Motherhood and Childbearing

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MOTHERHOOD AND CHILDBEARING

MOTHERHOOD AND CHILDBEARING. Church, society, and their own expectations shaped the lives of early modern European women of childbearing age toward the goal of reproduction. Marriage was viewed not as the culmination of personal desire, whether sexual or economic, but as the gateway to a woman's proper destiny of motherhood and the perpetuation of the human race. For poor women, the birth of children could be viewed as insurance against the deprivations of old age. For wealthy women, the birth of an heir conferred status and frequently ensured both wealth and affection in an "arranged" marriage. In societies across Europe, children were essential for the transmission of property, and women who failed to reproduce were looked upon as failures.

Women were most commonly in their midtwenties when they married, and could expect the birth of their first child twelve to thirteen months later. Motherhood was considered the highest calling for a married woman, but the unmarried mother was subject to moral, economic, and social censure. Poor, unmarried mothers were on occasion driven to commit infanticide, but the harsh penalties for such a crime were not always invoked.

In a barren marriage, the woman was always believed to be at fault. Against the despair and shame of infertility, women balanced their anxieties and concerns surrounding childbirth itself. Complications of childbirth, when they occurred, were often fatal. Many mothers in Italy, France, Holland, Spain, and England could call upon the services of capable and experienced midwives when they faced the childbed experience, but for others giving birth could prove disastrous. Throughout the countries of western Europe, the midwife played a key role in the event of childbirth, and women were well served for centuries by the traditional midwife, whose expertise had been acquired by observation and first-hand participation, usually as an apprentice to a more experienced midwife.

THE MIDWIFE IN EARLY MODERN EUROPE

Historians have increasingly turned their attention to the person and role of the midwife in early modern Europe, and the result has been a revised view of their competence and importance. Midwives were generally mature women who had themselves borne children. Often they were trained by their mothers, grandmothers, aunts, and other relatives who were themselves practicing midwives.

Opportunities for training and licensing varied from country to country. In southern Germany midwives were solidly respectable women who answered to civic authorities and drew their salaries partly from municipal treasuries and partly from the women who were their clients. Farther north, in late-eighteenth-century Brunswick (Braunschweig), for example, the situation was more complex, with the board of health acting as examiners. The church in Italy exerted control over midwives, touching issues such as baptism and female sexuality, but by the end of the eighteenth century the state had joined the church in attempting to regulate midwives. In eighteenth-century Holland midwives were generally regarded with respect, with the towns offering educational opportunities as well as paying their salaries and overseeing their work.

In France the French royal midwife Louise Bourgeois (c. 15631636) published a three-volume treatise based on her personal experiences as a midwife. Written between 1609 and 1626, this work, generally known as Observations diverses, was the first on the topic of childbirth by a female author. It was highly popular throughout the seventeenth century and a number of English translations appeared. Although facilities existed in Paris for teaching a relatively small number of midwives at the famous Hôtel Dieu, by 1759 the need for a training program, particularly for rural midwives, was so great that King Louis XV (ruled 17151774) appointed Angélique Marguerite du Coudray (17151794) as the national midwife. She traveled throughout France for the next thirty years not only instructing midwives in the practical techniques of delivery but also publishing a midwifery manual. In early modern Spain women traditionally called upon the services of midwives who shared knowledge among themselves and were relatively free from outside control. In the second half of the eighteenth century, however, this changed as the surgeons began to control midwifery, assisted by royal legislation that permitted them to prescribe and enforce a restrictive curriculum for midwives.

LONDON MIDWIVES

Of all the midwives, the English midwives, licensed by ecclesiastical authorities, have been the subject of the most intensive investigation. In particular the lives of seventeenth-century London midwives have been brought to light, and a wealth of information has been uncovered about their training, licensing, work, and in some cases their social and economic profiles.

London midwives trained in an unofficial apprenticeship system whereby less-experienced deputy midwives worked with highly experienced licensed midwives for periods varying from several years to several decades. A deputy midwife could become a licensed midwife by presenting proof, in the form of sworn "testimonials," of her competence and character before a church court, where she usually was accompanied by women whom she had successfully delivered as well as her midwife mentor. In addition the midwife paid a substantial fee to the ecclesiastical authorities for her license. Quakers, who rejected the tenets of the Church of England, were served in most cases by their own competent Quaker midwives, who also had non-Quaker clients.

The midwife drew her clientele from all levels of society, delivering both rich and poor women, as promised in her oath. In London a competent midwife could earn more from one delivery than a member of the working class earned in two weeks. As London inhabitants, a number of midwives were women of substance. All London midwives were either married or widowed, and their husbands were merchants, artisans, tradesmen, professionals, and gentlemen. Research on English midwives in the countryside supports this view of respectability and prosperity, and there is evidence emerging in studies from other European countries of midwives' general responsibility and competence.

A prospective mother usually saw the midwife for the first time when labor had begun. Births took place in the home, frequently in a room crowded with female relatives, friends, and neighbors. Childbirth was viewed as a strictly female affair, and the presence of males was taboo. For this reason knowledge of normal birth processes was the exclusive preserve of the traditional midwife until well into the eighteenth century. In England by the seventeenth century most women were delivered in bed. Italian and Dutch midwives employed a "birthing chair," which they carried with them to deliveries. Ninety-five percent of deliveries were uncomplicated. If a problem arose, such as a breech or other abnormal position, experienced midwives corrected the problem and successfully delivered the infant. Only in the worst situations would a surgeon be called, who then used his instruments to destroy the fetus in an attempt to save the mother's life. Midwives, aware that the medical profession was helpless in the face of a life-threatening event, such as postpartum hemorrhage, endeavored to ensure that the placenta or afterbirth was delivered whole so the mother would not continue to bleed. Cesarean section was seldom attempted by a surgeon and usually resulted in the loss of a woman's life.

After the baby was successfully delivered, the midwife cut the umbilical cord with her scissors or a knife. If it was a male, this action was carried out with considerable care, since conventional belief related the length of the penis to the length of the remaining cord. After tying off the stump of the cord, ensuring that the airways were clear, and checking for any deformities, the midwife or one of the female attendants swaddled (closely wrapped) the infant and placed him or her near the fireplace. According to Christian beliefs, each newborn must be christened or baptized. If the infant was in critical condition, baptism was performed immediately, in some instances by the midwife. Babies who were not in any danger were baptized in a more elaborate church ceremony before godparents and friends, usually a few days to several weeks after birth. Frequently the midwife who delivered the baby was in attendance, but the mother would not attend if the baptism took place during her lying-in period. In England, toward the end of the seventeenth century, private baptism came increasingly to replace the public ceremony, especially among the upper classes. The ecclesiastical service in church was transformed into a domestic occasion for eating, drinking, and gift giving from which the new mother was not excluded.

LYING-IN

After delivery the midwife washed the new mother and helped her change into clean garments. The bed was freshly made, frequently with elaborate "child bed linen," in order for the new mother to receive visitors and begin her four-week lying-in period. During this time she was relieved of many if not all of her normal household responsibilities. In addition husbands were expected to forego sexual relations with their wives for this period. In London parish officials engaged and paid for the assistance of a woman, who was usually herself the recipient of poor relief, to assist other poor women during their lying-in periods. The complication most feared by postpartum women in Europe and by far the most common cause of maternal mortality was childbed fever or puerperal sepsis, a bacterial infection. In an era when bacteria were as yet not understood, it could strike down unsuspecting mothers within two or three days after delivery. The sudden onset of chills was an ominous sign of the dreaded infection and frequently heralded septicemia, the excruciating pains of peritonitis, and death. Women delivered at home by a competent midwife using acceptable standards of hygiene were not at high risk for succumbing to its deadly effects. But in London, with the opening of lying-in hospitals in the first half of the eighteenth century and deliveries increasingly carried out by male midwives, the death rates of women stricken by childbed fever soared.

Once their lying-in ended, English women, the majority of whom were communicants of the Church of England, went to be "churched." This ceremony was performed with the new mother and her midwife appearing before the parish congregation and has been variously interpreted as a service of thanksgiving, celebration, or purification. By their participation, women affirmed their status as new mothers and their gratitude for surviving the perils of childbirth before parishioners and the whole community. The churching rite provided an occasion for happy celebration and partying. It was an important and positive ritual in the life of childbearing women. Once "churched," the woman could partake fully of all rites of the church, including Communion. In France, Italy, Spain, and Portugal, traditionally Roman Catholic countries, mothers went to church for a blessing after a forty-day period of purification following the "impurity" of giving birth, as instructed by the Council of Trent.

FEEDING THE NEWBORN

Although Puritan writers of the period as well as occasional medical authors urged women to breast-feed, there is no evidence that their advice met with widespread acceptance. Until the middle of the eighteenth century mothers followed the counsel of most medical writers and looked with distrust on placing the baby at breast immediately following delivery. Instead, many gave the infant frequent purges for one or two days. This was thought to aid in clearing the bowel of meconium. Others gave the newborn pap, a watery mixture of cereal and liquid. In the sixteenth century and well into the seventeenth century, women were often advised to wait for a month after delivery before attempting to breast-feed. The value of colostrum, the thin fluid that new mothers produce for several days before the breast milk is established, was not appreciated until the 1670s. Even so, the babies of wealthy women continued to be purged for several days and then sent to a wet nurse.

The practice of wet-nursing was a well-established social institution throughout western Europe by the sixteenth century. It began to decline in the eighteenth century, but until at least 1800 the institution flourished. Initially popular among the aristocracy and aspiring gentry in France and England, the practice of employing a wet nurse spread to the lower classes, where a woman's situation (illness, type of employment) might discourage breast-feeding. Wet nurses were usually married and had children. They were of the lower ranks of rural society, although not poverty-stricken, and nursed the infants in their own homes. In the case of London parents, the wet nurse might live twenty or thirty miles away. The infant would seldom, if ever, receive parental visits. Not surprisingly there was a high mortality rate among "nurse children." Deprived of the protective elements provided by their mother's colostrum and milk and exposed to the new germs of their wet nurses' homes, they succumbed by the score to gastroenteritis as well as a host of other illnesses of bacterial origin. Many foundlings, already in poor condition upon arrival at the wet nurse's home, were particularly at risk and failed to survive the first six months of life.

Wet nurses were employed by the family, and in Florence, for example, the father of the infant hired the wet nurse and oversaw all arrangements regarding her duties and obligations. In some cases wet nurses were engaged by parishes or foundling hospitals to nurse abandoned infants. Earning more than the occupations of indoor servant or dry nurse, the occupation of wet nurse was seen as a profitable and respectable one for many women of the period. It was not until the middle of the eighteenth century that the benefits of putting the newborn to breast within twenty-four hours of delivery began to attract attention. It was noted that neonatal feeding practices among poor women greatly reduced the incidence of milk fever, an affliction involving high fever, abscesses of the breast, and possible death. Not only was maternal mortality from milk fever decreased by putting the infant to breast soon after birth, infant mortality in the first twenty-eight days was lowered. The increased opportunity for bonding also resulted in a more positive attitude toward infants and their well-being. In mid-eighteenth-century Paris, however, fully 10 percent of infants were still sent out to wet nurses, and the aristocracy throughout Europe was slow to abandon the practice.

Because of high infant and child mortality rates from infections and communicable diseases, it was not uncommon for women who had experienced ten or twelve pregnancies to enter middle age with only one or two surviving children. Despite the expectation that many infants would not survive the early months of life, mothers were devastated by the loss of their little ones. Although women were well aware of the risks they faced in childbearing in an era when licensed physicians and qualified surgeons had nothing to offer by way of assistance in life-threatening situations, most of them chose to dwell on the celebratory aspects of childbirth. Well into the eighteenth century the majority of women continued to place their trust in God and the ministrations of their midwives.

See also Childhood and Childrearing ; Marriage ; Midwives ; Obstetrics and Gynecology ; Orphans and Foundlings ; Women .

BIBLIOGRAPHY

Clark, Gillian. "Introduction." In Correspondence of the Foundling Hospital Inspectors in Berkshire, 175768, edited by Gillian Clark, ilxii. Reading, U.K., 1994.

Cressy, David. Birth, Marriage, and Death: Ritual, Religion, and the Life-Cycle in Tudor and Stuart England. Oxford and New York, 1997.

Evenden, Doreen. The Midwives of Seventeenth-Century London. Cambridge, U.K., and New York, 2000.

Fildes, Valerie A. Breasts, Bottles, and Babies. Edinburgh, 1986.

Gélis, Jacques. History of Childbirth. Boston, 1991.

Hufton, Olwen. The Prospect before Her: A History of Women in Western Europe. Vol. 1: 15001800. London, 1995.

Klapisch-Zuber, Christiane. Women, Family, and Ritual in Renaissance Italy. Chicago and London, 1985.

Loudon, Irvine. The Tragedy of Childbed Fever. Oxford and New York, 2000.

Marland, Hilary, ed. The Art of Midwifery: Early Modern Midwives in Europe. London, 1993.

Perkins, Wendy. Midwifery and Medicine in Early Modern France: Louise Bourgeois. Exeter, U.K., 1996.

Wilson, Adrian. The Making of Man-Midwifery. Cambridge, Mass., 1995.

Doreen Evenden