The Midwife's Tale

by Billie Hunter

  ‘They didn’t put them in cots. Put them in the bed. They sleep all night if it’s in the bed. It won’t sleep if it’s out of the bed, will it.’

  Several of the midwives told us that they do not remember babies dying from cot death. Handywoman Mrs G. had a theory that has since been validated by research:

  ‘And another thing, these days I believe they lay the babies down on their face. Well, I don’t believe in that. We never put our babies down on their face, always on the back so that they can get the air. No wonder there are so many cot deaths, poor little mites! ‘Cause I mean what sense has he got to turn himself over, he’s not that clever. We never had no cot deaths.’

  Breastfeeding

  Mrs G.’s wisdom did not extend to breastfeeding, however; she had no belief in its potential benefits:

  ‘I never fed any of mine. Never had a drop. I fed them on Robinson’s Patent Groats [cereal]. You made it up thin and then they drank it through the bottle. Finest thing to feed a baby on, I think.’

  Josephine M. advocated breastfeeding according to the strict routine recommended by all the literature of the day:

  ‘Demand feeding? Oh no, no – by the clock. Oh no, this demand feeding is a lot of nonsense! You take, for instance, yourself [to Billie]. You’ve got a baby, you’ve got a kitchen, you’ve got a husband. You’ve got a dinner to get, you’ve got your washing to do, your ironing – how can you drop tools every five minutes and feed a baby? It’s a lot of nonsense.’

  Breastfeeding at predetermined intervals was by no means advocated by all midwives. Most midwives working in the community admitted that they knew that the officially advocated four-hourly, carefully timed feeding routine – still advocated until the early 1980s – was counterproductive. Take, for instance, Mary W., working in Yorkshire:

  ‘I never really insisted on clock feeding because you were fighting a losing battle anyway. If you can get a baby going by the clock, all well and good, but if you can’t, you can’t. Some babies you can. We used to get a lot of breast abscesses. You can’t imagine what it was like because you had to poultice them and then the doctor had to open it and drain out the pus – and then subsequent babies it was difficult and very often they couldn’t feed.

  ‘I think it was so common because they used to get cracked nipples. And I’ll tell you what else – if they used to get engorged breasts women would say, “Let your husband suck it out”. Well, you only had to have dental cavities and your infection was there to start with. We used Vaseline or lanolin on cracked nipples, but often they’d stop breast-feeding on it.’

  Katherine L. and her sister, Margaret A., remembered advising women to use lead nipple shields to cope with cracked nipples:

  ‘For cracked nipples we used these lead shields – that was something from Charlotte’s [Queen Charlotte’s Hospital], wasn’t it? It was marvellous, but mind you, it became unpopular because of the lead. It’s a bit hazardous but it clears them up ever so quickly. A piece of soft lead in the shape of the nipple sort of gouged out of it, which you put over a crack – and it was incredible how they would heal underneath it. But you had to be extremely careful and you daren’t give them to a mother that wasn’t sensible. You had to make sure she was going to clean herself to get rid of the lead, clean herself beforehand. Otherwise, baby would be sucking lead. They wore them in between feeds. It was the lead that cured the cracks, like a lead lotion, and it also kept the clothes from rubbing on the nipple.

  ‘If you weren’t going to breast-feed – and it’s all a question of fashion – then they’d give them Stilboestrol [synthetic oestrogen] to dry up the milk, and that would make them go all smelly and nasty. They don’t give that anymore, do they, because of the risks of cancer. It was ever so common in our day.’

  Mary W. mentioned the decline in breast-feeding due to women’s need to work, as described in Chapter 9:

  ‘A lot of these women went out to work, and then the mothers looked after the babies and it was so much easier for the mothers to use a bottle. Also, the doctors weren’t very good about insisting on breast-feeding and they’d say, “Oh, well, put it on the bottle”. They’d start off breastfeeding, and then you’d find they’d given up by the end of the month. Dried milk was on by then, but a lot used cow’s milk. I tell you what a lot of them used to use and couldn’t get them away from it – Nestle’s condensed milk.’

  Powdered milk companies were beginning to advocate artificial feeding for babies in the 1920s. Advertisements extolled the virtues of drinks such as “Glaxo” for both mother and baby. Nursing Notes, the midwives’ journal of that day, had the following advertisement:

  ‘Find in Glaxo a most valuable aid. Taken regularly two or three times a day by the mother herself (both before and after the birth of her baby), Glaxo not only maintains the mother’s own strength without taxing her digestion, but also enriches and increases the flow of breast milk. This is because milk makes milk, and Glaxo is the nourishing solids of the finest milk and cream made germ-free and comfortably digestible by the Glaxo Process.

  ‘Should the breast milk fail from any cause, or not nourish Baby satisfactorily, Glaxo can be given to Baby in turn with the breast or as the sole food from birth, for it contains everything to nourish Baby and nothing to cause him harm.’9

  Postnatal depression

  Mary W. countered the popular notion that women did not have the time for postnatal depression. When the subject was broached, she gave us two examples:

  ‘I have seen some. This girl, ever such a nice girl she was, she had delusions – thought the baby wasn’t being looked after properly and that the woman who was looking after her wasn’t doing her work properly. And I thought – “This girl is curious”. So I said to the doctor, “I want to watch this girl. I think she ought to go into hospital somewhere. I think she’s going in for puerperal insanity.” He got somebody out and they certified this girl, which I didn’t think ought to have been done. She went into a mental hospital – and she’s never been out since. This must have been 40-odd years ago or more [the 1940s]. Of course, nowadays they would probably have given her shock treatment.

  ‘I had another one. She had, not a puerperal depression, but a condition anyway. She was lethargic, you know, and she’d previously had a baby that she’d gone queer with. So this same doctor got this psychiatrist out (they had a business, you know) and he gave her shock treatment at home. And she’s been all right since. So I said to the doctor afterwards, “Have you said anything to her husband about not having any more children?” He said, “No, why should I?” And I said, “Well, I think you ought. This woman ought not to have more children. If she’s had two puerperal insanities she oughtn’t to have any more children.” But it hadn’t occurred to the man himself.

  ‘Actually we have had puerperal depressions and so forth from time to time, but it was not very common. As I say, they just didn’t have time to be depressed in the old days.’

  It is likely that, as today, a lot of postnatal depression went unrecognised. Women with severe psychosis were hospitalised but, unlike today, many women were never discharged from psychiatric care.

  The art of midwifery

  Whatever we may think about the attitudes of some of the midwives quoted in regard to their practice, there can be no doubt that they were true practitioners in their own right and that they understood the tried and tested midwifery art of patience. What also comes across is the industrious nature with which they approached their work.

  Subsequent to the authors’ own midwifery training, there have been many shifts in practice. For example, there is a move afoot towards creating a more ‘woman centred’ approach with less intervention in what, for most women, is a normal, healthy process. Already, the prophecy of Edie B. is coming true:

  ‘I’ve seen lots of changes. Sometimes I wonder if it’s all carried too far. I’ve got an awful feeling that you’re going to drop some of it later – maybe I shall never see it – but I think it’s all gone a bit too fa
r.’

  Whatever changes in midwifery practice and ideology have taken place over the years, there are basic attributes acknowledged as important by midwives of all generations. When asked about the important qualities for a midwife to possess, the following were some typical responses:

  ‘Understanding. It’s no good just learning theory. Practice is the thing.’ [Edie B.]

  ‘I think you need some commonsense. You need to find a way to get on with people and not be too bossy. And you’ve got to be able to instil confidence.’ [Elsie B.]

  ‘Kindness for one thing. You have to be in sympathy with the woman. And patience and love of the job.’ [Elsie K.]

  ‘You’ve got to be capable of working on your own in adverse circumstances, make up your own mind and, having done it, carry it through. And if you’ve made a mistake, you can’t afford to put your head in the sand and say, “How awful!” You have to learn by your mistakes. This I think is what it is all about.’ [Mollie T.] ‘Practical, down-to-earth knowledge is important, but it’s having the right attitude that’s so important, too. You have to be their friend. If you can befriend a mother and get her on a level with you, there’s an understanding and you’re both far better off. I think the midwife in her own mind should remember that the mother is important to her. She, the midwife, is not the most important person. She isn’t. The mother is the most important person.’ [Esther S.]

  ‘Elsie was always cheerful. She was chirpy, very sociable but she wasn’t rowdy. She wasn’t loud. She was thoughtful and she looked after the women. There was never a cross word.’ [Mary T.]

  ‘I think the most important thing is liking the mother. You know, when somebody comes and sits on your couch and says they’re going to have a baby, you think, “Oh, you’re going to see something come into the world from this mother”. And you get extremely fond of your patients – well, some of them you don’t – but mostly you have a feeling for them, don’t you? Even the tarts of the village. Oh, we’ve had some marvellous tarts, haven’t we, Marg!’ [Katherine L.]

  ‘Patience, tact and sympathy – the whole charter if you’re going to do it satisfactorily.’ [Elizabeth C.]

  Postscript: a tribute to the women and midwives in this book

  ‘I feel as tough as nails. I don’t inwardly. Inwardly, I feel very, very sad, terribly sad. But outwardly, I always put on a show. It doesn’t matter what might happen. Come what may, I always put on that show. Sometimes I feel like a clown wending my way through life, you’ve got to giggle and laugh – and inside it bleeds for such a lot of things. But then, once again, it’s life, it’s all happened – and crying now won’t help.’ [Edie M.]

  ‘Having a baby with Nurse Walkerdine, I can’t express it. It was marvellous, just marvellous. She was an angel through and through. If you needed bed clothes, that nurse found them. In them days, you often relied on neighbours if you never had nothing. And Nurse W. always found things for you. She’d say, “We’ll see if we can find you some bits”.’ [Sissy S.]

  ‘Recently, I’ve been thinking about how midwifery has developed over the years since the days of the handywoman. I think one always remembers the worst, and after that the best, and nothing in between. I can’t think that people have changed at all over the years, perhaps slightly different proportions. I should think we’ve probably still got a very small quantity of “Sairey Gamps”, but undoubtedly the average is always tending upwards and I think that of the upper echelons of the elite there are some of those that are extraordinarily competent and some that are very academic. This hasn’t changed a great deal, but that the academic lot wouldn’t have been there in Dickens’s time. We’re talking about human beings, and they haven’t changed. Even with good training, you always have the bossy midwife with the best intentions and yet apparently totally unfeeling in everything she says and does. I suppose we’ll always have that person, and you’ll always have somebody trying to tone them down, too. You can try to influence them in training. You can try to counsel them out of midwifery, but the difficulty is, they’ll very probably want to stay because it offers independence.

  ‘I don’t know whether you go into midwifery because you’re a bit of a square peg in a round hole or whether you get like it. Maybe it’s a bit of both, but midwifery has always attracted individualists.

  ‘You learn a lot as an observer of midwifery. It sounds as though I’m painting a very negative picture – I suppose being a teacher of midwives as well, one is well aware of the need to change or correct something – but I think that over the considerable amount of years that I’ve been observing, the overall impression is that I’m surprised that midwives do so much and so well in such adverse circumstances.’ [Mollie T.]

  Methodology: using oral history in midwifery research

  At the time of writing the first edition of The Midwife’s Tale, traditional textbook history rarely dealt with the everyday, commonplace experiences of most people’s lives. It focused on events – often using interviews or diaries of government ministers or members of the royal family. At that time it was relatively rare to read about what went on behind the scenes: how ordinary people felt, what they wore or ate, or the details of everyday life. Most of all, women’s experiences were absent, often because they were never recorded in the first place. Whole areas of women’s history had been ‘forgotten’.

  It seemed to us, as practising midwives, that there was a very particular gap in midwifery history. Some excellent historical overviews had been written, documenting the evolution of the midwifery profession at that time but no one appeared to have recorded the testimonies of women who worked as midwives in the first half of this century. This period is especially important since many changes in midwifery practice and legislation were occurring that were significant in the development of the profession.

  Getting started

  We decided to interview retired midwives and women who gave birth in the first half of this century, in order to try to piece together a more complete picture of the lives of childbearing women and those who attended them. The formation of the National Health Service (NHS) in 1948 brought dramatic changes, so this seemed a natural boundary for our research. We also decided to limit the interviews to people living in the British Isles. Encouraged by our first interviews with retired midwives whom we knew, we decided, in 1985, to collect more testimonies and shape them into a book. At this time, it was not considered necessary to seek ethical approval for this type of study. We sent letters to the Midwives Chronicle, as the Royal College of Midwives journal was known at that time, to midwives who attended the retired midwives’ Christmas party at the Royal College of Midwives and to the local papers asking for potential interviewees. We visited two day centres for the elderly and discussed our project with women there. The response was encouraging.

  The interviews

  With one exception – Ken W., whose vivid memories of his mother, a handywoman, form an important testimony – all of the interviews were with women. Each interview took place in the interviewee’s home, apart from two, which took place in the day centres. Before starting each interview, we agreed a length of time that it would last, bearing in mind that elderly people often tire easily and that we were guests in their homes.

  We made sure that the interviewees understood that we would be using the material for publication and explained that we would use their first name plus the initial of their surname in any published text in order to preserve their anonymity. We asked if we could use a tape recorder during the interview to avoid the intrusion that can be caused by the constant use of a notebook. Although some people felt initially nervous about this, they expressed surprise, in retrospect, at how quickly they forgot its presence once the interview was underway.

  We prepared a checklist of topics to cover, but as our confidence in interviewing developed, we referred to it less and less. We learned that asking open-ended questions and allowing silences resulted in far richer material. We also learned that sometimes you have to ‘s
top the flow’ tactfully, for instance after ten minutes of monologue about variations on ‘baby’s layette’.

  The midwives’ testimony

  Interviews with the midwives were often enhanced when a two-way process of discussion about midwifery practice was allowed to develop. Our contemporary experience was often of interest to the older women, and memories would be triggered as we compared notes about the similarities as well as the changes that have occurred over the years.

  Most midwives we interviewed had spent the whole of their working lives in the profession. They had a strong sense of professional identity and still read the Midwives Chronicle to keep themselves up to date. Usually, they were very enthusiastic and eager to reminisce and it seemed as if the interview gave them a chance to relive their experiences and to re-establish their sense of self-worth.

  We were amazed at the detail of the midwives’ memories and particularly at their ability to recite whole paragraphs of midwifery textbooks verbatim – details they had learned 60 years previously, repeated with the rigid conviction that had been expected of them all those years ago. This ‘going by the rules’ approach was disappointing, as we had approached the interviewing with a naive expectation that we would be uncovering a host of forgotten skills, a treasure chest of tips and ideas. Our romantic expectations were to be dashed in other ways too. We were often shocked, for example, by the authoritarian manner of the midwives. Many implied that they would go into women’s homes and lay down the law in order to ‘educate’ people. As one midwife put it: ‘They had to be taught to be good mothers. Some of them were very foolish and irresponsible.’

  On the whole, the working-class midwives we interviewed appeared to have more empathy with the women they attended. They talked more openly and appeared to enjoy telling stories. We are aware that, therefore, a large part of the book is shaped around their testimony and also that this class difference might have been due to the particular women who agreed to talk to us.