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

To these I shall add the case of the pendulous belly, which is not without its difficulty.

Of all these classes of labors I shall treat separately. But before I proceed on them, I presume, that it may not be improper preliminarily to corroborate what I have said of the intrusion of the men into the practice of a profession, of the essential part of which they were so ignorant and disqualified for it, by the testimony which one of the best men-midwives in Europe has not refused to the truth.

This is M. de la Motte, one of the ablest and most intelligent modern writers on the subject of midwifery, of which his works form an incontestable proof. The ingenuity and candor with which he has written, must render him less suspected than any other. This is no midwife. He is a man, and esteemed an able practitioner, who learned the principles of the art from Madam la Marche, head-midwife of the Hôtel Dieu at Paris. He made his advantage of the works of his predecessors Mauriceau, Peu, and of all the best authors on this subject. All that was worth it in them he has transfused into his own writings; and that in a very clear manner. He collected whatever the best physicians had usefully said on the diseases of mother and child: in short, he has added many good observations and reflexions of his own, in the journals of his manual practice: the reading of his works, with some precaution however, cannot but be useful to the students of the art.

I do this writer this justice, with the more readiness and pleasure, for, that though he himself exercised the profession of man-midwife, and consequently in favor of his own practice, and of the pupils he was bringing up, was not without the injustice of adopting the prejudices of his cotemporaries too indiscriminately against the midwives; he does not suppress any truth relative to the art itself. But even, as to the midwives, the truth escapes him without any design on his side of its coming out. But such is the force of truth. And thus it appears. M. De la Motte wrote in a little sorry country-town at a great distance from the capital, being at the very extremity of the kingdom of France, on a sea-coast, where there were no other midwives than poor country-women, without knowledge, without skill, or any other qualification, than a little of the habit of attending women in labor. Yet with all these deficiencies it will appear, that the men-practitioners were far more to be dreaded than those poor ignorant creatures, who had scarce any thing but Nature for their guide.

I shall here give the substance of what he says in his preface, followed by some examples of the unskilfulness, or rather of the most profound ignorance of the most able men-midwives of his time, for forty leagues round his place of residence in the country.

“It is (says M. De la Motte) astonishing, that the obstetrical art should, until the beginning of the preceding age, have been left either to ignorant women, or to surgeons, who had not (any more than too many to this day) any other resource in difficult labors, than some instrument guided by undextrous hands, always sure of killing the child, and endangering the mother. Do not these poor innocents deserve compassion for being exposed to operations of surgery, which one would rationally think they could not need, till providence should have at least given them leave to come into the world?”

Here be it observed, that by the word “ignorant,” M. De la Motte should not intend the application of it to the midwives of the Hôtel Dieu at Paris, since, by his own confession, it is the best school of midwifery in Europe. Nor certainly is he in the wrong. Be it in honor of truth allowed me to say, that I know of those women who have served their apprenticeship in this hospital, who would think they made a wretched bargain, if they exchanged the manner of operating they learned there, for all the Latin, Greek, Arabic, or the iron and steel instruments of the best man-practitioner in Europe; even though his excellence in the manual function should be thrown into the scale for make-weight. The most constant success justifies their practice. In whatever situation the fœtus has presented, I have seen them, without having recourse to a man-midwife, and consequently to instruments, procure a happy delivery in very difficult labors. I have myself seen one deliver a child that had been dead in the mothers womb for near six weeks, without dismembering it; and though it was half-putrified, and the head so rotten-tender as to have no solid consistence, I dare advance this, without fear of being falsified, since I can name the mother, now alive in London, the witnesses, the place and year.

Such real midwives as I am here discribing, for I do not mean the spurious nominal ones, only fit to create work for the instrumentarians, or whose cue of interest is to do so, have no reason to apprehend, that in the numbers they have lain, there can be any found, that can complain of having suffered, or of suffering any the least damage or inconvenience, after their lying-in, that might be imputed to ignorance or mispractice.

On the contrary, I dare aver, that such, genuine midwives have cured many women who had received notable injury, before they came under their hands, in their having passed through those of the men-practitioners. Nothing being more agreeable to Nature, to Reason, to Experience, than that the method of practice of a skilful midwife is not only the most easy and gentle, the least painful, but assuredly the most safe both for mother and child. This is what the most severe examination will to those, who give themselves the trouble of making it, establish, in contempt of that fashion, by which so pernicious an error, as that of preferring men-practitioners, has acquired more credit and influence than so salutary and demonstrable a truth, as that for which I am contending. In the mean time, let us hear what M. De la Motte himself, a man-midwife, says of those brethren of his, of whom heaven grant there may not exist to this day too many resemblers!

“To the shame (says M. de la Motte) of the profession they exercise, they have no guide but their avarice, while the grossest ignorance of the art of midwifery itself is their lot. Such are much to be dreaded by women in difficult labor; for (adds he) they having no help to offer them but that of their instruments, they employ them indifferently in all the situations in which the fœtus presents. Nay, even the hands of some who will use their hands, are not less dangerous when misconducted. The ignorant therefore should never meddle with lyings-in. It would save them from the reproach they may incur of murder, in undertaking what they cannot execute, and what surpasses their skill. They would not furnish scenes that make one shudder with horror.