Sunday, December 16, 2012

A brief history of Midwifery

Portrait of Mme Annabel Tatsu.

(Paris, 1775 - 1821, Paris)(Paris, 1775 - 1821, Paris)
From an unpublished work: Author unknown - Circa 1992

Midwives date back to references in the old testement (Genesis 24).

In Egypt midwives jealously guarded the secrets of their profession - therefore very little of practical value was handed down in writing.

In ancient Greece midwives were required by law to have had children themselves.

The "Sloan Manuscript No. 2463" was one of the earliest works on midwiferey.

Echarius Roesslin (Frankfurt) published “Rosegarten” a guide for midwives and physicians.

In the 1500s, childbirth was viewed as one of the “diseases of women”.

One of the first schools for midwives was in the early 16 century at the Hotel-Dieu, Paris. The first woman to write a text on midwifery was Louise Bourgeois (1563 - 1636). She was the wife of an army surgeon.

Maubray gave criteria for requirements of a midwife - not fat, considerate, grave, patient, pleasant and follows advice.

Edmund Chapman (1680-1756) the second public teacher (after Maubray), who wrote:
“ ... one of the most noble ... operations ... requires judgment for there is generally one and often two lives snatched from the jaws of death ...”.

William Giffard published “Cases of Midwifery”, surgeon and man-midwife, which gave accounts of practical experiences, including the use of forceps. There were also district advances around this time.

William Smellie (1698-1763) believed to be a single individual with most profound effect on midwifery. Around 1735 recorded the use of forceps in France. 1742 and Smellie became an instructor of midwifery. His published works include:

1751 A treastie on the theory an practice of midwifery
1754 A collection of cases and observations in midwifery
1764 A collection of peternatural cases and observations in midwifery.

Sir Richard Manningham (1690-1759) established General Lying-in Hospital and later, Queen Charlotte’s Hospital. Previously he had supplied beds in a rented house next door to his own house. he taught by using a manikin.

During the 18th century midwifery became respectable as a profession for men, due to William Hunter (1718-83). Before the end of the 18th century there were six or seven maternity hospitals as well as maternity wards attached to General hospitals.

Also around this time Alexander Gordon (1752-99), of Aberdeen (Scotland), made the discovery that it was Doctors and Midwives that actually carried infection from one patient to another and declared that if the patient’s clothing and bed linen were burned and Midwives and Doctors carefully washed themselves, changed their clothing and fumigated the infected clothing, this would contain infection. Many doctors and Midwives took exception to this advice.

The history of Midwifery has been a long struggle between firstly, a male dominated priesthood and, subsequently a system of organised medicine also controlled by men, and a women’s community-based network of helping and healing.

In the 19th century the rising middle classes came to prefer obstetric care to the traditional care from midwives. Right through the century, however, the poor had recourse to midwifery amongst the working class. There was a resistance to attempt to organise midwifery and make it a profession in case it affected the lucrative middle class doctor’s pracises.

Augustus Granville - founder of the Obstetrical Society of London said that women were “unsuited by nature for all scientific mechanical employment”.

Several medical schools and colleges added midwifery to the curriculum.

Royal College of Physicians and Surgeons award diplomas in midwifery for the first time. Many obstitricians believed they would never receive rightful status and many were still untrained.

Nightingale Ward, King’s College Hospital opened to train nurses in midwifery.

First Health Visitors were appointed by Manchester and Salford Ladies Health Society. The aim was to popularise sanitary knowledge in the home.

Midwives institute (later became the Royal College of Midwives) was founded and began arguing for increased and better training.

Buckingham County Council appointed three ‘Lady Missionaries’ to go into the community and give instruction on child welfare and hygiene. This was based on Florence Nightingale’s views.

Midwives Act becomes law. Midwifery became an established profession in Britain. Midwives had to undergo supervised training and registration.

At the turn of the century there was very littel antenatal care of the pregnant woman. A woman was rarely examined until labour was underway. Although she was given information about general health, diet, clothing etc.

Compulsory notification of births. There was also the appointment of a lot more Health Visitors as Medical Officers of Heatlh. They were essential in teaching the proper feeding and care of children. Improvements in living standards of families with young children were sought.

Newly established Ministry of Health and the Board of Education made conditions for the training and appointment of Health Visitors.

The National Service Act opened a new chapter in the history of public health. Here was the promise of a comprehensive medical service for the whole population. It was a service that provided a new look not merely at the hospitals, private practitioners and dentists, but nurses, midwives and health visitors. Also in 1946 a working party was appointed to consider the position of general nurse training. Its report was revolutionary and highly contriversal. A year later a similiar report was appointed to consider the recruitment and training of midwives. Its report was less arresting but some of its recommendations proved acceptable to the ministry.

For those who wanted to go further than the rest a new conception of nurse training had been evolved as a result of collaboration between Hammersmith Hospital, Battersea College of Technology and the Queen’s Institute. This was a four year integrated course of nurse education.

Teachers of Nursing Act - allowed qualified teachers who were also registered nurses to be admitted to the register of nurse tutors. A pilot study for new midwifery training course was set up. It replaced the previous two part courses by about 1970.

In mid 1975 training was offered at 116 schools. The course lasted for one year for RSN and RSCN and eighteen months for enrolled nurses and two years for those without previous training.

The number of midwives was reported to be 16,550. The training and practice is controlled by the Central Midwives Board on behalf of the Government.

Contraception became an inegral part of the NHS and contraceptive treatment, advice and supplies now available to women irrespective of age or marital status.

The Nurses, Midwives and Health Visitors Acts of 1979 and 1992 established the UKCC and the four National Boards to regulate nursing, midwifery and health visiting professions.

Three statutory bodies controlled the practice, education and training of midwives prior to the handover of functions to the new statutory bodies on 1st July 1983. They were:
  • The Central Midwives Board.
  • The Central Midwives Board for Scotland.
  • The Northern Ireland Council for Nurses and Midwives.
The strategy for Nursing produced the first major changes in nurse and midwifery education for over fourty years. Project 2000, and the implemention of a new career structure for nurses, midwives and health visitors which would reward clinical skills they acquired in relation to the responsibilities they take. It concentrates on five main issues.
  1. Nursing practice.
  2. Manpower.
  3. Education.
  4. Leadership.
  5. Management.
and was formulated to assist the professions in meeting changes in helath and health care.

White paper Working for patients. There were three other key policy initiatives
  • Caring for people (1989)
  • Health of the Nation (1992)
  • Patient’s charter (1991)
The Midwives Rules, UKCC.1992:The scope of Pprofessional practice, UKCC. The code of conduct for the nurse, midwife and health visitor, UKCC.


Clader J M 1954 The story of nursing Methuen, London.

DoH 1993 A vision for the future HMSO, London.

Kitzinger S 1988 Midwife challenge London.

Radcliffe W 1967 Milestones in midwifery Wright.

Stocks M A hundred years of district nursing.

UKCC 1992 The scope of professional practice UKCC, London.

UKCC 1992 The code of conduct for the nurse, midwife and health visitor UKCC, London.

UKCC 1992 A guide for students of nursing and midwifery UCKK, London.

Read more: A brief history of Midwifery

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