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Today, when most Western women are delivered in hospital maternity departments, it is not always appreciated that in historical terms childbirth is a recent addition to the medical curriculum. Until the late seventeenth century on the Continent and the early eighteenth in Britain, childbirth was not so much a medical as a social occasion, like weddings and funerals. At births, deaths, and marriages there was usually an 'official' or 'expert' (priest, undertaker, midwife), but the event centered around the immediate community of family and friends. Childbirth, however, differed in one important respect. It was exclusively female. The mother chose a midwife and a group of friends (the 'gossips') to attend her delivery. Men were rigorously excluded, unless some complication arose which left no alternative but to call in a surgeon to use the crude instruments available at the time to deal with an obstructed labor. It follows that before the eighteenth century medical practitioners knew very little about the nature or management of normal and abnormal labor. Only a handful of men such as Francois Mauriceau (1637-1709) in Paris and Hendrik van Deventer ( 1651-1724) in Holland had made a special study of childbirth and its complications and could therefore be thought of as the obstetricians of their day. But only a tiny and negligible proportion of women were attended in labor by a doctor.

In short, midwifery was in the hands of women, and until recently we knew very little about the history of midwives. Everyone has heard of Sarah Gamp, and it is sometimes imagined that, if she was typical of the nineteenth century, midwives in earlier periods were probably worse. While there is no doubt that there were always ignorant and illiterate midwives, the more we learn about early midwives the more impressive they seem. By the mid-fifteenth century municipal councils in Germany were overseeing and licensing midwives. In seventeenth-century Holland it is clear that the midwife was recognized as an important and respected member of the community on whom the welfare of mothers and babies and the future of the population of a prosperous country depended. By 1656 the surgeons' guild and the town council in Delft were responsible for ensuring that midwives were educated women and members of a respectable craft or profession, and by the eighteenth century Dutch midwives who applied for a licence had to be women of good name and reputation, legally married or a widow, with children of their own. Moreover, they had to be strong and healthy, able to read and write, and they served a long apprenticeship. That should not surprise us if we look at the portraits of rich seventeenth-century Dutch burghers and their families, with their clothes, furniture, and immaculate houses. Would they have entrusted their wives and children to Sarah Gamps? Of course not.

And so it was in most of Europe, especially in Sweden and Germany, where the regulation of midwives by the State probably began earlier than anywhere else. From France we have the memorable story of the midwife Mme du Coudray, a woman of impressive charisma, talent, and literacy with a profound knowledge of the management of childbirth. During the second half of the eighteenth century, King Louis XV, fearing that the population was shrinking, placed the future of midwifery in France in her hands. Armed with a royal warrant, a model of the female pelvis and infant (her own invention), and a remarkable entourage of assistants and servants, she toured almost the whole of France teaching hundreds of students in each region of the country.

Compared with the Continent, England was backward. In most continental countries it was the State or municipalities who were responsible for midwives, and later the same bodies were also responsible for establishing and maintaining lying-in (maternity) hospitals. In England, however, apart from occasional licensing of midwives by bishops (a process in no way comparable to what happened on the Continent), it was not until 1902 that the first Midwives' Act was introduced to regulate the training and practice of midwives. Likewise, in contrast with the Continent, lying-in hospitals in England were 'voluntary hospitals', dependent on charitable contributions. Although recent research has shown that eighteenth-century midwives in England were much more literate and capable than had been generally supposed, continental midwives played a much larger part in the provision of maternal care than the midwives of England before the twentieth century. . .

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