‘The baby gained weight rapidly. It did ever so well and when it should have been born, it was a normal birth weight and then Mary’s milk went! It weighed seven and a half pounds and the milk dried up!
‘Mary was a young, single girl. She had a boyfriend who lived there with them. And they got married before the time was up that the baby had to be registered … and she went along and she was “churched” [reference to ‘the Churching of Women’, a Christian service of thanksgiving and ‘purification’ for women who have recently given birth].
‘Of course, she had been keeping quiet about being pregnant because she was going to look after her sister, Edna, who was expecting her own baby in ten weeks time. So then we had Edna…! They were a very nice family. The baby grew up – he’s had seven lives! He was at the motor pump the other day, when we were getting filled up, and his hair’s white!
‘But that was a feat really! That really was a most remarkable feat: to rear that baby under those circumstances, because they hadn’t anything really, had they, Kath?’ [Margaret A.]
Clearly, the experience of birth in pre-NHS days presented both women and attendants with enormous challenges. Most women gave birth at home and there were surprisingly few fatalities, given the circumstances.
11
Midwifery Practice in pre-NHS days: ‘the tricks of the trade’
‘Nature is the best way but you can aid it.’
As we have seen in the last chapter, in pre-NHS days midwives were the sole practitioners at most births, including breeches and twins. Up until the late 1940s, most babies were born at home.1 In the Yorkshire mining town where Mary W. worked, 90 per cent of the births still took place at home when she retired in 1968:
‘I still think there’s a lot to be said for home deliveries you know. You’re so much more relaxed at home. I think on the whole they were happier at home.’
Most of the material in this chapter emerged from discussions we had about what we would do in certain midwifery situations. This was often a two-way process, with all of us equally interested in comparing notes. The midwives spoke about their work with awe-inspiring confidence and many of them were disparaging about what they saw as a lack of patience and a loss of skill in present-day midwifery. Elsie K. voices a common opinion:
‘They didn’t have so many caesars [Caesarean sections] then. One of my friends wrote to me last week of how her daughter had had a baby and they’d done a caesar because it was a face presentation – well, I’ve delivered a face presentation without any need for a caesar. They do caesars very easily these days. They’ve lost the old skills; they’re more slapdash today.’
As discussed in Chapter 3, until the 1936 Midwives Act made it mandatory for local supervising authorities to provide a salaried midwifery service, most midwives were on call 24 hours a day with little, if any, ‘off duty’. This system may have been exhausting for the midwives, but it did mean that most women benefited from total continuity of care from their midwife. Until well into the 1930s, however, the focus of midwifery care was on labour, birth and postnatal visiting, rather than on the antenatal period.
Antenatal care
The concept of preventative antenatal care was one that grew slowly in Britain and was applied variably until well after the Maternal and Child Welfare Act of 1918 encouraged local authorities to set up antenatal clinics. In the first decades of the century, midwives tended to visit the woman at home in early pregnancy to make arrangements for the birth, but thereafter, would only see her if an obvious problem arose in the pregnancy. In such a case, the woman would be referred to a doctor. Sissy S. from Deptford, has no memory of receiving antenatal care during her pregnancies in the 1920s and 1930s, although she remembered some contemporary advice:
‘If you was anaemic, you was advised to take a bottle of stout or Guinness. But sometimes the nurse would send you to the doctor to get a tonic.’
Mollie T. describes another, somewhat curious, initiative that was set up in an attempt to combat anaemia:
‘I think the reason for the low haemoglobins in the locality was in the industrial activity, and the women had a strong reluctance to taking iron. Iron really did upset them. In this area [Bermondsey] they were so undernourished that one of the jobs the midwife used to do was to deliver egg custards to try and get concentrated protein into them. She probably baked them in the health centre or hospital kitchen, if not at home. The early training schools included a course and examination in cookery for this reason. The problems of looking after these patients hinged very much on nourishment.’
Whatever methods were employed, in 1934 the Central Midwives Board Rules stated that the midwife should:
‘make as sure as is humanly possible that no complications occur that can be foreseen and/or prevented and that no early signs of disordered function escape undetected.’2
Despite the ruling of the Central Midwives Board, antenatal care was often not given high priority. Pregnancy was still seen as a normal process that did not need much attention. Mary W. explains:
‘Antenatal care was patchy. It was left to the midwife a great deal, and you were on you own and too overworked to do it properly. I used to try to keep to a pattern, but of course, if you got a delivery, the antenatal used to be pushed aside. But we always tried to get them in. You palpated [felt the woman’s abdomen to determine the baby’s position, size and development] and did urine tests – that’s about all. I think we got sphygs [sphygmomanometers] to do blood pressures in about ‘37. Some people objected to the antenatal examination. Some of them were very coy, even with the midwife. Some people thought antenatal care was all a lot of fuss.’
Preparation of the room
We gained the impression from our research that whereas antenatal care was often non-existent or given low priority in the 1920s and 1930s, a great deal of emphasis was placed on preparing the room and the linen for labour. This is understandable if we consider conditions such as those in the Yorkshire mining villages described by Mary W.:
‘You would tell the woman to have clean things and her bed ready, and plenty of newspaper and brown paper. And you spread it around the room, particularly round the bed. They also had to provide a mackintosh – we had a mackintosh that we could take if the woman couldn’t afford one. You had to be very careful with people’s belongings to see that they weren’t spoiled.
‘It was much easier once they got bathrooms. When I first started in ‘32, there was no pithead baths and quite a lot of the men didn’t bath every day because there was this old wives’ tale that bathing too much wasn’t good for your back. And you’d often find half of the bed black. It was hard work for women with all the coal dust everywhere. It got everywhere. The men came home in their pit things and the women had to wash them. And then all these baby clothes, woollens and long white gowns. Terrible! No wonder they died young you know – so much work to do!’
Complicated domestic arrangements were necessary for home births. Edie M. recalls her experiences in London in the 1920s:
‘It was quite a performance. You had to get the room ready with enough things. A nice piece of blanket, three or four nice sheets and fresh curtains. Everything had to be ready: buckets and bowls, spotlessly clean and some way of getting plenty of hot water. And two of everything for your baby. They used to wear body bands and vests – we dressed them different to what they do today. We’d have a penny ready to put over the navel and then bind it round. Terry towelling nappies. If you were very poor you’d only have six but I always had twelve. The reason you needed such a lot was that everything was washing in them days. No throwaway nothing, no tissues or anything. Everything was wash, wash, wash.
‘You had your brown paper on top of the mattress, then your blanket, then your sheet – right till the end of your confinement. Then you’d take them out, burn the afterbirth in the grate and someone would make the midwife a nice cup of tea after she done her job.’
Early labour
One midwife described g
iving quinine to start labours but others said they avoided any sort of induction of labour other than ‘the occasional dose of castor oil if the woman was getting fed up with waiting’. Nellie H. had strong views about this:
‘No, I didn’t ever start them off, however long overdue they went. I don’t think babies are overdue, myself. I used to wait till they started on their own. I think it’s more natural.’
Once a woman was in labour, the midwife would usually administer an enema and shave her pubic hair – practices that were only phased out in the 1980s after research showed them to be unnecessary and distressing. Elsie K. describes the process:
‘We always gave them enemas, unless it was too late. We used the Higginson’s syringe to give enemas long before the tube and funnel. The ball was about as big as your fist and it had a piece of tubing and a nozzle, and then a rubber catheter on the end. You squeezed the ball – green soap, it was. We used to shave the mums, too, not on the district in the very old days but in the hospitals. After about ‘37 they all had shaves. Its all gone out now, hasn’t it? Well, I hope so; I don’t think it’s necessary.’
The progress of labour
Today, women consider themselves lucky if they have met the midwife who attends them in labour, and luckier still if she/he is someone who they have got to know during pregnancy; who will support them throughout their labour; and who will visit them during the early weeks after they have given birth. Induction of labour, routine ‘risk management’ procedures; and the use of technology to monitor and accelerate the progress of labour have remained highly contested practices in recent decades. The culture of contemporary maternity care is in sharp contrast to that in which midwives practised in the first half of the twentieth century. This was particularly apparent when we asked the retired midwives to tell us how they assessed the progress of labour. Elsie K. echoed the scorn expressed by many of the midwives regarding today’s practice of carrying out frequent vaginal examinations to assess progress:
‘We did them sometimes in labour if we felt it was required, but very, very seldom. We got into the habit of realising how the labour was progressing without a vaginal. It was quite easy really when you were watching the patient. I think it’s a pity to do unnecessary internals. They shouldn’t really be necessary in normal cases if you’re keeping an eye on the patient. I think people rely too much on that and too little on their own observations. It can’t be pleasant having internal examinations.’
Margaret A. explains further:
‘Somehow or other you know, as you became more experienced, you could just look at the patient’s face and say, “She’s about two or three fingers [dilated]”, or, “She’s coming on”. You could tell by the look on her face, not always by the number of pains she’s having. You never got two alike. Some patients are terribly bad patients, they’re terribly, terribly bad. You know … they lose control and scream and carry on, and others are so relaxed and calm and quiet. But then some have a higher pain threshold than others don’t they, so you can’t ever be sure of how far on they are. If I could possibly stay with a patient in labour then I’d stay with them, all night if necessary. But if I was going to have to leave a patient in labour for any length of time I would always do a vaginal examination to see what was happening. If she was three or four centimetres [dilated] or more, I wouldn’t go. If the labour went on for hours and hours we’d do an examination to find out why, but otherwise not.’
Similarly, Esther S. would only do a vaginal examination in an emergency:
‘… such as an obvious delay or if I felt the baby’s heart was fluctuating – I wanted to know the reason, if it was hung up in any way … Sometimes I’d rupture the membranes but you didn’t do it ad lib. Because I think it’s a good thing to have them intact. In fact, sometimes you found that if they had their membranes ruptured, they had a longer delivery. Usually they don’t go till it’s coming up to second stage. Then you carry on and you get a better sort of pushing then, don’t you, a different sort of pushing.’
On reading Alice Gregory’s midwifery textbook, in which she describes the preparation considered necessary before doing a vaginal examination – sterile gloves were not in use until after 1937 – one can understand that a midwife might think twice before subjecting her hands to such a rigorous procedure:
‘However necessary vaginal examinations may be, they must not be undertaken without plenty of time, and soap and water. A quarter of an hour is the least time that can be allotted for this purpose. For the preliminary bathing, three minutes’ scrub of your hands, and one minute’s scrub in perchloride of mercury, 1 in 1,000. After the bathing, change the water; and in a full basin of clean hot water, five minutes’ scrub; then a three-minute soak, and one is ready. If you have not enough time for these processes, so much the better – you have evidently not enough time to examine and the labour must be advancing rapidly.’3
In order to be convinced that a woman was getting near to the second stage of labour, handywoman Mrs G. would have to see what she describes as ‘a linking pain’. Midwives today might describe such a change in the nature of the contractions as signs of ‘Transition’ (transition from the first stage of labour, which is concerned with the dilating of the cervix, to the expulsive contractions of the second stage):
‘I used to press their stomachs sometimes when they said there’s a pain there. And I used to say, “Well, how long have you had that pain, how long in between?” Perhaps it’s an hour; perhaps it’s half an hour? I’d say, “Ooh, you’ve got lots more to go through first.” I’d say, “You really must have a linking pain before you have the baby – a linking pain.” Now that’s got you guessing [laughs]! A linking pain – they might call it something else now – but you have a pain and just as it’s going, it comes back, you see. And then, of course, when they have a second sort of pain with the linking pain, then soon the head starts to show. I don’t know whether they call it a “linking pain” these days, do they? No, I don’t suppose you’ve heard of it. Always have to have that linking pain. You had a double one. Just as one’s going, you get another one – ooh – and it comes again.’
Today, we measure dilatation of the cervix in centimetres. Previously, midwives talked about how many ‘fingers’ apart the cervix was. Alice Gregory, in her book, uses the coinage of the day to describe dilatation:
‘“Os from sixpence to a shilling” … “Os a half-crown” … “Os has reached four shillings” … and finally the exquisitively painful stage of “lip all round”, or “edge of a teacup”, as some people call it. This is the moment when a bath is a perfect godsend and I know few things which are pleasanter to do. One had to perform so many disagreeable treatments of sorts, that to drive away, or at any rate lessen, these horrible pains for half an hour and to see the patient go to sleep with her head on your knee, is really a very great pleasure.’4
Long labours
Water immersion has long been recognised for its soothing potential to help women cope with pain in labour. Esther S. extolled the value of baths when women are having particularly long or difficult labours:
‘I might give her another hot bath. I think that helps – you can’t really quicken it up I don’t think … Nature is its only best way, but you can aid. I used to rub her back because the contractions there were more severe with a posterior position [the baby lying on its back, rather than the more straightforward position of lying with its back towards the mother’s abdomen]. They get more backache with the posteriors, don’t they; very, very, painful, I believe, from what they say.
‘And well, I just have to keep on trying to encourage her and tell her that some people do have slower labours – to see if you could put her mind at ease as well. Also, see her diet is kept up with food and drinks. They get very dehydrated if not – a very important factor. And see they empty their bladders, which is another important thing. Then you can see if there’s dehydration as well [by noting the concentration of the urine].’
Lou N. gives
the impression that she was in control of what happened during her labours. She describes some interesting techniques for coping with a long, ‘back-ache labour’.
‘When you had it at home, you tied a towel round the end of your bed, then you twisted it and you pulled on it, ‘cause you feel that’s what you want to do. [Groans] How these women want their husbands with ‘em, I don’t know! Blimey, I never wanted mine about the place. I just had the midwife and the woman that came in. The first one, Tommy, I had three days labour with him. Ooh! [Grimaces] I started on the Saturday and I didn’t have him ‘till Wednesday. Blimey, he weighed 9lbs something. Oyey, he really went to town!
‘I was married in 1931 and I had him ten months later. When I was in labour I couldn’t sit still. I was moving about – I only sat down when I had to, not otherwise. Because all my pains wasn’t in the stomach, they was in the back. If you were longwinded you were made to drink castor oil. Yeah, but I got the winkle of that afterwards – you put orange juice in first and then a tiny drop of orange juice on top [of a layer of castor oil], and that was it. It speeded you up!
‘When I was having Joan, the old lady that was with me sent out for a great big jug of eels! She thought I had to eat hot eels during the labour. But me, all the time I’m in there you can guess what I do – I talk, all the way through it. I talk and talk, and then when a pain come on I held on till the pain went and then I start talking again. Well, as you can guess, I’ve got a bad habit of talking, [laughter].’
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