Women to be Feared: Midwife Series Part 1/4

Laurie has saved her best information for the last post in her research into midwifery. If you’re writing historical fiction, what Laurie has revealed can add conflict to any manuscript if you have any issues central to this theme. You can find Part 1, Part 2, and Part 3 by following the links.

The following is redacted from “Women of Power” by Laurie Alice Eakes.

One of the reasons why midwives took an oath, the main reason why the licensure fell under the jurisdiction of the Church, was to prevent sorcery being used in the aid of childbirth.  In the event that the child died before, during, or soon after birth, midwives needed to baptize the child; thus a portion of their oath assured the Church that they would do so in a Christian manner.

By the mid seventeenth century, few midwives still performed baptisms; however, another part of their oath outlines their responsibility of learning the truth about who fathered the child being delivered.

Occasionally, women were called to testify in court for civil suits or to recount conversations they had heard or in which they had participated.  Midwives, however, were the only women who regularly appeared in court as witnesses and, in special cases, jurors.  Under both English and colonial laws, a midwife needed to learn the identity of a baby’s father.  Persons were fined for fornication, but the most important reason for the requirement was to determine who was responsible for supporting the child.  The custom was for the midwife to wait until the woman lay in the most intensive throes of labor, then ask the identity of the father, for the belief was that, due to pain and desire for aid, the woman would be compelled to tell the truth.  Martha Ballard notes thirteen such incidents in her diary.

Being the recipient of private information gave midwives unique power among and over their female peers.  Besides being called upon to testify in court regarding paternity and bastardy suits, an unscrupulous midwife could ruin a woman’s reputation with her knowledge.  Anne Johnson, a Maryland midwife, harassed her patient, Mary Taylor, into confessing an adulterous affair that resulted in a child.  Instead of going immediately to the courts as required, Mrs. Johnson waited several months during which time she attempted to obtain a bribe from Mary Taylor to keep silent about the matter.  When Mrs. Taylor physically and verbally attacked Mrs. Johnson, she went to the authorities.

A woman who failed to call a midwife and consequently bore a dead child, could be accused of infanticide. Courts assigned midwives to question women suspected of committing infanticide. Midwives examined the bodies of babies who were born in secret and died to determine whether the cause of death was natural or induced.

These posts only scratch the surface of the role of midwives in society. It is, and forever will be, a fascinating subject for me to continue to read about and explore as more and more documents from history come into my possession. If you want to read more, Google Books has a number of treatises for and by midwives. And I endeavored to cover some of the issues with which midwives dealt in my midwives series from Baker/Revell.

*Originally posted March, 2011.*

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Since Laurie Alice Eakes lay in bed as a child telling herself stories, she has fulfilled her dream of becoming a published author, with more than two dozen books in print and several award wins and nominations to her credit, including winning the National Readers Choice Award for Best Regency and being chosen as a 2016 RITA®

She has recently relocated to a cold climate because she is weird enough to like snow and icy lake water. When she isn’t basking in the glory of being cold, she likes to read, visit museums, and take long walks, preferably with her husband, though the cats make her feel guilty every time she leaves the house.

You can read more about Eakes and her books, as well as contact her, through her website.

 

Women in Practice: Midwife Series Part 3/4

Today, Laurie Alice Eakes continues her four-part series on her research into midwifery. You can find Part 1 and Part 2 by following the links.

The following is redacted from “Women of Power” written for and presented by Laurie Alice Eakes at the 1999 New Concepts in History conference.

In writings such as Martha Ballard’s journal, and in advertisements for their services, midwives referred to their work as their “practice” as would any professional healer.

“Ann Anmes, Lately arrived from England, is requested to practice Midwifery in this city, as she is informed many of the most experienced Midwives are infirm, and aged, and cannot attend with that assiduity, as so important an affair requires.”

In England, several midwives extended their professionalism through writing books on the art of midwifery, presiding over the childbed of queens, and campaigning for regulated midwifery colleges. Their work exemplifies education, independence, and most importantly, professionalism. Jane Sharpe, a seventeenth century midwife practitioner of thirty years, wrote in the introduction to her book:

“Sisters, I have often sat down sad in consideration of the many miseries women endure in the hands of unskillful midwives; many professing the art (without any skill in anatomy which is the principal part effectually necessary for a midwife) merely for lucre’s sake.”

Elizabeth Cellier, a midwife to the wife of James II, campaigned for a midwifery college and licensure for practitioners. Her own dubious reputation resulting from trials for treason and libel, worked against her, and nothing came of her scheme. After her death, papers emerged that outlined a system of standardized education for midwives and payment for licenses to give those practitioners the right to employ their art.

In the first half of the eighteenth century, Mrs. Sarah Stone, first of Taunton, then Bristol, also wrote a book on midwifery. She had learned the art from her mother and passed it on to her daughter. In her writings, Mrs. Stone expressed that a midwife should serve no less than three years of an apprenticeship under another skilled midwife, and that seven years would be better.

These women had precedents for desiring regulation of their profession. As early as the 1450’s in the Low Country and several German cities, midwives were regulated through training by doctors and licensing by the municipal government. Under the Tudor monarchs, English midwives began to form a regulation for midwives under the jurisdiction of the ecclesiastical courts. Midwives were supposed to present statements of their good character and their skill to a bishop, pay a fee for their license, then take a lengthy oath.

*Originally posted March, 2011.*
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Since Laurie Alice Eakes lay in bed as a child telling herself stories, she has fulfilled her dream of becoming a published author, with more than two dozen books in print and several award wins and nominations to her credit, including winning the National Readers Choice Award for Best Regency and being chosen as a 2016 RITA®

She has recently relocated to a cold climate because she is weird enough to like snow and icy lake water. When she isn’t basking in the glory of being cold, she likes to read, visit museums, and take long walks, preferably with her husband, though the cats make her feel guilty every time she leaves the house.

You can read more about Eakes and her books, as well as contact her, through her website.

Women of Authority: Midwife Series Part 2/4

Today, we’re continuing with Laurie Alice Eakes four part series on the historical aspects of midwifery. You can find Part 1 here.

Childbirth was more than a duty to God and husband.  Childbirth was a time when the woman was guaranteed attention in an atmosphere of “supreme drama”. Because, except in extreme cases, men were excluded from the birthing chamber, the laboring woman held the leading role with her friends, relatives, and neighbors as supporting actresses and, directing them all, was the midwife.

Well into the early modern era in Europe and throughout the American colonial period, women in religious orders and mistresses of the local manor performed the office of midwife as charitable work, but in the towns and villages, other women made a living presiding over childbirth.  More than likely, many of these women were unskilled practitioners, relying mainly on personal experience with childbirth or observation of other women’s labor. However, from the beginning of the sixteenth century to the end of the eighteenth century, when “man midwives”— physicians in obstetrical practice— became the reigning practitioners in the birthing chamber or hospital, midwives could and did consider themselves professionals.

 Unlike other members of their gender, midwives received wages and, through necessity, more often than not, worked outside the home.  Yet, unlike actresses, prostitutes, and domestic servants, midwives were respected, revered, and sometimes even feared members of society, giving them a power few of their peers realized.

In comparison with obituaries of good women at the same period, the death notices of midwives laud them as not merely exemplary human beings, but extol the virtues of their work and their benefit to their communities.  Mary Bradway of Pennsylvania and Lydia Robinson of Virginia were, according to their obituaries, exceptional women and midwives:

“Yesterday was interred here the Body of Mary Bradway, formerly a noted Midwife.  She was born on New-Years Day, 1629-30, and died on the second of January 1729-30; aged just One Hundred years and a day.  Her Constitution wore well to the last, and she could see to read without Spectacles a few Months since.”

“Last Sunday died here Mrs. Lydia Robinson, aged 70 years, who during her practice as midwife for 35 years past, delivered a number of women, in this and the neighboring towns, of Twelve Hundred children; and it is very remarkable that in the whole of her practice she never left one woman in the operation.  The death of a person so eminently useful is a very great loss to the public in general, and to this town in particular.”

Martha Ballard, made famous through Laurel Thatcher Ulrich’s work with her diary, received only a one-line obituary.  Ulrich, however, quotes the eulogy of Jared Eliot, a Connecticut minister, delivered in 1739 on behalf of another midwife, Mrs. Elizabeth Smithson:

“The deceased was a true light upon a hill. She was a person of Humility, Affability, Compassion, and on whose Tongue was the Law of Kindness; Her Ear was open to the Complaints of the Afflicted, and her Hand was open for the Supply of the Needy.

As a Midwife, she was a person of Superior Skill and Capacity; as was found by Experience in the most difficult Cases ….

She regarded the Poor as well as the Rich ….

She denied herself both Sleep and rest, and spared neither Skill nor Pains for the Belief of those that were Afflicted and Distressed.”

*Originally posted February, 2011.*

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Since Laurie Alice Eakes lay in bed as a child telling herself stories, she has fulfilled her dream of becoming a published author, with more than two dozen books in print and several award wins and nominations to her credit, including winning the National Readers Choice Award for Best Regency and being chosen as a 2016 RITA®

She has recently relocated to a cold climate because she is weird enough to like snow and icy lake water. When she isn’t basking in the glory of being cold, she likes to read, visit museums, and take long walks, preferably with her husband, though the cats make her feel guilty every time she leaves the house.

You can read more about Eakes and her books, as well as contact her, through her website.

 

Qualities of a Good Midwife: Part 1/4

I’m reposting Laurie Alice Eakes four part series on midwifery. Today, she’ll be focusing on the character of a good midwife.

Welcome, Laurie!

The following section is redacted from the presentation I made at the 1999 New Perspectives in History Conference.  For facility of reading, I have changed the arcaic spelling into modern spelling.

“As concerning their persons, they must be neither too young nor too old, but of an indifferent age, between both; well composed, not being subject to diseases, nor deformed in any part of their body; comely and neat in their apparel; their hands small and fingers long, not thick, but clean, their nails pared very close; they ought to be very cheerful, pleasant, and of a good discourse; strong, not idle, but accustomed to exercise, that they may be the more able if need require.

Touching their deportment, they must be mild, gentle, courteous, sober chaste, and patient; not quarrelsome nor chollerick; neither must they be covetous, nor report anything whatsoever they hear or see in secret, in the person or house of whom they deliver…

As concerning their minds, they must be wise and discreet; able to flatter and speak many fair words, to no other end but only to deceive the apprehensive women, which is a commendable deceipte, and allowed, when it is done, for the good of the person in distress.”

Thus did William Sermon, a seventeenth century physician and clergyman, describe the attributes of a good midwife.

Compared with the attributes of a good woman, described in the numerous pamphlets, obituaries, and epitaphs of the same time period, a midwife in Early Modern England and the North American colonies was expected to embody the traits of a good woman as well as the characteristics of a good professional.  Though one cannot expect that midwives met the standards Sermon, his peers, and other midwives set down for childbirth practitioners, through the nature of their work, and the standards set down through the ecclesiastical and municipal laws, and the expectations of other women, midwives achieved goals superior to the ideals of mere virtuous women.

In an age when women possessed little to no authority outside the home, the midwife achieved a position of power over other women and  within society itself.

Would you make the cut?

*Originally posted February, 2011.*

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Since Laurie Alice Eakes lay in bed as a child telling herself stories, she has fulfilled her dream of becoming a published author, with more than two dozen books in print and several award wins and nominations to her credit, including winning the National Readers Choice Award for Best Regency and being chosen as a 2016 RITA®

She has recently relocated to a cold climate because she is weird enough to like snow and icy lake water. When she isn’t basking in the glory of being cold, she likes to read, visit museums, and take long walks, preferably with her husband, though the cats make her feel guilty every time she leaves the house.

You can read more about Eakes and her books, as well as contact her, through her website.

What’s the Difference Between?

Today, I’m pleased to host guest blogger Jason Joyner. Have you ever been confused by certain letters behind health care provider’s names? Jason is here to clear that up.

Welcome, Jason!

When I interviewed for the physician assistant program at my university, the program director offered this scenario to me.

“You are working as a PA, and you need to consult with your supervising physician on a patient. You go to the exam room he’s in, knock softly, and when you don’t hear an answer, you crack the door to see if he’s really in there. You find him making love to a patient. You shut the door quietly, apparently escaping detection. What do you do?”
 Recently there was a guest post by Amitha Knight on How To Write A Hospital Scene that described the different levels of medical training from med students to interns, residents, and attending physicians. There are other levels of health care providers that can be in a hospital or clinic setting, with potential for deeper conflict and development in a story.
A relatively new concept is the “mid-level provider,” a clinician that is under a doctor but can still see and treat patients. There are three main types of mid-levels: nurse practitioner, nurse midwife, and physician assistant. They function in similar ways and are often indistinguishable to a patient, but there are training, legal, and practice differences.
A nurse practitioner has to be a graduate from an RN (registered nurse) program first, with a bachelor’s level degree. Most of the time they will have practiced as a nurse before going back to school. They are trained in the nursing model, with an emphasis on patient care and learning diagnosis and treatment algorithms to treat patients. They often can practice independently – an NP could hang out a shingle and see their own patients, but they are usually working with other physicians. This may vary by state. NP’s are often trained in a specific field, such as pediatrics, ob/gyn, or internal medicine.
A nurse midwife is similar in that they are RN’s first, but then do advanced training that focuses on ob/gyn. They are an option for uncomplicated deliveries, but have to be able to have back-up in case of complications.
A physician assistant is trained in the medical model like a regular physician, but with a shortened time frame. The average program is two years, and it is mostly a master’s level degree anymore. A PA is required to work under the supervision of a physician, but it does not mean that the doc has to see every patient the PA does. It means that the doc has to review a certain amount of the PA’s charts and be available for consult. The PA could be hundreds of miles away from their supervising physician in a rural area, if the doc is available by phone. PA’s are trained in primary care, not usually specializing at first. They can be trained by their supervising physician for specialties such as orthopedics, cardiology, or urology.
Oh, and my pet peeve? It is physician assistant. No “apostrophe ‘s'”. We’re not someone’s possession.
Mid-level providers have received a lot of acceptance in the medical field by both patients and professionals alike, but there are still barriers. I get asked when I’m going to finish medical school by patients. Cardiologists in hospitals fight against giving privileges to an NP, because they don’t want to be asked to consult by a “lowly” mid-level. PA’s and NP’s have a friendly rivalry, but there can be sniping between the two groups. Nurses and mid-levels can be partners together against a tyrannical MD, but may have turf battles or issues on their own.
Many patients now prefer to see mid-levels, feeling the PA or NP listens to their concerns better. Doctors are so busy that they may rush through patient visits more (of course this is stereotypical – there are very caring physicians and mid-levels that have the bedside manner of moldy bread). Mid-levels are working more and more in hospitals to help alleviate shortages of physicians, so it is realistic to have one involved in a medical scene.
As my opening hook suggested, there can be a lot of drama created by utilizing a PA, NP, or nurse midwife in a story. What if a doctor orders the wrong medicine for a patient, but the NP sees it in the chart? What if a PA makes a mistake and has to tell their supervising physician?
A good novel has many layers of depth and sub-plots going on that help drive the plot or challenge the characters. I would encourage a writer to use mid-levels in their books to give them a better prognosis.
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Jason works as a physician assistant in southeast Idaho, while trying to keep up with three crazy boys and a little princess. He is working on a medical suspense with international flair. Follow him on Twitter @JasonCJoyner or his blog at http://spoiledfortheordinary.blogspot.com/

Perinatal Providers: Scopes of Practice

Heidi Creston returns today for her monthly blog post. Today, she covers a very important topic: scope of practice for different obstetrical providers. Scope of practice dictates what a medical provider can and cannot do so it is important to know a particular providers limitations. For instance, as a registered nurse, I cannot diagnose illness though most nurses are very good at this very thing and we may indicate to a family what we think is going on. However, only a physician, nurse practitioner, or physician’s assistant can diagnose.

Now, I’ll turn it over to Heidi.

It is especially challenging for the perinatal patient to understand the scopes of practice that different providers offer. As authors, we must remember that our audiences are impressionable, and may believe your fictional story as the Gospel truth. If your character is a perinatal provider it is imperative, that you keep them working within the means that their occupation allows.

The providers:  Obstetrician-Gynecologist, Perinatologist, Family practitioner, Certified Nurse Midwives, and Doula’s.

Obstetrician-Gynecologist (OB/GYN) is a medical doctor who provides both clinical and surgical care for their patients. The OBGYN serves not only the perinatal patient but all women’s medical issues from puberty to post hysterectomy.

Perinatologist is an obstetrician who specializes in the care management of high-risk pregnancies. Patients assigned to a perinatologist are referred out by their OBGYN or family practitioner due to the extensive or specialized care that is required maternally and or for the fetus. Patients with cardiac issues, diabetes, Eclampsia or HELLP, and multiple gestations are prime examples of patients referred to perinatologists. Fetuses with severe abnormalities such as gastrocentisis or Tetralogy of Fallot are also referred.

Family practitioner is a medical doctor who specializes in the health care of all family members. They are prepared to provide normal OB/GYN care, but usually refer pregnancies and other women’s health issues to an OB/GYN. All family practitioners are trained to perform Cesarean births in an emergency and also to assist other specialists in doing the procedure.

Certified Nurse Midwives are registered nurses who have earned their master’s degree in nursing, with a strong emphasis on clinical training in midwifery. Midwives work with obstetricians who are always available to assist if complications occur during pregnancy, labor, or delivery. CMW’S can assist with cesarean sections but can not perform them independently.

Doulas are not licensed or certified personnel. Doulas are support liaisons hired by the patient, to assist them through the pregnancy, and offer support during the labor process. There currently are no mandatory qualifications, regulations or requirements necessary in order for someone to become a doula.

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Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished.