A Treatise on the Art of Midwifery / Setting Forth Various Abuses Therein, Especially as to the Practice With Instruments: the Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgement Upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-midwife; Or, a Midwife

by Elizabeth Nihell

Objection the Fourteenth.

You must allow, however, that it must be a false modesty that, in the women, which can oppose the preference of the men-practitioners to the female ones.

ANSWER.

I know indeed that Dr. Smellie (page 2. of his introduction) attributes the opposition made by the Athenian women[^[23]] to the prohibition of midwives, and to the acceptance of men-practitioners in their room to “mistaken modesty.” It may however with more reason and truth be averred, that the admittence of men to that function by women, would be in the women a most egregiously MISTAKEN IMMODESTY. Since, surely the virtue or grace of female modesty is not an object to be held so cheap, as to be sacrificed for worse than nothing, for nothing better, in short, than the purchase with it of danger or perdition to both the mother and child. After so valuable a sacrifice as that of modesty itself, it may perhaps sound mean to add any thing comparatively, so trifling as that of the hire not given to the person who prostitutes herself in some sort on a so much mistaken hope, but to the very person to whom she is prostituted in that hope of superior safety.

I am not then here to assume a character, that would become me so ill, of a Casuist or Divine, by pretending to fix the degree of moral turpitude in the submission of modest women to a practice, which, I will even allow might be justified by the superior consideration of safety to two lives, if that consideration was not a question most impudently begged, with so little foundation, that the very contrary thereof is the truth.

Neither would I here incur the just charge of impertinence, in giving my private and insignificant opinion on an undecency so unwarranted by any necessity. That would look too like dictating to others, what they are to think of a practice, of which every one will doubtless judge for himself. The boundaries of female modesty are so well known, and so ascertained by common consent, that surely it little belongs to me to offer new lights upon that subject.

What I have then to say, on this head, is purely in justification of that modesty, which the men-midwives are for obvious reasons pleased to call a false one, though so far as it pleads for excluding them, it is an ingratitude to that Nature, of which it is the peculiar gift to the female sex, not to term it even a wise virtue.

Society especially stands indebted to Nature for her suggestion of modesty in this point. If in all ages, in all civilized countries, the wife is considered as the peculiar property of a husband, insomuch, that all laws human and divine consecrate, if I may use the expression, to him alone, exclusive of all other men, the access to the reserved parts of the wife’s body, certainly such a privilege can hardly be thought lightly communicable. And what can be more so than suffering a man, mercenarily or wantonly, or perhaps both, to invade that so sacred property, under the mask of a service, for which he is by Nature so evidently disqualified? While Nature too has made so ample a provision for this very service, in fitting the women for it, with so much more propriety and safety, both to the concern of the public in the welfare of population, as well as to the domestic honor of families, which is not without some danger, at least, from the practice of midwifery being in the hands of men.

As to this last averment of mine, the truth of it is so glaring, that it does not even need Dr. Smellie’s own implicit confession of it, in his instructions to the men-practitioners in general, or, if you please, to his more than nine hundred pupils.

“He (the Accoucheur) ought to ACT and SPEAK with the utmost DELICACY of DECORUM, and NEVER VIOLATE the TRUST reposed in him, so as to harbour the least IMMORAL or INDECENT design; but demean himself in all respects suitable to the DIGNITY of his PROFESSION,” p. 447.

Here I confess myself so smitten with the propriety and sanctity of the precept of the good Doctor’s, and particularly with the needfulness of it, that I would advise every man-practitioner of midwifery, of a certain age that might require it, to have the said commandment wrote out in gold letters, and wear it about his arm, especially on his proceeding to officiate, by way of amulet, phylactery or preservative against any incident temptation to violate his trust, or to fall off from the high dignity of his profession. All that I fear is, that its virtue may not always be to be depended upon, against the energy planted by nature in the difference of the sexes. No one would be farther than I from the cruel injustice of drawing consequences unfavorable to any set of men, from the misconduct of any particular individual in it.[^[24]]Errors are purely personal. If I then so much as mention the case of a man-midwife convicted of having debauched a gentleman’s wife, in consequence of his admission to the practice of his profession of midwifery upon her, it is by no means neither with a design to insult the unhappy criminals, nor to draw from thence an inference to the disfavor of the men-practitioners in this point, beyond what I am authorized by the constancy of the temptation from Nature, to all, yes, to all, who, by their age, in one sex, are not past it: I say in one sex, because in the other, the female, the very circumstances of a woman’s needing a midwife, shews that she is not past the age of, at least, causing a temptation. Further, it would even be a matter of argument on the side of the men-midwives, that so few instances come to the knowledge of the public, of the ill-consequence of a practice which breaks down the capital barriers of modesty; if those ill-consequences were not, in the nature of them, not only a secret, but easy to be kept secret. Who would complain but the husband or relations of transactions between a man-midwife and his patient? But then how seldom need a third to be let into such a secret?

I would not then have the men-midwives to be too forward to treat the modesty of the women on this head as a false one, or their scruples as a weakness. Modesty in this case is not only the safeguard of the lives of themselves and children, but of their own honor, which if it does not receive an actual fall in such a subjection to a man-midwife, had perhaps better not be so unnecessarily risked so near the brink of the precipice.

I am not writing here for Italians or Spaniards, or any of the inhabitants of those countries who are so prone to jealousy, perhaps because they know their women. I am now addressing myself to Englishmen, not jealous, because, if they know theirs, they must know that, in proportion to the number, no women on the earth have more of the reality of virtue and modesty. I will not suppose then any thing so offensive, as that the chastity of the generality of them is not infinitely superior to the advantages or overtures for design afforded the men admitted to such a privacy, as that of attending them in their lying-in and delivering them. But would the honestest woman, or one however sure of herself or of her virtue, think it eligible, without a full satisfactory proof of that superior safety, which is her object in preferring men-midwives, to be herself the occasion of temptation to those people? How can she answer that she will not be it? In that so formidable army of mercenaries, actually continuing to form itself under the banners of Fashion, and headed by Interest, can she answer that the insensible stoics of it, will fall to her share? Would a woman, I will not say, of strict principles of honor, but barely of not the most abandoned ones, submit herself in the manner she must to a man-midwife, on her employing him, if she would but satisfy herself, as she easily may, that his aid cannot be more effectual than that of a woman? But what! if it is most undoubtedly a less safe one?

But this is far from all to be objected on the head of modesty to this practice. The opportunities, if not of temptation, if not of seduction by it, at least of offensiveness to female reserve are such, as would make even a husband, the least susceptible of jealousy, so uneasy for the outrages to which the employing of a man-midwife in the course of his wife’s pregnancy and delivery might expose her, as would make him think it no indifferent point for his judgment to settle whether such outrages might not better be spared her. It will not I presume be denied, that all female modesty is a flower, the delicacy of which cannot be too much guarded against any tendency to blast it, and that nothing can threaten more that effect, than such infringements of the unity of a husband’s privilege in the sole incommunicable possession of his wife’s body, as are implied in the course of a man-midwife’s attendance. An unity of privilege, which, when broke in one point, does not always stop at that, but may proceed to farther breach, where there is art on one side, and weakness on the other. Many women are doubtless proof against the slipperiness of such an overture: but all have not alike strength of mind.

But lest I should be here taxed with forging of phantoms merely for the honor of combating them, I shall only entreat all parties concerned to consider the following so probable circumstance, and then let them decide as their own judgment will direct them: a circumstance taken (can any thing be fairer?) even from a man-midwife’s own stating, as well as from the nature of things, of which none need be ignorant that will think at all about them.

It is then to be observed, that during a woman’s pregnancy, and before the labor-pains come on, one of the principal points of midwifery is, what is called the art of Touching. Thence are derived the surest prognostics for preparation, and especially from the signs it affords of rectitude or obliquity of the Uterus. I have already offered reasons needless to repeat, why the men can never arrive at the excellence of skill in the women in this particular. But as to the importance of this faculty of Touching, hear what Dr. Smellie himself says.

P. 180. “The design of touching is to be informed, whether the woman is or is not with child; to know how far she is advanced in her pregnancy; if she is in danger of a miscarriage; if the os uteri be dilated; and in time of labor to form a right judgment of the case, from the opening of the os internum, and the pressing down of the membranes with their waters, and lastly, to distinguish what part of the child is presented.”

Again, P. 448. speaking of a midwife, he says, “she ought to be well skilled in the art of touching pregnant women, and know in what manner the womb stretches, together with the situation of all the abdominal VISCERA: she ought to be perfectly mistress of the ART of EXAMINATION in the time of labour”.

Here you have from an unsuspected authority a certainly not over-rated importance of the expedience of preliminary TOUCHING. Now granting, only for argument’s sake, what is assuredly false, that a man-practitioner can be equal (superior he would not in this point, at least, have the impudence to pretend himself) to a midwife; let a husband, let a wife, but reflect on the difference, every thing else being equal, there must be as to modesty, between the function of touching being performed by a man or by a woman. Let a husband, I say, for an instant figure to himself what a figure he must make, what a figure his wife must make, under such a ceremony performed by a lusty HE-MIDWIFE, exploring those arcana of the female fabric, and especially to so little purpose, with his natural disqualifications for so much as knowing what he is about. Will the husband be present? What must be the wife’s confusion during so nauseous and so gross a scene? Will he modestly withdraw while his wife is so served? What must be his wife’s danger from one of those rummagers, if she should be handsome enough to deserve his attention, or a compliment from him on such a visitation of her secret charms, the more flattering from him, not only as he must be supposed so good a judge from the frequency of his occasions of comparison, but as it must imply a superior corporal merit in the woman so visited, as could overcome that satiety which a fastidious plenty of patients might so naturally be imagined to create in a man-midwife? Will any one say, that these suppositions are over-strained, or out of Nature? I fancy, that if the secret histories of many families were ransacked, of the practice on which the men-midwives were in possession, it would not be always found, that those preliminary visitations were not turned to some account of interest or seduction. And yet an omission of that touching might be dangerous. How kind is it then in Nature, to have of herself so far consulted the good and tranquility of society, in palpably bestowing upon women a faculty, which she has as palpably refused to the men, in whom the exercise of it would for obvious reasons be big with so many inconveniences? Is there any breach of charity in the taking for granted the existence of such inconveniences, unless indeed, all of a sudden, in favor of this lucre-begotten sect, the men were ceased to be men, and the women women?

But allowing that nothing was to pass between a man-midwife and his patient, in this act of touching, beyond the necessity of the practice, or in a merely technical sense, that in short no such libertine impression should make itself be felt in the course of such touches, as should discompose the good Doctor’s DIGNITY, and endanger the patient’s honor, by present or future attempts derived from such a strange privity; is it not to be feared, that a designing or interested person may take other advantages besides that of gratifying sensuality? May not a woman, the more attached she is to her modesty, the greater sacrifice she has made of it, in her innocence of intention, only imagine herself but the more subjected to a man, to whom she has submitted in the manner she must do to a man-midwife, and let him take an ascendant over her and her family, of which a midwife would not so much as dream, from her office being so much in course, and too little extraordinary for her to have any extraordinary pretentions or designs? On the contrary, a man-midwife need scarce set any bounds to his. In any differences in a family, especially between man and wife, must not a man-practitioner, from such a familiarity with the wife’s person, have such a footing in the confidence of the wife, as may enable him to dispose of her will almost in any thing? He may be her apothecary, physician, surgeon, privy-councellor, what not? What can a woman refuse a man, to whom she is so deluded as to think she owes her own life, or that of a darling child, all his merit, in which I have before explained? What can a woman in short refuse a man, to whom nothing of that has been refused, in which consist all the preliminaries of granting every thing? She may indeed refuse him the sacrifice of her virtue, if he should think it worth designing upon, but how few things else could she refuse him? Once more the greater value she put on the sacrifice of so much of her modesty, the less would she be able to deny him any thing else, as any thing else must comparatively appear so inconsiderable.

But hitherto I have spoke only of those outrages and dangers to modesty from the preparatory attendance of the man-midwife as occasion may require, during the pregnancy. But as to his officiating in the crisis of the labor-pains and delivery, there are two very essential points of consideration.

The first. The modesty of the women, unaccustomed to the approaches of other men than a husband, must be in great sufferance in the moments of their labor-pains. All Nature agonizes in them. They are at once weakened in the flesh and in the spirit. The bare presence of a man to officiate at such a time, may excite in them a revolution capable of stopping the labor-pains caused by the expulsive efforts of delivery, which thus becomes dangerously retarded, and may so overpower them, as to put them in the greatest peril of their lives. This is what has often happened. You may see frequent examples of this revolt of Nature against the ministry of men-midwives in Dr. La Motte himself, a man-midwife. If Nature then suffers so much in women at that juncture, when a person, nay even of the same sex, offers her aid, in certain indispensable occasions, to which humanity is subjected; how greatly must the presence of a man increase their constraint and embarrassment, and rob them still more of that so necessary freedom in the animal functions! But how greatly ought the women to thank that their instinctive repugnance of Nature to such a prostitution of their persons, if they consider those tortures, which, by the listening to that same repugnance, may at once be saved to their modesty, and to their personal feeling. Let them paint themselves the following posture prescribed by a man-midwife. “The patient must be commodiously placed, that is to say, on the bed-side, her thighs raised and expanded, her feet drawn up to her posteriors, and kept steady in that posture by some trusty helpers.”[^[25]] Levret, p. 161. On the use of the new crooked forceps. Here it may be said; “why there is nothing in this attitude, however shockingly indecent, but what may be sanctified by the extremities of necessity”. Very well. But what must a husband, what must a wife think at her being spread out in this manner, under the hands and eyes of a man-practitioner, with his helpers, perhaps his trusty apprentices, only for the experiment of a forceps of a new invention, the merit of which too is a so contested an one, that Levret himself is forced to own that, “that same FORCEPS would be[^[26]] an instrument of pure SPECULATION, and not of PRACTICE, IF (N. B. that IF) a certain general precept should be true,” which, by the by, is most certainly so! So that, in this case, for example, you see how a woman may be treated, only to ascertain the merit of some new-fangled gimcrack of an instrument. But to how many occasions of as little, or even less necessity than this, for putting a woman into postures of this sort, might not wantonness, interest, or other motives give birth? Or can pretexts for such insults to modesty be wanting to designingness?

The second consideration is this. Those moments of weakness of spirit, and infirmity to which the labor-pains subject the women may, in some of naturally the weakest of them be, liable to leave impressions in favor of a man-midwife, the less suspected of harm, and consequently the more dangerous for their being suggested by that gratitude for his imaginary[^[27]] contribution to their deliverance, which is itself a virtue, though the object of it is so miserably mistaken by them. Let any one image to himself what must often happen in Nature, a woman sinking under her pains, her mind all softened and overpowered with her present feelings, and looking up for relief to the man, employed, as she imagines, to procure it her, though the real fact oftenest is, that he will not have enough prevented her pain, or perhaps greatly occasioned its increase. Of this however she knowing nothing, sees him in the amiable light of her deliverer from her actual and intolerable state of pain. In the mean time, those aukward uncouth endeavours of his to relieve and deliver her, even though they should aggravate her torture, pass upon her for master-pieces of art or skill. “Who would be without a man-midwife?” At length, Nature sometimes, even in spite of all his omissions, or bungled operation, proceeds in her favorite task of delivery, that is to say, if he has not hurried or made tragic work of it, with his mispractice or his instruments. The patient then is rid of her burthen, and what are then her feelings? Those of exquisite delight, from the comparison with what she was induring but the instant before. It is a transport of joy, not unmingled with gratitude, to the person to whom she fancies herself in any measure obliged for it. The ugliest wretch on earth, so he could but be imagined the cause of such a delivery, would, in those instants, assume in her eyes the form of Loveliness itself. Even with the greatest innocence of heart she could hug, she could kiss him in the ebullitions of her joy and gratitude. Let no one imagine these expressions are over-strained. Such a rapture of felicity, in the sudden case of being taken as it were down from a rack, is not of a Nature to know any bounds of moderation, nor can be conceived but by those who have felt it. Her gratitude would even extend to inanimate things, much more to the dear Doctor, to whom she conceives she owes so much. She eyes him with all the intense eagerness of a gratitude so fond, that its transiency into a passion of another nature would not appear such a prodigy, to those who consider how apt passions of tenderness are to confound motives and run into one another. The melting-softness of those moments of infirmity and weakness of spirit, affords a susceptibility of impressions, which may not afterwards be so soon worn out, and of which the usual affection from the difference of sexes, in the parties, may sooner or later come in for its share. Dr. Smellie has, as I have before observed, implicitly allowed the possibility of a temptation to men, and shall I not follow his laudable example of candor, and confess that there may also be weak women?

It is indeed true that in cases of extremities, such as most certainly are not the frequentest ones, any thought of immodesty may be intirely out of the question. The sad and suffering state of a woman agonizing with pain, at the gates one may say of death, leaves little room for licentious temptations. But, once more, those cases are much the rarest: and even in those, the greater the danger will have been, the greater must the gratitude afterwards be for the imaginary service, that will be supposed to have accomplished the deliverance. Let a midwife have really rendered that service, the gratitude will scarce be so quick, so lively or so lasting, only because she is not a man.

If it shall be here objected, that the men-midwives ought to be above all suspicion or scandal of this sort; I shall only say, that at least it is their interest to appear so. But they themselves will not pretend to an exemption from temptation, nor can answer for themselves that such a temptation may not come into existence, as that all their virtue, fortified by the divine precept before quoted from Dr. Smellie, may not defend them from yielding to it. They are not, or at least ought not to be men in years for obvious reasons as to that manual practice of theirs which at the best is so indifferent. Let any one then consider the consequence of this worse than unnecessarily putting young women, in such manner, into the hands of men in the vigor of their age. Let any impartial person but reflect what barriers are thrown down, what a door is opened to licentiousness, by the admission of this so perfectly needless innovation. Think of an army, if but of barely Dr. Smellie’s nine-hundred pupils, constantly recruiting with the pupils of those pupils, let loose against the female sex, and of what an havock they may make of both its safety and modesty, to say nothing of the detriment to population, in the destruction of infants, and I presume, it will not appear intirely in me a suggestion of private interest to wish things, in this point, restored to the old course of practice of this art of midwifery by women. A course which Nature has so self-evidently established, in her tender regard to the female sex, and to its darling offspring, and in which she has not less consulted one of her primary ends, the Good of Society, in the greater security of the conjugal union and property, which ought to be so sacred, and especially so, for the honor of the human understanding, from the invasion of an upstart profession, sordidly mean in its motives, infamously false in its pretences, shamefully ridiculous in its practice, and yet dreadfully serious in all its consequences.