Birth: a changing scene. Part II: A controversial figure of man-midwife

Is it a man? Is it a woman?

No, it is a man-midwife, a figure that stirred much controversy upon its arrival on the British soil in the beginning of the 18th century.

Carciature of a man-midwife as a split figure. Wellcome Images no.L0018481.

The alleged hermaphroditism of a man-midwife, as portrayed in this caricature by Scottish illustrator Isaac Cruikshank (for a 1793 pamphlet against man-midwifery), was a commentary on the fact that from around second half of the 17th century medical men—both physicians and surgeons—have been encroaching on an area of medicine traditionally controlled by women: normal childbirth. Moving beyond assisting only at difficult births, men started to argue that they make the best midwives. No matter what scientific explanations these ‘man-midwives’ provided to support their ways of delivering babies, the general public had its reservations. For many, a man assisting a birth progressing without complications was a freak of nature with ambiguous genitals and/or sexuality.

In the history of medicine the trend of men taking over traditional midwives’ role is referred to as “obstetric revolution”. Some scholars say this revolution wouldn’t have happened without two ‘F’s: fashion and forceps. In the times of the crystallisation of English ‘middling classes’, it was fashionable for families aspiring to higher social status to have male practitioners attend births. Doctors charged a substantially higher fee than midwives and so learned men’s authority helped show off family wealth. Interestingly enough, women too poor to afford even a female midwife were often delivered by the same doctors: from the 1740s, Lying-in Hospitals were established as institutions for delivering poor and destitute married women. They became centres for teaching obstetrics and midwifery to (mostly male) students.

Doctors in the avant-garde of obstetric revolution did not take over female midwives’ toil empty-handed.

They were aided by a path-breaking invention of forceps, or rather its coming into mass use in the 18th century. Invented by the French surgeons family of Chamberlens already in the 17th century, the instrument was kept secret for almost 100 years. Forceps allowed to extract alive baby from mother’s womb in difficult (other than head-first) presentations. Before that, in such cases the dead foetus was retrieved from the womb partially by means of hooks and crochets while Caesarian sections took place after mother’s death in hope of saving the foetus.

The use of instruments initially widened the gap between male and female practitioners: at first women, considered not technical savvy enough, were banned from using forceps.

Forceps. From a collection of engravings representing the most modern and approved instruments used in the practice of surgery. By J.H. Savigny, London 1798.
Wellcome Images L0033040

Both experienced midwives and man-midwives took pride in using instruments as rarely as possible. For example, Scottish physician and obstetrician William Hunter was cautioning against their indiscriminate use and took pride in his forceps being rusty. Sarah Stone, a practising midwife and author of a 1737 manual A complete practice of midwifery, consisting of numerous case studies, wrote how in her extensive practice she used the forceps only four times and how “out of 20 women delivered with instruments, 19 could do without.”

More opportunist man-midwives made forceps their trademark. Laurence Sterne portrayed such practitioner, one Dr Burton of York, in the character of Dr Slop in his epic The Life and Opinions of Tristram Shandy, Gentleman (1759-1767).

Dr. Slop with his wig on fire angrily gesticulating to Susannah who holds her nose near the wounded baby Tristram Shandy. Coloured etching after H.W. Bunbury after L. Sterne. Wellcome Images V0011226

In the coloured etching (after H.W. Bunbury) above, Dr Slop, on applying his favourite instrument, breaks the bridge of a nose of a newborn baby Tristram, meeting with an outrage of chambermaid Susannah. This event influences the whole of Tristram’s life as one of his father’s pet theories was that a large and attractive nose is important to a man making his way in life. In Sterne’s book the French word accoucher is used for the first time in English to signify a “male midwife”.

A woman giving birth aided by a surgeon who fumbles beneath
Wellcome Images V0014919

The presence of men in birth chamber was frowned upon also for modesty reasons, like in this engraving (left), showing a doctor “fumbling under the sheets to save the lady from embarrassment”. Percival Willughby, the author of a 17th century casebook Observations in Midwifery, mentions various tricks male doctors had to resort to not to compromise woman’s dignity, like crawling on all fours under the bed.

Some man-midwives were seen as predators seducing innocent young wives to whom they had apparently unrestricted access. In the engraving from 1773 (below), a man–midwife ‘suggestively’ examines a pregnant woman to her husband’s visible discontent.

The Wellcome Library holds a 1741 pamphlet The tryal between J. G. Biker, plaintiff; and M. Morley, doctor of physic, defendant for criminal conversation with the plaintiff’s wife, describing an affair Dr Morley, practicing “in that way of man-midwifery”, had with Katherine Biker, a young woman prone to miscarriages whom he treated.