What began as a review of my latest read has turned into a trip down a little known rabbit hole of our history. Conspiracy and propaganda resulting in a deception spanning generations that has a significant effect on the lives of modern women.
Just how does an entire profession go from highly respected and trusted members of the community to being compared with prostitution?
Farewell to the East End by Jennifer Worth
Overall I found the book even more riveting than the first two. It’s an excellent read and I highly recommend it.
But I found myself distracted by what I know to be historical inaccuracies referenced in the book, clearly wholeheartedly believed by the author. That is, despite her frequent observances of evidence to the contrary.
So I went down the internet rabbit hole and did some investigating of my own . . .
Slatternly Midwives
Just like in the first book Jennifer Worth references the appallingly high maternal death rate prior to the regulation and formal training of midwives in 1902.
In this book she references a specific figure of 25 – 30% maternal mortality rate in the poorest areas. She states that this figure is estimated by the “pioneers calling for registration of midwives”.
As explained in my review of the second book, the Shadows of the Workhouse. In reality the pre 1900 maternal mortality rate ranged from 0.6 to 0.3%. Source – https://ourworldindata.org/maternal-mortality.
Just like in the first and second books Jennifer Worth describes the approximately 40,000 unregistered midwives as slatternly. She uses this word repeatedly. It’s an unusual adjective.
SLATTERNLY
adjective DATED
dirty and untidy (typically used of a woman or her appearance).”a slatternly housekeeper”
Oxford English Dictionary
Whilst the formal definition is given as above there is also an extended definition as follows:
Definition of slatternly
1: untidy and dirty through habitual neglect also: CARELESS, DISORDERLY
2: of, relating to, or characteristic of a slut or prostitute
https://www.merriam-webster.com/dictionary/slatternly
The use of the specific word slatternly doesn’t just bring to mind an unkept and dirty woman but also a spiritually unclean immoral woman.
The exact wording is frequently used, almost like a slogan. It is also not the first time I have heard it used to describe midwives from prior to the 20th century.
The availible evidence simply doesn’t support the use of the word slatternly to describe early midwives. Nor does it support the idea that they presented a danger to their patients.
To my mind the repeated use of this specific wording from difference sources (Jennifer Worth being one of them) suggests that they have a common source. I find myself wondering who that was. Who told Jennifer Worth that older midwives were “Slatterns” who put their patients lives at risk?
Licencing Prior to 1902
Contrary to the book, from around the year 1500 midwives were required to have a licence. Like much of the regulation in history it was provided by the church. She had to pay a fee, pass exams and provide references from medical practitioners, clergy and satisfied customers.
After all that she would then have to appear before a Bishop accompanied by her satisfied customers and obtain his approval. Then she would swear an oath much like the medical practitioners of today. Having satisfied all these conditions she would then be granted a licence to practice medicine.
It is worth noting that there was no special licence for midwifery, they were required to have the same licence as other medical practitioners. However, only midwives were required to provide testimonials from clients. This was considered evidence of her “fitness to practice”.
It strikes me as a significant mark of respect that the men issuing the licences accepted that they had no knowledge of midwifery and so asked the opinion of the women who had received treatment. I find myself wondering how often such a courtesy is extended today.
no pson within the Citie of London nor within vii myles of the same take upon hym to excise and occupie as a Phisicion [or Surgion] except he be first examined approved and admitted by the Bisshop of London or by the Dean of Poules.
outside London no person should practise ‘as a physician or surgeon, in any diocese within this realm but if first he be examined and approved by the bishop of the same diocese.
1511 Act concerning Phesicians and Surgeons
It is generally accepted that the church’s interest in the regulation of Midwives had more to do with licencing them to perform baptisms upon babies who were unlikely to survive until a priest could arrive, then in regulating their medical practices.
But the point remains that midwives prior to 1900 were indeed regulated and licenced.
Informal Regulation
Just as today women didn’t give birth alone. A woman’s own mother would usually be present along with a number of other family members, friends and neighbours.
Similar to today these birth attendants were chosen from women who had experienced childbirth themselves. They didn’t just offer practical assistance such as helping with housework and childcare but they actively assisted with the birth itself.
Their presence ensured that any malpractice on the part of the midwife would be witnessed and reported.
In addition to any consequences from official justice the slightest misdemeanour from the midwife would be the subject of gossip. Gossip will spread quickly and enough of it would damage a midwife’s reputation. Without a good reputation she would not be able to continue her practice.
Therefore midwives were effectively regulated by their own communities.
In fact I came across a reference that indicated that this exact scenario was the origin of the very word “gossip”.
Training
It follows common sense that midwives were drawn from birth attendants who showed a particular affinity for the role.
In place of formal training they assisted the existing midwife in the way of an apprentice. Only after she had gained enough experience would a new midwife be trusted by her clients to perform her work unsupervised.
Crucially only an experienced and competent midwife would be accepted by the community.
This effectively made training and experience compulsory for a midwife to practice.
Again the image of the untrained “slatternly” midwife just doesn’t fit with the society of the day.
Respect for Midwives
Prior to the 19th century midwives were treated with the upmost respect. Not just in their communities as described in the Call the Midwife books but they were considered to be upstanding citizens, called upon to testify in courts upon “women’s matters”.
During their work in the community they were trusted to enforce the law. For example they were instrumental in ensuring that an unwanted baby was not smothered. It was part of their duty to identify the father of the baby when an unmarried mother gave birth.
They worked alongside doctors when necessary. As well as calling upon the assistance of each other. A skilled midwife would be in demand far beyond the bounds of her own parish.
So What Changed?
How did a highly respected professional role become so contemptable as to be described as slatternly?
Licensing of midwifery by the church became almost obsolete during the 1700’s.
The first laying in hospital was established in 1739. For the first time in history midwives were not regulated by their patients but by doctors.
As with their predecessors, the independent midwives, the laying in hospitals were responsible for identifying the father responsible for babies born to unmarried mothers. The regulations regarding laying in hospitals were more concerned with alleviating the burden on the state of illegitimate children than of protecting the health of mothers and their babies.
1773: An Act for the better Regulation of lying-in hospitals, and other places, appropriated for the charitable reception of pregnant women; and also to provide for the settlement of bastard children, born in such hospitals and places.
https://journals.sagepub.com/doi/full/10.1177/0968533220976174
1852 brought about the formation of the London Obstetrical Society.
It took another 50 years to bring about the formal registration and licensing of midwives. Many, many acts were brought before parliament only to be withdrawn or rejected.
The issue wasn’t weather midwives SHOULD be licenced and regulated, this was agreed upon. There was some debate about which governing body should be held responsible for this licensing and registration.
But the main point of contention was that by licensing midwives they were being granted legitimacy as a medical proffessional.
It was argued that a woman was not intellectually capable of acquiring the nesseccary knowledge and skill to perform in a medical capacity.
In order to support this fallacy the competence of independent midwives was called into question. Despite numerous allegations there wasn’t actually any evidence of incompetence being widespread among independent midwives.
And so the male doctors took to slandering the characters of their competitors in order to discredit them.
Licencing from 1902
When the licensing did eventually come about obtaining a licence had more to do with a woman’s social standing than her skill or experience. A few months of training was all that was necessary.
As is always the case with new regulations, it was impossible to train enough people all at once. And so experienced professionals who have been practicing unlicensed are often granted the licence after meeting certain conditions.
A Work of Fiction
I propose that the incompetent, slatternly midwife is nothing more than a work of fiction. Invented by the “pioneers calling for the registration of midwives” and their early obstetric colleagues for the sole purpose of discrediting their competitors, the independent midwives.
Whilst it is certainly true that early midwives did not have access to modern obstetric procedures such as caesareans. There are also many conditions that they would be powerless to diagnose or treat resulting in death for mother and / or baby. This would also apply to trained and registered midwives who would also be without the benefits of the same modern obstetric procedures.
Most of the obstetric treatment practiced today is entirely preventative. For example today large or breech babies are delivered by caesarean section as a standard procedure. A competent midwife is capable of managing all of these scenarios with a high probability of survival for both mother and baby. Such scenarios are often described in the Call the Midwife Books.
Therefore it is highly unlikely that the untrained and unregistered midwife had a negative effect on the chances of survival of mother or baby compared with the chances of survival were a modern midwife present.
Why the Slander?
I find myself asking why? Why were midwives discredited? And why is the slander so widely believed to this very day even by those in the profession?
Medical Practitioners
I suspect that early midwives were not just midwives but providers of more general medical treatment.
Most cultures had some form of ordinary medical practitioner such as a Sharman or Witch Doctor. Such figures are often dismissed by modern medicine, they are described as providing treatment based more on ritual than medicine. And yet even today we are still learning that many of their practices had sound scientific basis. For example certain herbs have medicinal uses that are now recognised.
In the days before modern medicine was accessible to the masses surely these figures were an important part of life for the majority of working class people. And yet there is little mention of them in the history of western culture.
Where did normal people turn when they were ill or injured? They couldn’t possibly afford a doctor, these would have been reserved exclusively for the upper classes. It’s certainly possible that some families were so poor they couldn’t afford help of any sort. But surely the majority would be able to find some money for some medical assistance. I’d certainly go hungry to pay for treatment for my sick child, I can’t believe that the mothers of 200 years ago were any different in that respect.
Even today midwives still work closely with health visitors and nurses. Jennifer Worth for example, frequently describes fulfilling all three roles, often in a single day. And even in 2021 nursing is still seen as predominately female role with the overwhelming majority of nurses still being female, even more so for midwives.
Before modern medicine was accessible to the masses nursing was practiced by the lady of the house. In fact treatment of minor ailments was commonly considered to be part of good housewifely practice. It seems reasonable to conclude that these mothers and housewives would turn to their local midwife / nurse for advice on medical matters. Just like the modern mothers of today turn to their midwives and health visitors for advice of dealing with nappy rash or colic etc.
Of course historically medicine was provided by women. Most common complaints relate to children, the sole domain of their mother. Of course she would turn to another woman, what man would know how to treat nappy rash for example. Of course she would turn to another woman regarding “women’s issues”, what man would know the first thing about easing period cramps. And so of course, when her husband couldn’t shake a cough she would turn again to the same woman. Having established a high degree of trust in her.
The result of course being that the doctors were threatened by these women. And so they discredited them with slanderous insinuations.
The Church
It’s interesting to note that those doctors also had the support of the church.
Infant mortality was terrifyingly high in past times. Unlike inflated the maternal mortality rates, this is no myth. My own grandmother buried 20% of her children and that was with access to rudimentary modern medicine such as antibiotics. I dread to think how high it would have been without even this.
I couldn’t help looking it up, 46.2% of children died before the age of 15. 26.9% of babies died in their first year. (https://ourworldindata.org/child-mortality#mortality-in-the-past-around-half-died-as-children)
Yikes!!
With religion being such an important part of everyday life it makes perfect sense that midwives were licenced by the church to perform baptisms on new born babies that were not likley to survive until a priest could arrive. In fact this religious licencing further discredits the concept that midwives were disrespectable women as well as the fiction that there were unlicensed or untrained.
Wow, the power of propaganda.
In 1604, James I, at a conference addressing reforms of the Church of England, declared that he would ‘rather his child was baptised by an ape as by a woman’ and expressed his fear that the custom of midwives baptising dying infants was a cover for witches to steal the bodies of dead infants for satanic rituals.
https://journals.sagepub.com/doi/full/10.1177/0968533220976174
King James’ comment sheds shocking light on the attitudes of the day towards midwives. Even this early on there was a distinct connection made between midwives and witches.
I suspect that in addition to providing services at birth and of course during pregnancy just like modern midwives, the midwives of history also provided advice and treatment to prevent and terminate pregnancies.
It was they who informed and empowered women to abstain at particular points during their cycle. In the days when understanding of women’s bodies was so limited and a husbands rights were considered to be paramount, it is conceivable that an individual advising a wife to refuse her husband would be the recipient of his wrath as well as the contempt of wider society.
And of course the issue of termination is not to be ignored. Whilst unreliable and dangerous terminating a pregnancy was possible prior to modern medicine. I wonder how many midwives were accused of murdering a desperate young girl or her unborn baby? Or later blamed for her infertility? How many men reported this to the church? It doesn’t take much imagination to conclude the likley consequences of such accusations, especially as they will have been rooted in fact.
In Conclusion
And so there you have it a collaboration of church and modern doctors that resulted in the widespread deformation of the characters of midwives throughout history. Hundreds of thousands of imaginary deaths they are supposedly responsible for.
A conspiracy so widely believed that even today most people will tell you that childbirth is dangerous without modern medical intervention.
A misguided belief that has shaped modern maternity care and still governs the laws of far too many modern western countries.
All thanks to the overwhelming power of propaganda.
Summary
Wow that was a long post. Here’s the quick version:
Throughout history midwives are repeatedly referred to as “Slatternly” meaning slut. They are blamed for terrifyingly high maternal death rates.
In reality the maternal death rate was only a tiny fraction of what it is generally believed to be. Midwives were formally licenced, regulated and trained. They were highly respected members of society.
Until modern doctors got involved and created the myth of the incompetent and dangerous midwife. They did this by slandering their character as there is no actual evidence of widespread malpractice.
I suspect this is because doctors were threatened by the trust most people placed in the medical expertise of their local midwife.
The church strongly supported the doctor’s accusations as they wished to prevent midwives from offering women rudimentary birth control.
Despite the evidence to the contrary, the slander continues to this day.
I’ve delayed publishing this blog post because I wasn’t too sure how it would be received. It’s just my uneducated lay person’s opinion which flies in the face of widely accepted “fact”. I’m hesitant to share those opinions knowing that they contradict those of more highly qualified people such as Jennifer Worth for example.
However I have eventually decided to publish this blog post because it is an issue which occupied much of my mind while I was reading the book and for some time afterwards. And after all the main point of this blog is for me to record and preserve the day to day that is my life.
I do hope my thoughts encourage you to question and to search for the facts underneath the story you are told.
A Little Bit About Me . . .
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