rules). Mrs. Turnley tried this, telling one patient that “she had but two shillings and sixpence for every Woman she delivered, and that… it [was] hard to come so many times for half a crown.”[8] Some midwives were disciplined for refusing to attend charity patients.   It was not uncommon for women to give birth without medical assistance after several midwives had been applied to without success.[9]

The governors launched enquiries into almost all complaints recorded in the minute books.[10] They interviewed patients and staff. Disgruntled patients often brought family members and neighbours who had been present during the alleged incident to the board meeting. These witnesses supported the woman’s testimony. Where there was insufficient evidence of misconduct or where midwives had good reason for not attending a patient, the governors frequently dismissed complaints. In other cases —including that of Mrs. Edwards— midwives were reprimanded and warned that a repetition of the offence would have severe consequences. The committee also handed out fines and, in extreme cases, dismissed midwives.

It is difficult for the historian, whose only evidence is the minute books, to judge whether the punishment fit the crime. Certainly, patients, too, could behave badly. The governors worried that some patients invented stories to settle personal scores with midwives or to secure monetary compensation. Nevertheless, some patients certainly felt that they had been treated unfairly. Patients frequently enlisted the support of wealthy charity subscribers (donators) if an initial enquiry had not been concluded to their satisfaction. With the charity’s income and reputation on the line, the governors acted quickly to resolve matters.

The complaints in the minute books reveal that some midwives conformed to the Sairey Gamp stereotype, while others were responsible employees who struggled to cope with intense demands on their time. Patients like Mrs. Edwards, although sometimes left helpless in the birthing room, assertively sought redress.

About the Author:

Megan Webber is a doctoral student in history at the University of Hertfordshire. Her dissertation examines how poor Londoners interacted with a variety of early nineteenth-century charities. Megan is grateful for the support of the Commonwealth Scholarship Commission in the United Kingdom.

 

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[1]                 Royal Maternity Charity minute book (S60/A/7), February 23, 1804.

[2]           The charity adopted the catchier title of the Royal Maternity Charity in 1824.

[3]                 Account of the Lying-In Charity for Delivering Poor Married Women at Their Own Habitations. Instituted 1757 (London: S. Gosnell, 1804), 26-27.

[4]                 The Times, April 12, 1805.

[5]                See, for example, Augustus Bozzi Granville, A Report of the Practice of Midwifery, Practiced at the Westminster General Dispensary, during 1818… (London: Burgess and Hill, 1819), 202-203.

[6]           Royal Maternity Charity minute book (S60/A/7), October 31, 1816.

[7]           The Medical Evidence Relative to the Duration of Human Pregnancy, as Given in the Gardner Peerage Cause… (London: Burgess and Hill, 1826), 96; 102.

[8]                 Royal Maternity Charity minute book (S60/A/7), February 23, 1804.

[9]                 Royal Maternity Charity minute book (S60/A/7), March 29, 1804.

[10]               It is possible that some complaints were simply dismissed by the committee and not recorded in the minute books.