Changing childbirth through the decades
When writing the first edition of The Midwife’s Tale we found early twentieth century documents describing heated debates about the respective roles of midwives and doctors, in particular, the role of midwives in protecting and promoting normal birth. Almost a century later, these debates continue. The role of the midwife is no longer predominantly based in the community; most midwives practise in, what has been described as, a ‘technocratic culture’,12 where the majority of women give birth in hospital and around a quarter of them (or more) will have a Caesarean section. The imperative for midwives to promote normal birth is more pressing than ever, as identified on the website of the Royal College of Midwives ‘Campaign for Normal Birth’ (www.rcmnormalbirth.org.com):
‘Together we can change the way childbirth happens. The Campaign aims to inspire and support normal birth practice. It’s a reminder that good birth experiences can happen despite the challenges. Intervention and caesarean shouldn’t be the first choice – they should be the last.’
We ended the Introduction to the first edition of The Midwife’s Tale with a reminder that most midwives share with their predecessors a passion for the work we do and a commitment to improving the services offered to childbearing women. For us, that passion and commitment continues to be expressed in our academic writing: the importance of promoting a positive experience for all childbearing women through engaging in the ‘emotion work’ of midwifery13 and adopting ‘woman centred’ principles.14 We continue to identify with the spirit of early midwifery campaigners in their efforts to highlight the important role midwives can play in the lives of childbearing women and their families. In all of these efforts, the stories we gathered of women’s and midwives’ lives in pre-NHS Britain have had a profound influence on us both, as midwives and as women. Mavis Kirkham offers an explanation:
‘A story tells more than its tale. It speaks of context and of values. Listeners absorb the story through a web of their own view of the world and by links with their own stories … Stories reveal important aspects of midwives’ work and their careful examination may open up new dimensions in which we can usefully be with women.’15
The stories that we have shared in this book continue to inspire us; we trust they will do the same for all new readers and those who, like us, will enjoy re-reading this new edition of The Midwife’s Tale.
Nicky Leap and Billie Hunter
March 2013
Introduction Original (1993) Edition
In the 1990s in Britain, midwifery is a profession open to women of all social classes and backgrounds, but this has not always been the case. In the early part of this century the profession was restricted to women who could afford the training, in terms of both money and opportunity. A successful campaign to professionalise midwifery was in operation, spearheaded by socially influential, aristocratic and middle-class women whose aim was to build a new profession for women and eradicate the practice of the working-class lay midwife – the ‘handywoman’.
The campaigners asserted that professional midwifery would reduce the appalling rate of infant and maternal deaths. As the testimonies in this book reveal, another pregnancy was often something to be dreaded at a time when poverty imposed a lifetime of struggle and hardship for so many people.
The authors of this book are also both midwives. We have used original interviews and secondary research to weave together vivid, often moving stories of midwives, handywomen and the women they attended in the days before the National Health Service. Although the experience of childbirth could be harrowing for both mother and midwife, the strength and tenacity of the women involved shines out in their accounts of their lives and experiences.
The book begins by looking at the evolution of the profession of midwifery and the demise of the handywoman. This is followed by an exploration of the lives of handywomen as remembered by their children, by the mothers they attended and by the professional midwives who succeeded them.
It is rare to find a handywoman alive today in Britain. They tended to be elderly when they were practising at the beginning of the century, and their traditional skills – midwifery, laying out the dead and tending the sick – faded into extinction as such tasks became institutionalised within a state-run health service. It was, therefore, an unexpected privilege to find Mrs G., a 95-year-old handywoman who was prepared to talk to us and describe her working life.
Next, the book explores the training and working lives of the new professional midwives who took the place of the handywomen. Most worked ‘on the district’ in an age when the majority of babies were born at home. They saw midwifery as a vocation and describe the dedication that was necessary when they were on call 24 hours a day with little, if any, off-duty time. In the words of Dr Janet Campbell, Senior Medical Officer at the Ministry of Health throughout the 1920s:
‘The work of a busy midwife is very hard, holidays and off-duty times are difficult to secure, the responsibility is exceptionally grave, the remuneration comparatively small. Midwifery, more than any other branch of nursing, unquestionably taxes to the utmost professional skill and judgement, physical capacity and endurance, patience and sympathy.’ [Report on the Physical Welfare of Mothers and Children, England and Wales 1923].
Subsequent chapters of the book explore the context within which midwives worked during this era. In particular, the lack of sex-related information and women’s low expectations of sexuality are explored. Women describe a time when contraception was unavailable for the vast majority, abortion was a common method of fertility control, and single parenthood often meant social isolation.
Women also talk about how their work, whether paid or in the home, affected their physical and emotional health. Working-class women recall lives of drudgery and exhaustion, where each pregnancy brought increasing poverty and the possibility of bereavement. The situation was not to improve until the Second World War, when concern for the state of the nation’s health brought about a new system of welfare benefits. This led to a dramatic reduction in both infant and maternal mortality figures. During the war, midwives had to adapt their practice to cope with the disruption of evacuation and air-raids. They describe how everyone ‘rallied round’, and how they saw themselves as the mainstay of the community while the men were at the front.
The book concludes with mothers’ and midwives’ accounts of their experiences of birth. Midwives describe the details of their practice at a time when they were able to offer complete continuity of care and utilise all of their skills. In the postscript, three quotations pay tribute to the tenacity and courage of many women who gave birth in the first half of this century, and to the midwives who attended them.
As can be seen in the chapter entitled Methodology, we had somewhat romantic expectations about our midwifery heritage when we set out to research this book. We expected to uncover a treasure chest of forgotten skills: experiences that would enhance midwifery practice and inspire the midwives of today.
Disappointed by the rigid and authoritarian attitudes that often accompanied the professionalisation of midwifery, we decided that the key to reclaiming the art of midwifery must lie with the much-maligned and persecuted handywoman. Again, we were disappointed. Women described equally disturbing experiences of being at the mercy of authoritarian behaviour from handywomen. There were also accounts that highlighted meddlesome, even dangerous practices, that sometimes took place in the absence of education, where there was limited access to information about the basic anatomy and physiology of childbirth.
The word ‘midwife’ is derived from the Old English mid wyf, meaning ‘with woman’. Increasingly, it became clear that the roots of building a new woman-centred midwifery do not necessarily lie in our recent past. However, over the years that it has taken for this book to evolve, our own attitudes towards the midwives and handywomen who worked in the first half of this century have changed and softened. As we gained more insight into the context of their lives and t
imes, we began to appreciate the extraordinary achievements of these women in the face of severe restrictions imposed by the politics of gender, class and poverty.
The concept of woman-led midwifery care has been developed in recent years within a culture that acknowledges certain egalitarian principles that were unheard of in the early 1900s. However, today’s midwives share with their predecessors a passion for the work we do. Many of us will identify with the spirit of early midwifery campaigners. The ideology and language may have changed, but our motivation is common – the commitment to improving the services offered to childbearing women.
Nicky Leap and Billie Hunter
London, December 1992
Who’s Who: midwives, mothers and other contributors
Midwives who we interviewed
Bronwen H.
Born 1897
Bronwen H. grew up in Swansea, South Wales, and, apart from her midwifery training in London in 1921, she spent all her working life there. The third of six children, she trained as a nurse in 1919. She worked as a district nurse/midwife in the docklands area of Swansea. She gave up this work after marrying the local GP, since it was not considered ‘proper’ for the doctor’s wife to continue in such a job.
We interviewed her in 1985 and 1987.
Edie B.
Born 1894
The eldest of eight children in a working-class family, Edie B. trained as a midwife in Newcastle in 1921. She moved south to Lambeth, where she worked in a maternity home for 50 years.
We interviewed her in 1985.
Elizabeth C.
Born 1905 in Eire.
Elizabeth C. came from a working-class background and trained in Bradford in the 1930s. She worked as a district midwife in Battersea for many years and was known as ‘Auntie Betty’ to her clients.
We interviewed her in 1986.
Elsie B.
Born 1906.
Elsie B. trained as a midwife (direct entry) in 1929 in Plymouth. She was a district midwife in rural Devon for the County Council all her working life.
We interviewed her in 1985.
Elsie K.
Born 1904 in a Lancashire town.
Daughter of a congregational minister and a teacher, Elsie K. trained as a midwife in 1935 in Derby. She worked mostly in hospitals but also undertook some private cases with wealthy families, ‘living in’ before and after the birth. She later became a midwife tutor.
We interviewed her in 1986.
Esther S.
Born 1916 in Portsmouth.
Deprived of educational opportunities in her schooling, Esther S. was able to train first as a nurse and then as a midwife during the war. Apart from an initial spell in a small maternity hospital, Esther S. worked as a district midwife in the working-class area where she grew up. She continued to work as a district midwife after having children.
We interviewed her in 1985 and 1992.
Florence W.
Born 1909.
Daughter of a handywoman, Florence W. grew up in impoverished conditions in Great Yarmouth. She was ‘rescued’ by the Salvation Army, who trained her in nursing and midwifery in the early 1930s. She worked in various Salvation Army hospitals and homes for unmarried mothers and their babies and was promoted to the rank of Brigadier.
We interviewed her in 1987.
Josephine M.
Born 1906 in Sligo, Eire.
Josephine M. came to England in 1906 and continued to live there. In 1928 she trained as a nurse, followed by midwifery training in London. Initially, she worked in a small maternity home in West London, but then worked on the district in various London boroughs.
We interviewed her in 1986 when she was still doing ‘monthly nursing’ [living-in postnatal care] for wealthy London families.
Katherine L. and Margaret A.
Sisters who were born into a middle-class family in Bromley, Kent, Katherine L. and Margaret A. defied family pressure by taking up nursing and, later, midwifery. They eventually worked together as district nurse/midwives in a small Essex town.
We interviewed them in 1985.
Mary W.
Born 1908 in a Yorkshire mining village.
Mary W., a miner’s daughter, trained as a midwife in 1931 and returned to the Yorkshire village where she grew up in order to practise as an independent midwife. After 1936, she was employed by the Local Authority and continued to practise in the same village all her working life (37 years), including after she married a winder at the pit and after she had a child. She retired in 1968, having attended the births of 2,002 babies.
We interviewed her in 1986.
Mollie T.
Born 1923 in Bombay, India.
A retired midwifery tutor from a middle-class background, Molly T. worked in London teaching hospitals, ‘on the district’ for local authorities and in provincial hospitals.
We interviewed her in 1982.
Nellie H.
Born 1889 in a Kent village.
Nellie H. trained as a midwife in 1926. She then went to an Essex seaside town to run a private nursing home with her sister Rose. They lived together until Rose died in 1973. Apart from running evacuation programmes for pregnant women during the war, her midwifery career was spent in private nursing homes.
We interviewed her in 1985.
Mothers who we interviewed
Alice F.
Born 1903 in Dulwich, South London.
Alice’s father was a surveyor and her mother’s family had a hotel in the English ‘home counties’. They were a well-off, middle-class family. She had one son by Caesarean section in 1937.
We interviewed her in 1986.
Edie M.
Born 1902 in London.
Edie came from a working-class home. Her father was a market-stall holder and her mother was in service. She married in 1920 and had five babies between 1920 and 1935. Two of them died in early infancy. Edie had various jobs throughout her life, including washing-up, waitressing, cooking and factory work.
We interviewed her in 1986.
Hannah H.
Born 1901 in London.
Born into a Jewish East End family, Hannah was one of three children. Her father was a tailor’s cutter and her mother was a home dressmaker. They were reasonably wealthy, lived in West Hampstead, and had a maid. Hannah left school at 14, went into office work, and later worked for an estate agent. Her husband was a tailor and she had two babies in 1928 and 1937.
We interviewed her in 1986.
Ivy D.
Born 1904 in South-east London.
Ivy lived all her life in South-east London. She had four children between 1927 and 1946. Her husband was in the building trade and she owned and ran several shops including a florist’s. Later, she and her husband bought and ran a country club in the suburbs of London.
We interviewed her in 1992.
Jane W.
Born 1902 in Bermondsey, South London.
Jane was one of 14 children and her father was a tanner. Her mother, a laundress, died when she was four, and Jane was brought up by an aunt. In 1923, she married a clerical worker and had two babies, one in 1924 and the other during the war. She worked as a machinist with the Army and Navy Territorial Outfitters.
We interviewed her in 1986.
Lou N.
Born 1912 in the Angel, London.
Lou’s parents separated and she was brought up by a ‘Mrs Amos’. She married in 1931. Her first child, a boy, was born in 1931 and died when he was nine months old. Between 1934 and 1942 she had three daughters. Her various jobs included being a coil-winder, French polisher, brush-maker and office cleaner.
We interviewed her in 1986.
Ruby C.
Born 1900 in Belfast, Northern Ireland.
Ruby’s father was an engineer; her mother was a court dressmaker. She married a policeman in 1917, and between 1918 and 1924 she had four babies, all born at home in Ireland.
We interviewed her in 1984.
Sissy S.
&
nbsp; Born 1906 in Deptford, South-east London.
Sissy S. had four babies in the 1930s, all with midwife Elsie Walkerdine in attendance.
We interviewed her in 1986.
Vera W.
Born 1903 in Hartlepool, County Durham.
Vera came from a middle-class family. Both her father and her husband were in the building trade. She was one of three children and the family emigrated to Australia in 1909, returning in 1920. She was married in 1934 and had one child by Caesarean section in 1936.
We interviewed her in 1986.
Other contributors
Alice W.
Born 1884.
A handywoman who lived in Great Yarmouth, Alice W. had 13 children, three of whom died. Her story is told by her son, Ken, in Chapter 2.
Elsie Walkerdine
Born 1892.
Elsie Walkerdine attended the births of over 4,000 babies in Deptford, South-east London. Until 1937 she worked independently and thereafter for the London County Council. Elsie’s mother died soon after she was born. She was brought up by an uncle and aunt who doted on her and saved up for her midwifery training. Before this, Elsie was a needlewoman – ‘sewing rich people’s cloaks’. She retired in 1957 and is remembered here through the reminiscences of Mary T. and Sissy S.
Granny Anderson
A handywoman in Tyneside, remembered by Molly B. and Lily N.
Ken W.
Born 1925.
Ken was Florence W’s brother and a nurse. He lived near Reading, and he and his wife had four children. Ken related memories of growing up in Great Yarmouth, where his mother, Alice W, was a handywoman.
We interviewed him in 1987.
Lily N. and Molly B.
Born 1919 and 1921.
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