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

But perhaps I exaggerate. Let the reader judge for himself, and pronounce as his own reason shall dictate to him. Let him if he can read without shuddering, the following quotation from one of the most celebrated men-midwives of the age, Levret, p. 199. “Mauriceau had invented a new tire-tête, which was to be introduced into that part (the uterus). Peu or Pugh, like many others, made use of different hooks (crochets) and La Motte opening the head with scissors, scooped out the brain, &c. We read, with horror, in all these authors, that they have extracted children, who, tho’ much maimed or mutilated, have yet lived several hours.”

Upon this many reflections will naturally occur. These children thus destroyed, owed most probably their death neither to nature, nor to the difficulties of the passage through which the launch is made into our world, but to the labor being prematurely forced, and the delivery effectuated by those torturous instruments, which at once kill the child, and not seldom irreparably wound the mother in the tender contexture of these parts. A midwife, with less learning and more patience than those gentlemen, and well acquainted with the power and custom of Nature to operate in some subjects, sometimes more slowly, and in all ever more safely and gently than art, would have left to nature, not without her tenderest assistance of that nature, the expulsion of the child. A proper predisposal of the passage, and direction of the posture, with an unremitting attention to employ the fingers, so as not to lapse the critical moment of operation, often never to be recovered with safety to mother and child, would have, I repeat it, and appeal to common sense for the probability thereof, saved the lives of those innocents, which thus fell the victims of those learned experiments, with instruments, which, by the way, be it remarked, none are so forward to use, as those who are the loudest in exclaiming against the employ of them. And reason good, if they exclaim against them, it is evidently in order to cover their practice with them, against which the minds of their patients must so naturally be revolted. But that exclaiming does not evidently hinder their being used, when, the truth is, that if due care was previously taken with the patients, those execrable substitutes to the fingers need never be used at all.

But if these instrumentarians were called to account for their so justly presumable massacres, what would be their defence? Most certainly not the truth. One would not own, that in order to attend a richer patient, or perhaps to return to his bottle, he had recourse to his fatal instruments, to make the quicker riddance or effectual dispatch; another would not confess, that he employed them purely because his fund of patience was exhausted; some would not care to allow, that they used them purely on the scheme of trying experiments; and none of them would, you may be sure, plead guilty of ignorance of better and more salutary methods. No! their wilful error, or that want of skill, they would be sure to conceal under the cloud of hard words and scientific jargon, in which they would dress up their respective cases, and insult the ignorance of those silly good women, who know no better than to deliver those of their own sex with the help of their fingers and hands, and who are so undextrous, as to have no notion of putting them to such unnecessary tortures and risks, as are inseparable from the use of those iron and steel instruments. Instruments which rarely fail of destroying the child, or at least cruelly wounding it, and never but injure the mother, not only in those exquisitely tender-textured parts, where they are so blindly and ungovernably introduced; but in the often irrecoverable dilatations of the external orifice, the vagina, and especially the fourchette or frænum labiorum, all which, in general, they considerably damage: and always originally without necessity. For if through carelessness, if through an impatience, so much more natural to men than to women, in a case and position of this nature; if through ignorance of the critical minute of extraction, the occasion of operating with the fingers has not been lapsed, any recourse to instruments is perfectly unnecessary, and they will hardly ever succeed where the subject is inaccessible to the fingers, without having the worst of consequences to dread from them both to mother and child. Nothing then can be worse for a man-midwife, than to be tempted to any negligence, to any precipitation, to any ostentation, in short, of expedition or of superiority of skill to that of the women, by his having those instruments at hands, the doing without which is at once so much better and safer, even by the confession of those who use them nevertheless.

How greatly then is the ignorance of the midwives preferable to such an use, as the male-practitioners commonly make of that deep learning of theirs, which only misleads them, at the expence of humanity! How over-compensated is that want of theoretical knowledge, so unjustly reproached to women, since they profess a sufficiency even of that knowledge; how over-compensated, I say, is that supposed want, by that instinctive keenness of apprehension, and ready dexterity of theirs in the manual operation, which in them is a pure gift of nature, and to which not the utmost efforts of art or experience can ever make the men arrive, for reasons which will be made clearly appear in the two following considerations.

First, It will hardly be denied, that the art of midwifery requires a regular training or education for it. The season of that education can only be that of youth. And surely in that season precisely, the very nature of the study excludes those of the male-sex, at the same time, that there is nothing in it indecent or improper for the females destined to that profession. This proposition will be more clearly illustrated, by an appeal to the reader’s own sense and reason upon what passes, and must necessarily pass in those hospitals for the reception of lying-in women, where those of the male-sex are allowed to attend for the sake of learning the profession.

This Charity is indeed founded upon specious motives, but the conduct of it would make humanity shudder, even where no violence is expressly intended to humanity; and without the least forced or uncharitable conclusion, may serve to demonstrate the impropriety of attempting to throw the practical part of midwifery into the hands of male-practitioners, the implicit consequence of which must be the exclusion of the midwives, without any direct and formal exclusion of them, but purely from the discouragement that will hinder any good and able ones being formed in future. And that no thoroughgood men-midwives, except perhaps two or three extraordinary men in a whole nation, can ever be formed, the procedure at the lying-in hospitals, open to men-pupils, such as it must of all necessity be from the nature of the thing itself, without any the least reproach herein meant to the worthy managers, will convince all who will make an unprejudiced use of their judgment.

We will then suppose a lying-in hospital, in which, for the sake of training up men to the profession of midwives, there are young pupils of the male-sex admitted to attend and learn the practical and manual part of the business. To obtain this end, we will not say that women of virtue and character are subjected to the inspection and palpation of a set of youths, who perhaps pay largely for their privilege of attendance; but we will grant, that the objects of this charity are entirely women, who, though they may have unfortunately forfeited their right to virtue, cannot however have lost their claim to the protection of that humanity, which, besides the great and most political attention due to population, pays especially a tender regard to the innocent burthen, though of a guilty mother. Yet among these wretched victims, there may be not a few who, if they were not even to deserve more compassion than blame, for particular circumstances of their ruin, in which the villainy of men has often a much greater share than female frailty itself, cannot surely deserve that all traces of modesty, or natural remains of regard for it, should be utterly eradicated by that hard necessity of theirs to accept of a charity, by which they must be abandoned up to the researches of a set of young men, to whose approaches their age and sex must alone give an air of petulance and wantonness not to be explained away, to the satisfaction of the poor passive sufferer, by the goodness of the intention. Every one must be sensible of the dreadful effects such a treatment must have on the mind of a poor creature in that condition, when the imagination is known to be the most weak, and susceptible of the most dangerous impressions. At that critical time, amidst all the terrors and apprehensions inseparable from her situation, she is moreover exposed to the greatest indignity that can be well imagined, that of serving for a pillar of manage to break young men into the exercise of that most unmanly profession. Nay, that very circumstance of the use she is put to, which she is in fact to consider as a kind of valuable consideration by her paid for the relief afforded her, and which in that light can scarce be called a charity; that very circumstance, I say, of her submission, at all calls, and upon all pretences of the pupils, being accounted for to her by the good intention of it, will yet hardly pass on a wretched, frightened, harrassed woman, who, whatever may be said to procure her tame acquiescence, can scarcely, if she has a spark of female modesty left in her, be reconciled to the grossness of such usage, whether she considers herself as the butt of wantonness, or the victim of experiments, or perhaps of both the one and the other. It is well if she is defended by her ignorance from any idea of those dreadful instruments, of the having practices tried upon her with which, her circumstances might but too reasonably render her apprehensive, since a needless resort to them may be too often presumed in the course of practice, where the men are even paid for their assistence. These the men-midwives may possibly indeed conceal from the sight of their patients, but I defy him to conceal them from their wounded imagination, if they are not wholly ignorant or can think at all.

Yet in pure justice to all parties it should be observed, that, besides many other points to be learned only by ocular inspection and manual palpation, of which no theory by book or precepts can convey satisfactory or adequate notions, that great and essential point in our profession, a skill in what we call the Touching, is not to be acquired without a frequent habit of recourse to the sexual parts whence the indications are taken. And in this nothing but personal experience can perfect the practitioner. But this admitted, only proves the more clearly the utter impropriety of men addicting themselves to this occupation. For, once more, most certainly the season of acquiring the nicety of that faculty of Touching, besides other requisites in the art, is for obvious reasons that of youth. Now let any one figure to himself boys or young men, running at every hour, and exercising a kind of cruel assault on those bodies of the unfortunate females, upon which they are to learn their practice. But will they learn it by this means? It is much to be doubted. It may perhaps be granted, that men of a certain age, men past the slippery season of youth, may claim the benefit of exemption from impressions of sensuality, by objects to which custom has familiarized them. But, in good faith, can this be hoped or expected in the ungovernable fervor of youth? Can such a stoic insensibility be imagined in a boy or young man, as that he can direct such his researches by pawing and grabbling to the end of instruction only? Must not those researches, humanly speaking, be made in such a disorder of the senses, as to exclude the cool spirit of learning and improvement? May he not lose himself, and yet not find what was the occasion of losing himself? In short, granted, though it is surely hard to grant, that the wretched women, admitted to this so falsely called Charity, may not deserve much tender consideration; but in what can the poor young pupils have deserved so ill of their parents or guardians, as to be thus exposed to temptations so shockingly indecent? What father, what mother, what considerate relation can paint to himself a child, or charge of his, at an age so incapable of resisting the power of sensual objects, as is that of youth, employed in exploring such arcanums, and exploring them too in vain? It is surely easier to guess the natural consequences, than to defend either the subjecting youths to them, or the hoping any good from the subjecting them. In short, even Dr. Smellie’s doll is a more laudable method of instruction.

But besides this reason taken from the moral impossibility of laying a timely foundation of practical knowledge in the male-sex, for preferring women under the false charge of ignorance, to the so unconsequentially boasted learning of the men, there remains a yet stronger argument against the male-practitioners: an argument furnished by nature herself, and of the which, every impartial reader’s own feelings will in course render himself the judge.

Nature has to all animals, from the man down to the lowest insect, to all vegetables, from the cedar to the hyssop, to all created beings, in short gives what is respectfully necessary for them. Nor can it without the grossest absurdity be imagined, that this tender universal parent, or call her by a yet more sacred name, the divine providence, would have failed women in a point of so great importance to them, as that of the ability to assist one another, in lying-in, at the same time, that she has given them so strong and so reasonable a sympathy for those of their sex in that condition? Can it be thought that nature, so vigilant, so attentive, to the production of fresh generations, through all beings, should have been deficient or indifferent as to women, her favourite work, the friend, the ornament of human kind? And so she must have been, if she had left her in the necessity of recourse to others than those of her own sex, in whom there exists so sensibly a superior aptitude for tending, nursing, comforting and relieving the sick, that even the men themselves, in their exigences of infirmities, can hardly do without them. But to say the truth, and as I have before remarked, nature has been even liberal in her accomplishments of those of the female sex for this office. Not content with giving them a heart strong imprinted with a particular sympathy for their own sex, on this occasion, a sympathy, which for its tenderness, has some resemblance or affinity to the instinctive love or storge that parents have for their children; she has also bestowed on them a particular talent, both for the manual function in the delivery of women, and for all the concomitant requisites of their aid during the time of their lying-in: a talent in short, which may even be felt, without the necessity of definition or proof, to be superior to any possible attainment of the men in that art, though they should have sacrificed hecatombs of pregnant rabbits, or have brooded over thousands of coveys of eggs in their search of excellence in it. To say nothing of a certain softness, flexibility, and dexterity of hand, palpably denied to the men, there is, both in the management of the manual operation, and in the attendance due on those occasions, a quality in which the women, generally speaking, excel the men, and that is, patience, a quality more essential, more indispensable than can well be imagined. For on patience it is, that the salvation of both mother and child often depend; whether that patience is considered in the so needful point of predisposing the passages, or of waiting, without however over-waiting, the critical efforts of nature in the expulsion of her burden. Now nothing is more certain, than that nature, who to woman has in general given all that vivacity and quickness of spirit, which seems incompatible with the phlegmatic quality of patience, has, as if she had purposely meant an exception favourable to her darling end, the propagation of beings, especially the human one, bestowed on the female sex, such a remarkable assiduity and diligence in aid of women’s labors, as are rarely to be seen in men, and when seen, appear rather forced than naturally constitutional to them. Women, in those cases, have more bowels for women: they feel for those of their own sex so much, that that feeling operates in them like an irresistible instinct, both in favor of the pregnant mother and of the child. Thence it is, that a woman-practitioner will employ, without stint, or remission, all that is necessary to predispose the passages, for the least pain, and the greater safety; she will patiently, even to sixteen, to eighteen hours, where an extraordinary case requires so extraordinary a length of time, keep her hands fixedly employed in reducing and preserving the uterus in a due position, so as that she may not lapse the critical favorable moment of extraction, or of assisting the expulsive effort of nature: and what man is there, can it be imagined, would have endurance enough to remain so long in a posture, the very image of which, in one of his sex, is so nauseating and so revolting, to say nothing of the want of that pliability and dexterity of management of the fingers, on those occasions, so necessary, and so uncommon in the men, especially in that very age, when their practice should be supposed the greatest.