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.

C-section Primer for Writers

Today, Heidi Creston gives some nursing insight into the world of obstetrical nursing.

Welcome, Heidi!

STAT Sections, TOLAC, VBAC, Let’s think about all that . . .

STAT C-sections definitely give your story drama, critical hysteria in some cases, just what you need to keep your readers turning pages except . . .

The patient who has had only one prior cesarean section for an indication that no longer presents itself in her next pregnancy may ask the physician for a trial of labor termed trial of labor after cesarean section or TOLAC. For example, if her first baby was breech but the second baby is not. These patients that deliver vaginally are then referred to as successful VBAC (vaginal birth after cesarean section). The patient, however, will undergo a TOLAC for each succeeding pregnancy thereafter.

Midwives, physicians assistants, and nurse practitioners cannot manage the care of these patients alone. There must be a physician present during the labor process. It is important to note that the physician has to agree to the TOLAC. If the doctor does not agree to it then it is the patient’s responsibility to find another physician who will. Some physicians do not carry the insurance for TOLAC or VBAC. There are some states and countries that do not offer TOLAC or VBAC option regardless. Some hospitals do not carry TOLAC or VBAC insurance due to the maternal risks and expenses associated with these procedures. If you’re writing a novel set in a real life state, city, and or hospital with this type of scenario then it would be important to check out these specifics for those locations.

The first thing writers should keep in mind is that cesarean sections are major abdominal surgeries. There is nothing lackadaisical about it. Given that information, any time a muscle in our bodies is cut, torn, or otherwise altered, that muscle is weakened permanently. During a cesarean section the abdominal muscles are both cut and then torn. The uterus is also a muscle. The physician cuts into the uterus in order to remove the baby.

There are two commonly used incisions: Lower Transverse (aka the bikini cut) and the Classical Incision (aka the T-cut). Lower Transverse is the preferred, most common and least damaging of the incisions.

The uterus can develop a uterine window, a fragile site on the uterus that can lead to medical emergencies for the mother and baby. Partial and full abruption of the placenta and ruptured uterus are the most lethal and common complications associated with TOLAC and VBAC procedures.

An abruption is when the placenta dislodges from the uterine wall prior to delivery. In this case, without emergency intervention (imminent birth or emergency cesarean section), the baby will die.

A ruptured uterus is a breakdown of the uterine wall, in which case both mother and baby are at risk for sudden death. Cesarean sections leave the uterus in a compromised state. The more c-sections a patient has, the more compromised the uterus is, which leaves the patient more at risk for abruption and or rupture.

In my experience, patients having had two or more cesarean sections, regardless of the indication, a TOLAC or VBAC are not an option. At this point the risks outweigh the benefits. This risk is so prevalent neither the hospital nor the physicians are willing to accept that responsibility. The physician and hospital will go to great lengths to explain the risk associated with a TOLAC to the patient.

Ultimately the decision is up to the patient. The patient can go against medical advice. Proper paperwork must be filled out indicating that the patient is cognitively aware of their decision and understands the risks involved. The physician and hospital can also file a legal petition to a judge concerning the patient’s decision.

What plot scenario can you think of using these guidelines that will still have a lot of conflict?

C-section Primer for Authors. Click to Tweet.

*Originally published 4/25/2011.*

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Heidi Creston 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.

Author Question: Motorcycle Injuries

Tory Asks:

I’m currently writing a fan fiction and the two main characters get in a motorcycle crash. The female just found out she was pregnant. I have three (very unrelated) questions. Could the crash send her into cardiac arrest? Would the male (who was driving) be able to survive with just a broken arm and a sprained ankle? And would the baby survive?

Jordyn Says:

Hi, Tory. Thanks for sending me your questions.

1. Yes, a motorcycle crash could send someone into cardiac arrest.

2. Could the male survive with just a broken arm and a sprained ankle? Sure, this is possible, but I don’t know if it’s probable. When looking at accidents, medical people always look at the injuries of the other people involved to determine how serious everyone’s injuries might be.

If the female in the accident suffers a cardiac arrest, it would be surprising that the male walks away with just, essentially, a broken arm. You could make it more believable in the description of how the accident happens. For instance, the female is thrown from the bike, but the male is trapped underneath it. You could also have them differ in the type of protective equipment they’re wearing (helmet, jackets, etc.)

3. Would the baby survive? Again, it depends on a lot of factors. How far along is she in the pregnancy? Cardiac arrest— how long is she pulseless? What other injuries does she get in the accident? The sicker she is from her injuries, the more likely she will miscarry the pregnancy. The body will defer energy and resources to the mother over the pregnancy. Then again, some women have maintained a pregnancy through terrible injuries so you would have some leeway as an author here.

If the mother is far along in the pregnancy (at least 22-24 weeks along) and in cardiac arrest the providers might consider C-section to save the infant. So, without more details as to the nature of the accident, her injures and the state of her pregnancy, it would be hard to say if the baby would likely live or die.

Good luck with your story!

A Sad Story of Royal Obstetrics: Part 4/4

Today, JoAnn Spears concludes her fascinating observations on Queen Anne’s obstetrical history. I know that I sure learned a lot. You can find the previous installments of this series by following the links: Part I, Part II, and Part III.
 
Thank you JoAnn for such a wonderful look into this woman’s life.


Part Four: Was Diabetes the Cause?

Diabetes may be the most likely culprit in Queen Anne’s story. Her first three pregnancies went to term, and resulted in two healthy children. Statistically and fertilely, Anne, at that point, was par for the 17th century reproductive course. From there, though, things went terribly wrong.

The beginning of this downhill descent, 1687-88, coincided with the death of two of Anne’s daughters from smallpox. It also coincided with her father’s ascent to the throne and his loss of it during the Glorious Revolution. The familial loyalties and betrayals involved in this were deep and complex, and Anne was not a deep or a complex person. The compound stress must have been enormous. She was eating, and probably drinking, heavily. Might Anne have developed diabetes around the time of, or during, her 4thor 5th pregnancy?  Anne’s lifestyle was characterized by overindulgence. She was not very active; her preferred recreation was playing cards. She would certainly be at greater risk than most for developing diabetes during a pregnancy, and unconsciously fueling the diabetic trajectory with her personal habits.

Uncontrolled diabetes is associated with a host of poor fetal and neonatal outcomes. Unusually low or high birth weight, premature birth, cardiac or skeletal anomalies, neurological problems, cerebral palsy, lung immaturity with RDS (respiratory distress syndrome), and even intrauterine death are some of the sad set of possibilities that Anne may have run the gamut of. Unfortunately, medical descriptions of the babies Anne lost or miscarried are sadly lacking.

Diabetes is a progressive condition. Anne became increasingly obese and debilitated as she aged, bringing to mind her distant relative Henry VIII. Both Henry and Anne had pains in their lower extremities that prevented them from moving about well. This may have been peripheral neuropathy associated with diabetes in both of their cases. Anne and Henry also had chronic, non-healing leg ulcers, another diabetes symptom, in common.

As his desperate attempts to father sons were ended by his declining physical condition, the morbidly obese Henry VIII had lifts and other machinery devised to move his unwieldy body around. It’s said that Queen Anne had this machinery refitted for her own use as her own health began to fail. If it’s true, it’s an ironic footnote to the two saddest stories of infertility in English history.
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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.