Midwives, Society and Childbirth

Debates and Controversies in the Modern Period

Hilary Marland, Anne Marie Rafferty

• Publisher: Routledge
• Year: 2002
• Topic: History
• eBook ISBN:
  9781134785995
• Subtopic: World History
• Index: History

Midwives, Society and Childbirth is the first book to examine midwives' lives and work in the nineteenth and twentieth centuries on a national and international scale. Focusing on six countries from Europe, the approach is interdisciplinary with the studies written by a diverse team of social, medical and midwifery historians, sociologists, and those with experience in delivering childbirth services. Questioning for the first time many conventional historical assumptions, this book is fundamental to a better understanding of the effect on midwives of the unprecedented progress of science in general and obstetric science in particular from the late nineteenth century. The contributors challenge the traditional bleak picture of midwives' decline in the face of institutional obstetrics, medical technology, and the growing power of the medical profession, while stressing the importance of regional influences and locality. Dr Anne Marie Rafferty, Philadelphia, Dr Hilary Marland, Erasmus Universiteit Rotterdam, Dr Irvine Louden, Oxfordshire, Joan Mottram, Wellcome Unit for the History of Medic

1
ESTABLISHING THE SCOPE OF PRACTICE

Organizing European midwifery in the inter-war years 1919–1938

Anne Thompson

‘The midwives’ story, like that of all women, is filtered through a distorted glass of words’¹ Achterberg’s generalization of early midwife practice is arguably even more pertinent to the events surrounding the emergence of midwifery as a profession in the early decades of this century than to the period she describes. Midwifery in many European countries (Britain excepted) had a long history of formal education, licensing, organization and control.² Despite all this, the decades leading up to the inter-war period saw midwives grappling with the problem of establishing a public image, a professional identity for themselves which would once and for all give the lie to the old stereotypes of handywomen and Sairey Gamps, to win them parity with other, newer, women’s occupational groups.³

It has been claimed that the status of midwives reflects the status of women in society. This chapter does not permit any in-depth exploration of this assertion, but it is worth acknowledging from the outset that the midwives’ struggle for recognition and status within various European countries took place against the backdrop of vigorous efforts to renegotiate the place and role of women in society as a whole.⁴ The midwife’s professional standing was uneven, just as the level of women’s emancipation and occupational organization was uneven across the different countries of Europe. The last decades of the nineteenth century and the first decades of this saw irreversible social changes for women. Midwives had either actively to engage in this process of change, or, very probably, face extinction.

Within this context, the story of the birth of the International Midwives’ Union (IMU) is to a great extent the account of how a small and scattered body of women used the processes of professional organization to develop strategies to convert the threat of near-extinction into the opportunity for public recognition of midwifery’s potential to make a unique contribution to the wellbeing of mothers and babies. A number of efforts had been made to organize midwives internationally before the First World War, notably the congress in Berlin in 1900 which brought together over 1,000 midwives from Denmark, Holland, Rumania, Russia, Switzerland, Sweden, Austria and Hungary.⁵ Other meetings were held, in Scandinavia, Italy and again in Germany, but no lasting structure emerged. A congress planned for Vienna in 1914 had to be cancelled because of the outbreak of war.

Once the war was over it was possible for another, more durable attempt to be made. In Belgium, in 1919, a long—standing professional partnership between a midwife, Mile Marie Perneel, the innovative matron of the maternity hospital at Bruges, and an obstetrician, Professor Franz Daels, from the University at Ghent, led to the first formal steps in the establishment of an organization for midwives, the IMU, which was to pass through many phases before it became what is now known world-wide as the International Confederation of Midwives (ICM) .⁶

The records for the foundation years, 1919–32, are scanty in the extreme, and none are contemporaneous, since the proceedings of the IMU were not published in printed form until 1932. Even after that date little material survives, for the archives were lost in Belgium during the Second World War, and what remains has had to be gathered from member associations outside continental Europe. None the less, these sources, particularly the Communications of the IMU, published at two-yearly intervals from 1932 and complemented by contemporary accounts in French, Swedish, Dutch and English professional publications, offer evidence of the major preoccupations of the midwives at this time. The biennial congress took place in centres across Europe, including Antwerp, Prague, Vienna, Ghent, London, Berlin and Paris, and the Communications reported the proceedings of the meetings and the reports of the countries represented at the congresses. By 1939, in Paris at the last congress held before the outbreak of war, some eighteen European countries were represented (membership being corporate, not personal). Each issue of the Communications listed, together with the names of the member associations throughout Europe, the professional journals published by them—an astonish-ing twenty or so—offering some measure of the vitality of the profession. The number of countries in membership varied but virtually all the European nations, except perhaps Spain and Portugal, belonged at some time or other, though not all were equally active. From representation by a handful of women at the first congress in 1919, around eight hundred participated in the Berlin congress in 1936; the Nazi Minister of Health’s mother was a midwife and this, together with rampant pro-natalism in Germany, provided an extra stimulus.

During the early years of this century midwives throughout Europe were under threat of extinction. Midwifery had achieved very varied levels of professional organization, public recognition and state regulation in different countries.⁷ Without a stepping-up of professional organization and increasing competence and sophistication in developing strategies to cope with the new challenges in the way health care was organized, midwifery could well have disappeared as a distinct occupational discipline. The early records of the IMU make it clear that midwives in Europe considered that common action across national, cultural and language barriers was essential to their survival.⁸

Midwives themselves, throughout the IMU debates of the interwar years, identified five main factors which threatened the erosion and possibly the extinction of midwifery as a profession, namely, a falling birth-rate; a steady increase in the number of medical practitioners; a shift in the place of birth; the movement of other health care workers into the community, who focused on maternal and child welfare; and, throughout the 1920s and 1930s, the increasingly severe economic crisis.⁹ Faced with such challenges, midwives were fighting for survival as a distinct professional group. A small group of women from a handful of countries embarked on setting up a permanent organization which had the authority to speak for the whole profession, despite the considerable differences in training, legal status and practice of the IMU’s member associations. Only such an international mechanism had the capacity, they believed, to combat the challenges, raise the standards and the standing of the profession and breathe new life into midwifery.

This chapter will limit itself to a necessarily brief discussion of these five main challenges of the inter-war years as they constituted the stimulus for midwives to organize themselves for the first time, through the IMU, in a systematic manner across national boundaries, followed by an examination of the strategies adopted by the IMU to address the challenges.

THREATS TO SURVIVAL

The falling birth-rate

The first of the major threats to the survival of the midwife was the falling birth-rate. This was a Europe-wide phenomenon, which gave rise to acute anxiety among politicians in a period when war and the threat of war were rarely absent. Driven by these concerns, the pronatalist movements in many countries used a variety of tactics to induce women to have more babies, but only Germany after 1935 succeeded in reversing the trend.¹⁰ In France the birth-rate fell from 21.4 per thousand in 1920 to 14.6 in 1938. By 1938 the birth-rate had fallen below the death rate, with a population decline of 35,000 per annum. Politicians and doctors were swift to identify the culprits. Dr Doléris, a pro-natalist physician writing in 1918, exclaimed, ‘What is woman’s great duty? To have children, to go on having children, always to have children! If a woman refuses motherhood, if she limits or suppresses it, she forfeits her rights: she is good for nothing any more’.¹¹

Looking back on those years, Professor Binet, a distinguished gynaecologist, wrote in 1946, ‘In the modern society of the interwar years feminine decadence found expression in the refusal of motherhood or its undue restriction’.¹² In 1920, France established an award for mothers—women with five children won a bronze medal, eight a silver one and ten a ‘gold’ medal. By the mid-1930s motherhood was honoured in public in a procession of 20,000 women from the Place de la Concorde to 1’Étoile and a massive stone ‘Monument aux Mères’ was erected in the 13th arrondissement, copied from a similar sculpture in Berlin.¹³

Midwives, of course, were threatened in their very livelihood by the drop in the birth-rate and it is hardly surprising that their survival strategies included working very closely with the pronatalist movement. Midwife associations also put their objections to birth limitation into a moral framework, and strongly resisted neo-Malthusianism. Many organizations concerned with maternal and child welfare during this period took a clear pro-natalist stance. Noting the fact that French feminists took the view that, in the name of republican solidarity, national and family interests should take priority over individual or personal needs, Klaus writes:

Women who worked in organizations dedicated to protecting maternal and infant health [the IMU would seem to be a prime example] consistently defined their work in these terms. A few articulated a distinctive, women—centred approach to maternal and infant welfare, but they did not challenge the ideological basis of pro-natalism. Instead, they served goals defined by male politicians and physicians, often working under the direction and influence of men.¹⁴

Many authors, including Koven and Michel, Elizabeth Roberts and Angus McLaren, have explored the phenomenon of the falling birthrate, particularly in relation to the changing position of women in society, their growing political awareness and economic independence, as well as the increasing acceptability of fertility control through the use of contraceptives and abortion.¹⁵ The contemporary accounts of Pember Reeves and Llewelyn Davies make it painfully clear just why women were more and more reluctant to have large families.¹⁶ The tension between women’s desire for smaller families and official government pro-natalist policies impacted directly on the work and attitudes of midwives, yet there is very little overt acknowledgement of the issue in IMU records in terms other than the threat to midwives’ livelihood posed by the falling birth-rate.

The pro-natalist movement was stimulated not just by the falling birth-rate but also by the fact that, despite some improvements, an unacceptably high number of babies continued to die in infancy. At a time of chronic political instability, the wealth and security of a nation were perceived as being largely assured by a growing, productive work-force—which could, if occasion demanded it, become the military defence of the country. Politicians and doctors had expressed increasing disquiet since well before the turn of the century about the general health of the population, and, more particularly, the high maternal and infant death rates. Table 1.1 shows the infant mortality rate in a number of European countries in 1934.¹⁷

Although ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• FIGURES
• TABLES
• CONTRIBUTORS
• ACKNOWLEDGEMENTS
• INTRODUCTION
• 1: ESTABLISHING THE SCOPE OF PRACTICE
• 2: SWEDISH MIDWIVES AND THEIR INSTRUMENTS IN THE EIGHTEENTH AND NINETEENTH CENTURIES
• 3: HOW TO BE A MIDWIFE IN LATE NINETEENTH-CENTURY SPAIN
• 4: ROSALIND PAGET
• 5: THE ‘ANTISEPTIC’ TRANSFORMATION OF DANISH MIDWIVES, 1860–1920
• 6: STATE CONTROL IN LOCAL CONTEXT
• 7: THE MIDWIFE AS HEALTH MISSIONARY
• 8: MIDWIVES AND THE QUALITY OF MATERNAL CARE
• 9: THE END OF HOME BIRTHS IN THE GERMAN LANGUAGE ISLANDS OF NORTHERN ITALY
• 10: MIDWIFERY AND MEDICINE
• 11: THE CONTROLLING POWER OF CHILDBIRTH IN BRITAIN
• 12: MIDWIVES AMONG THE MACHINES