Midwifery for Men

Pat here: I’m still in the process of moving from one side of town to the other and everything is still in boxes except my computer. Which is convenient since I have a new book coming out Tuesday—AURA OF MAGIC, the fourth in my Malcolm and Ives Unexpected Magic series—and I really need to tell people about it. There’s an excerpt and buy links on my website.

Since I like mixing things up, this time the scientific protagonist is the heroine, Brighid, the Countess of Carstairs. She comes from a long line of physicians and has been trained by her family to the same standards as the men who were allowed to attend university--except, of course, she was expected to marry. Devoted to the village where she grew up, she obediently wed the highest ranking aristocrat in town, then continued her family's medical practice—illegally.

By the 1830s, even the role of midwife had been usurped by men. While women were quietly learning techniques from each other, men pontificated to the public in pamphlets and pulpits about the evils of letting excitable, delicate women perform medical procedures—like giving birth. While experienced midwives had learned the hard way that they must wash their hands and wear clean clothes and use clean linens, men were inventing forceps and other instruments that they declared women too feeble to use.

Just as one example of how midwives were vilified, the medical journal The Lancet declared, “The women of England  are. . . wholly deficient both in the moral  and physical organisation necessary for performing the duties of that most responsible office.” Yet some male practitioners were as lethal as the worst midwives. The 1845  Medical  Gazette condemned the “disembowelling accoucheurs”  who cut out womb or intestines with scissors or knife.

But such ugliness led the public to go to male doctors instead of the traditional midwives, who didn't have the ability to fight back. Women continued dying in childbirth at a high rate in the hospitals where men performed their “scientific” procedures-- because hospitals did not use the sanitary practices midwives understood. But it was the men who ruled the courts and the minds of other men, and so women were barred from their age-old traditions.

It’s against this background that my heroine, after her husband’s death, decides to establish a midwife’s school for women. It was the rational, charitable thing to do to prevent more women from dying in what ought to be a natural process. When the king’s man arrives in town—Bridey has every right to resent him and be afraid of what he can do. My hero, Pascoe, being all Ives male, doesn’t really care what she’s teaching behind closed doors—all he wants is someone to take care of his irrepressible, mysterious brats while he goes about the king’s business. Taking care of children was women’s business, was it not?

But, of course, when Ives and Malcolms come together, ghosts and riots, and laughter and love happen, because this is romance.

In real life, women had to fight for the right to care for their own bodies. In the late Victorian era, Florence Nightingale began to turn the tide, ever so gradually.

But why is it that women allow men to bully them in public and push them aside, even in these modern times? Why are women still so underrepresented in public that it’s hard to make our voices heard? I wish I had an answer.

Comments

[LindaB]

"But why is it that women allow men to bully them in public and push them aside, even in these modern times? Why are women still so underrepresented in public that it’s hard to make our voices heard?"

If you have just about nothing, you're terrified of losing what little you have. Up until very recently, marriage was mainly an economic union, and one that a woman needed to survive. In early 19th century England, a married woman was a feme covert, which meant that she had no legal identity--she was subsumed into her husband. Nothing belonged to her, not her children, not her own body. Try standing up for yourself when you can't even hire a lawyer.

Then there were the social attitudes, which lauded "the woman who endures", i.e, the woman who put up with every sort of bad treatment (usually dished out by men), and never complained, but just "endured" it all without complaint.

That any historical woman at all stood up for herself was almost a miracle. Mary Wollstonecraft was pilloried for standing up for women. Most people, male or female, wouldn't be able to withstand such treatment.

Women have a few more rights now, but social attitudes haven't changed much. Patriarchy is alive and well and still vilifies accomplished women. Even in the 21st century, we women are still taught to give in, right from childhood. Some break away from their training, but when the world is stacked against you, fighting back is almost impossible for all but the bravest.

[Kathy K]

Midwives, by this I mean master's prepared nurse midwives, have an excellent record of safety and a lower rate of complications. However, that could be partly because the midwife's purvue is normal pregnancy and childbirth. If there is any indication of complication coming on, they are supposed to hand the patient over to the obstetrician. In many countries midwives do all the deliveries at home because hospital care isn't readily available. And about 90% or more of deliveries are normal and uncomplicated. In countries that train nurses in the English system (started by Florence Nightengale) it is expected that all nurses will complete a post graduate rotation in midwifery. Here in the US we don't have that expectation. We also have so-called "granny midwives" that learn their trade by apprenticeship with another midwife and aren't licensed nurses. Statistics about their complication rates are hard to get, but they often serve out in rural areas where medical care of any sort isn't available. In Texas they are in the rural areas and also along the southern border, helping immigrant women deliver.
I wish I knew why we women allow the men to bully us, especially in the medical field. But part of it is the power structure being set up to assure they keep control. In Texas we have a very powerful medical lobby that has kept nurse practitioners from being able to practice to the full extent of their license and training. They say it is because of concerns about quality and patient safety, but I believe it is because they like the power being in their own hands and don't want to share. They feel threatened and are not afraid to fight dirty. But the needs of the people cannot be met by the primary care doctors available. So I'm very hopeful that within my lifetime Nurse Practitioners will be doing all primary care and you won't see a doctor unless it's a specialist.
I hope this hasn't been too long or too far off the topic. You hit a nerve, obviously.

[Patricia Rice]

Sadly, all you say is true. I'm just not certain how we allowed ourselves to get into that place. Why did we allow ourselves to become possessions? I know we've always needed someone to look after the children, but there had to be a better way than becoming an unpaid servant!

[Patricia Rice]

You're responding to the nerve I feel! Maybe men need to be threatened by women. If they had to fight with us, they'd spend less time fighting each other.

[Cindy A]

Women were taking care of other women giving birth for millions of years before men stepped in to "help". Smart women ( usually the poorer ones) went to a midwife and had healthier children.

[Shannon]

There are a handful of countries that have abysmal maternal and infant mortality rates. In almost all of them, Western NGOs have tried to start midwifery programs. Some have been huge successes. Other have found that male leaders for various reasons oppose the idea. One country found the best way to spread a program was to build it slowly, starting in a few towns, having successes, and then have the community leaders (male and female) talk to other community leaders about the risks and benefits. One of the key issues is who pays and who is paid. As someone told me just last week: change is difficult. It is especially more difficult when a change threatens someone with a vested interest, which doctors and hospitals have. It's not just a male thing, it's a money thing.

[Patricia Rice]

well, there were always bad women, too. But saying all women were bad was pernicious evil!

[Patricia Rice]

oh, bingo, you've hit it exactly! Greed wins again. The Victorian docs preaching against female midwives were building their own business. Those barber surgeons hated losing out to women, especially if women were doing it for free, which they frequently did. We need a vaccine against greed.

[jeanette dilts]

This is timely as I've just spend part of the day searching my Kindle library for a fiction book about a medieval midwife who developed a tool for breach births and had it made by an armorer (who's daughter ended up needing the midwife's help). Betrayal to the church by a friend who was tied somehow to the religious authorities of the day (who believed women should suffer during birth even unto death of the mother and baby in atonement of original sin) was also part of the story. I think there was a romantic component which I can't call to mind. Anyway, if anyone knows of this story, I'd sure appreciate receiving the name of it as I've been searching with no luck for the book for an acquaintance who'd like to read it.

[Patricia Rice]

It sounds vaguely familiar but I have no memory. Let me pass this on the wenches. Some of them remember every book they've ever read!

[Patricia Rice]

Mary Jo says it sounds roughly like Judith Merkle Riley's A VISION OF LIGHT. I'd thought it sounded like one of Judith's themes but I don't remember titles or details.

[jeanette dilts]

Thank you to both. I do have that book so will check it out.

[Annette Naish]

I was fortunate enough to read this book and it is wonderful. Brighid is a wonderful heroine in the truest sense of the word. She has intelligence and strength and a sense of self.

I believe that greed has been a powerful force since the beginning of time. Men had the power and except in unusual circumstances they controlled the money.

And then there is fear. I believe that men feared what would happen if it were realized and recognized that women were the strong, intelligent and powerful people they are. Look at the power they used to prevent the suffrage movement from succeeding. That was not a mild response, that was cold, hard fear.

We are still working on it, but the Grand Canyon was not built in a day.

[Patricia Rice]

Thank you for the kind words! Sometimes my heroines come off as harsh, but I imagine strong women were considered harsh then and now.

I'm not sure the human race can last as long as it took the Grand Canyon to be carved!

[Janet Sorenson]

As a nurse and now as a patient who has seen both sides of the MD personality it is not pleasant. Doctors want all of the power over their patient's care but do very little of the actual assessments themselves to do that. In the hospitals they rely on the floor nurses. In their offices it is the Physicians Assistants and the attending staff that do the work (and catch all the flack when a patient is denied something like a test or a referral). Patients are very seldom seen by the doctors these days. The doctor signs off orders, medications and medication changes and he has power to send through or deny a request to be seen by a specialist or order a test but he ver seldom interacts with the patient directly. He still holds all of the power though.

[Laura]

Fascinating post. Thank you so much. How had midwives learned that cleanliness aided a good outcome?
I am told that now most obstetricians/gynecologists coming out of school are women, because women prefer going to women rather than men. It used to be hard to find a woman - as any type of physician.

[Patricia Rice]

I hear ya! I know some fabulous docs and know what an extraordinary amount of work they had to do to get there, but all people are not made the same. Still, I blame our healthcare system for allowing this medieval problem to continue

Patricia Rice
http://patriciarice.com

[Patricia Rice]

they learned by observation. physicians in hospitals went from patient to patient without cleaning anything, and women died in huge numbers. Midwives who only worked with one patient at a time were far less likely to pass on childbed fever

Patricia Rice
http://patriciarice.com