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Demography and the midwives: deliveries and their dénouements in north Shropshire, 1781–1803

Published online by Cambridge University Press:  07 September 2010

ALANNAH TOMKINS
ALANNAH TOMKINS
Affiliation:
School of History, Keele University.
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Abstract

This article uses the evidence of midwifery deliveries to investigate the strengths and shortcomings of parish registers, and to pose questions about infant and maternal mortality. It focuses on the delivery notebooks of Thomas Higgins, a man-midwife of north Shropshire, but also employs comparators from Staffordshire and Yorkshire. The research incorporates a technique for dealing with infants where neither a baptism nor a burial can be found. The findings include rare evidence about rates of stillbirth and maternal mortality, and suggest some adjustments to the assumptions made for conducting parish reconstitutions.

Démographie et sages-femmes: les accouchements et leur dénouement dans le shropshire du nord, 1781–1803

Etant donné le rôle des sages-femmes dans les accouchements, l'auteur en tire parti pour analyser ce que sont les points forts et les points faibles des registres paroissiaux ainsi que pour aborder la question de la mortalité infantile et maternelle. Elle analyse en particulier les carnets d'accouchements de Thomas Higgins, un accoucheur du Shropshire du Nord, mais se réfère aussi, pour comparaison, à des données analogues du Staffordshire et du Yorkshire. Cette recherche s'appuie donc sur une technique permettant de traiter le cas de jeunes enfants pour lesquels on n'a retrouvé aucune donnée mentionnant baptême ou décès. L'auteur a pu dégager des informations peu courantes concernant le taux de morts-nés et de mortalité maternelle et suggère quelques corrections à apporter à la façon dont sont conduites les recherches faites à partir des registres paroissiaux.

Demographie und hebammen: entbindungen und deren denouement im nördlichen shropshire, 1781–1803

Dieser Beitrag untersucht auf der Basis der Eintragungen über die Entbindungen durch Hebammen die Stärken und Schwächen von Pfarrregistern und fragt nach Säuglings- und Müttersterblichkeit. Besonderes Augenmerk gilt den Notizbüchern von Thomas Higgins, einer männlichen Hebamme im nördlichen Shropshire, aber zieht auch Vergleichsfälle aus Staffordshire und Yorkshire mit ein. Als Forschungsergebnis kommt auch eine Technik zur Erfassung von Säuglingen zur Sprache, für die weder eine Taufe noch eine Beerdigung verzeichnet ist. Zu den Ergebnissen zählen ferner Befunde zur Verbreitung von Fehlgeburten und der Sterblichkeit im Kindbett, die sonst kaum greifbar sind und die gewisse Modifikationen der Grundannahmen bei der Erstellung gemeindlicher Rekonstitutionsstudien nahelegen.

Type
Research Article
Information
Continuity and Change , Volume 25 , Issue 2 , August 2010 , pp. 199 - 232
Copyright
Copyright © Cambridge University Press 2010

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References

ENDNOTES

1 E. A. Wrigley and R. S. Schofield, The population history of England 1541–1871: a reconstruction (Cambridge, 1981).

2 E. A. Wrigley, R. S. Davies, J. E. Oeppen and R. S. Schofield, English population history from family reconstitution, 1580–1837 (Cambridge, 1997).

3 J. T. Krause, ‘The changing adequacy of English registration, 1690–1837’, in D. V. Glass and D. E. C. Eversley eds., Population in history: essays in historical demography (London, 1965), 385. See also P. Razzell, ‘The evaluation of baptism as a form of birth registration through cross-matching census and parish register data: a study in methodology’, in P. Razzell ed., Essays in English population history (London, 1994), 82 and passim.

4 Woods, R., ‘Lying-in and laying-out: fetal health and the contribution of midwifery’, Bulletin for the History of Medicine 81 (2007), 730–59CrossRefGoogle ScholarPubMed: Woods specifically calls for new evidence about obstetric experiences in addition to that available from the records of lying-in institutions (p. 753).

5 For a characterization of cohort studies as ‘simple’, see Wrigley, Davies, Oeppen and Schofield, English population history, 569.

6 Berry, B. M. and Schofield, R. S., ‘Age at baptism in pre-industrial England’, Population Studies 25:3 (1997), 453–63CrossRefGoogle ScholarPubMed.

7 R. S. Schofield, ‘Did the mothers really die? Three centuries of maternal mortality in “the world we have lost”’, in L. Bonfield, R. M. Smith, and K. Wrightson eds., The world we have gained: histories of population and social structure (Oxford, 1986); Woods, R., ‘The measurement of historical trends in fetal mortality in England and Wales’, Population Studies 59:2 (2005), 147–62CrossRefGoogle ScholarPubMed.

8 Wrigley, E. A., ‘Births and baptisms: the use of Anglican baptism registers as a source of information about the numbers of births in England before the beginning of civil registration’, Population Studies 31:2 (1977), 281–312CrossRefGoogle Scholar: 311.

9 I. Loudon, Death in childbirth: an international study of maternal care and maternal mortality 1800–1950 (Oxford, 1992), 532–3.

10 Riley, J. C., ‘Did mothers begin with an advantage? A study of childbirth and maternal health in England and Wales, 1778–1929’, Population Studies 57:1 (2003), 5–20CrossRefGoogle ScholarPubMed.

11 A. Tomkins, ‘The registers of a provincial man-midwife, Thomas Higgins of Wem, 1781–1803’, Shropshire Record Series, 4 (University of Keele, 2000); A. Tomkins, ‘Who were his peers? The social and professional milieu of a provincial surgeon-apothecary, 1781–1803’, Journal of Social History (forthcoming).

12 Shropshire Archives, Shrewsbury, 1848/44.

13 Fortunately, this study is supported by an excellent series of published parish registers: Shropshire Parish Record Society, Shropshire parish registers, diocese of Lichfield (London, 1901–1942, volumes I, II, V, VII, IX, X, XI, XIX, XX, XXI.

14 There are precedents, though, for studies of this size; see Lewis, J., ‘“ 'Tis a misfortune to be a great ladie”: maternal mortality in the British aristocracy, 1558–1959’, Journal of British Studies 37 (1998), 26–53CrossRefGoogle Scholar.

15 Higgins did not comment on the character of the women's labour, unlike William Waylett who employed a brief notation of ‘quick’, ‘lingering’ or ‘laborious’; see J. Douch, ‘William Waylett (1728–1815): surgeon and man-midwife of Lydd’, The Local Historian (1993), 166.

16 Lane, J., ‘A provincial surgeon and his obstetric practice: Thomas W. Jones of Henley-in-Arden, 1764–1846’, Medical History 31 (1987CrossRefGoogle Scholar).

17 A. Wilson, ‘Childbirth in seventeenth- and eighteenth-century England’ (unpublished D. Phil. thesis, University of Sussex, 1982). I am indebted to Hilary Marland for access to this source.

18 Waylett only noted the use of forceps in five cases out of 2,863; Douch, ‘William Waylett’, 166.

19 Woods, ‘Lying-in’, 754.

20 Wellcome Trust Archive, London, MS 8965.

21 The medical register for the year 1783 (London, [1783]), 108.

22 Frances and Martha Johnson were born in 1768 and 1769, and were baptised at the Presbyterian chapel in Flowergate, Whitby; see www.familysearch.org [accessed 22 January 2008].

23 Whitby Museum Archive, 942.747. Whitby is possibly unique in the history of midwifery, since it was home to two female midwives in the eighteenth century, both of whom left casebooks to posterity. See H. B. Browne, Mrs Katherine Manley: a Whitby midwife 1720–1764 (Whitby, 1947).

24 The simplest explanation for this difference is that she did not need to keep a financial account: it is probable that parents paid her on the spot. Her charges were certainly much lower than those of her male comparators, so there was plausibly less need to extend credit to parents, and it would have been a courtesy to the woman, and part of the traditional ceremony of childbirth, to include payment of the midwife as a part of the events. See A. Wilson, ‘The ceremony of childbirth and its interpretation’, in V. Fildes ed., Women as mothers in pre-industrial England: essays in memory of Dorothy McLaren (London, 1990), 73.

25 E. A. Wrigley and R. S. Schofield, ‘Nominal record linkage by computer and the logic of family reconstitution’, in E. A. Wrigley ed., Identifying people in the past (London, 1973), 75, 88–94.

26 In practice, births could occur less than 270 days apart (see Riley, ‘Did mothers begin with an advantage?’, 8). The shortest interval between two deliveries to the same couple in this study was 307 days (Higgins midwifery casebook numbers 683 and 751).

27 Wrigley, Davies, Oeppen and Schofield, English population history, 433–4.

28 Lewis, ‘“ 'Tis a misfortune”’, 49–51.

29 Wrigley, Davies, Oeppen and Schofield, English population history, 214.

30 Wrigley and Schofield, Population history; Laslett, P. and Oosterveen, K., ‘Long-term trends in bastardy in England’, Population Studies 27:2 (1973), 255–86Google ScholarPubMed; Jones, R. E., ‘Infant mortality in rural north Shropshire, 1561–1810’, Population Studies 30:2 (1976), 305–17Google ScholarPubMed.

31 Jones, ‘Infant mortality’, 311–12.

32 Berry and Schofield, ‘Age at baptism’, 461.

33 Berry and Schofield, ‘Age at baptism’, 458.

34 Krause, ‘The changing adequacy of English registration’, 384–5; Berry and Schofield, ‘Age at baptism’, 461.

35 Wrigley and Schofield, Population history, 89–102.

36 Wrigley, ‘Births and baptisms’, 310.

37 Razzell, ‘Baptism’, 117.

38 Wrigley, Davies, Oeppen and Schofield, English population history, 219.

39 Wrigley, Davies, Oeppen and Schofield, English population history, 221.

40 Wrigley, Davies, Oeppen and Schofield, English population history, 242–8; Lewis, J. S., ‘Maternal health in the English aristocracy: myths and realities 1790–1840’, Journal of Social History 17:1 (1983), 102CrossRefGoogle ScholarPubMed.

41 P. Razzell, ‘Further evaluation of Anglican baptism as a form of birth registration through cross-matching census, parish and civil register data’, in Razzell, Essays in English population history, 147.

42 Jones, ‘Infant mortality’, 309, 314.

43 Wrigley, ‘Births and baptisms’, 292–3. Assumptions made for this simplified, partial reconstitution are themselves rendered more problematic by the Higgins data. For example, it was assumed that children who were named at the time of burial had been baptised whereas, of the 36 Higgins infants whose burials cannot be matched to a baptism, 33 were named and not merely denoted as an infant.

44 See Wrigley and Schofield, Population history, 98.

45 A priority identified in Wrigley, ‘Births and baptisms’, 283, 296. There is no evidence that Higgins became regularly employed in the care of fragile newborn infants, although this was becoming an accepted element of generalized practice; see Lloyd, J. M., ‘The “languid child” and the eighteenth-century man midwife’, Bulletin of the History of Medicine 75 (2001), 641–79CrossRefGoogle ScholarPubMed: 653.

46 Jones, ‘Infant mortality’, 316.

47 Schofield, ‘Did the mothers really die?’, 235.

48 Stillbirths attended by the Greenes could only be considered for the period 1765–1804; stillbirths for Higgins and Johnson were counted for the whole duration of their respective casebooks.

49 Schofield, ‘Did the mothers really die?’, 237, 239.

50 Finlay, R., ‘Distance to church and registration experience’, Local Population Studies 24, 26–40Google Scholar; see also Woods, ‘Lying-in’, 739.

51 E. A. Wrigley, ‘British population during the “long” eighteenth century, 1680–1840’, in R. Floud and P. Johnson eds., The Cambridge economic history of modern Britain, volume 1: Industrialisation, 1700–1860 (Cambridge, 2004).

52 Lewis, ‘Maternal health’, 103.

53 G. J. Kloosterman, ‘Some obstetric comments on Vrouw Schrader's notebook and memoirs’, in H. Marland ed., ‘Mother and child were saved’: the memoirs (1693–1740) of the Frisian midwife Catharina Schrader (Amsterdam, 1987), 36.

54 Johnson recorded premature deliveries (occasionally noting the birth of an eight-month child, for instance) but did not obviously memorialize miscarriages. The Greenes, like Higgins, recorded miscarriages from the fourth month of gestation onwards.

55 Loudon, Death in childbirth, 43.

56 Bland, R., ‘Some calculations of the number of accidents or deaths which happen in consequence of parturition’, Philosophical Transactions of the Royal Society of London 71 (1781)Google Scholar, quoted in Schofield, ‘Did the mothers really die?’, 253.

57 Loudon, Death in childbirth, 141.

58 In 7 cases the crotchet was the strategy for dealing with a narrow pelvis, a typical response to maternal rickets. The Greenes were at odds, however, with nineteenth-century practitioners who used forceps in (at most) 2.7 per cent of cases, and only then by a consultant obstetrician whose records deal exclusively with complex cases; see Loudon, I., ‘Deaths in childbed from the eighteenth century to 1935’, Medical History 30 (1986), 1–41CrossRefGoogle ScholarPubMed: 14–15.

59 Loudon, Death in childbirth, 97, 102–3.

60 Kloosterman, ‘Some obstetric comments’, 31, 37.

61 Wilson, ‘Ceremony’, 73–4.

62 Bland, ‘Some calculations’, 361; Lewis, ‘“ 'Tis a misfortune”’; Woods, R. (‘Medical and demographic history: inseparable?’, Social History of Medicine 20:3 (2007), 483–503CrossRefGoogle Scholar: 496) finds that peers' wives did endure a higher-than-average risk of dying in childbirth. Loudon, though, had reason to question the accuracy of this low maternal mortality from the evidence of published accounts of private practice in the nineteenth century; see his ‘Deaths in childbed’, 18.

63 Loudon, ‘Deaths in childbed’, 19.

64 Bland, ‘Some calculations’, 363.

65 See Schofield, ‘Did the mothers really die?’, 234, for some variations around this length of time.

66 Loudon, Death in childbirth, 22.

67 A further 16 maternal burials can be linked definitely or provisionally within one year of deliveries, giving a maximum maternal death rate of 22.5 per 1,000.

68 Schofield, ‘Did the mothers really die?’, 237, 250.

69 Eccles, A., ‘Obstetrics in the 17th and 18th centuries and its implications for maternal and infant mortality’, Bulletin of the Society for the Social History of Medicine 20 (1977), 8–11Google Scholar: 9.

70 As reported in Schofield, ‘Did the mothers really die?’, 241.

71 With only 21 sets of twins, this result is perhaps unremarkable, but it does help to expose the danger of over-generalization; see Dobbie, B. M. W., ‘An attempt to estimate the true rate of maternal mortality, sixteenth to eighteenth centuries’, Medical History 26 (1982), 79–90CrossRefGoogle ScholarPubMed: 86–7.

72 See Dobbie, ‘An attempt’.

73 Wrigley and Schofield, ‘Nominal record linkage by computer’. The names of both parents are recorded for the baptism of Thomas Forgeham in January 1798, for example, although his mother had been buried the preceding month.

74 Schofield, ‘Did the mothers really die?’, 244.

75 Only one visit involved a woman (named ‘Chester’) whose labour had stopped, and who Higgins did not see again.

76 McIntosh, T., ‘“An abortionist city”: maternal mortality, abortion and birth control in Sheffield, 1920–1940’, Medical History 44 (2000), 75–96Google Scholar.

77 Dobbie, ‘An attempt’, 90; see Schofield, ‘Did the mothers really die?’, 235.

78 Pantin, C. G., ‘A study of maternal mortality and midwifery on the Isle of Man, 1882 to 1961’, Medical History 40 (1996), 141–72CrossRefGoogle ScholarPubMed; Fox, E., ‘Powers of life and death: aspects of maternal welfare in England and Wales between the wars’, Medical History 35 (1991), 328–52CrossRefGoogle ScholarPubMed; Winter, J. M., ‘Infant mortality, maternal mortality, and public health in Britain in the 1930s’, Journal of European Economic History 8 (1979), 439–62Google Scholar. Loudon (‘Deaths in childbed’, 27, 35–41) indicts both midwives and general practitioners.

79 Winter, ‘Infant mortality’.

80 Loudon, ‘Deaths in childbed’, 18.

81 Initial indications suggest that the same could be said of the registers in south Staffordshire, albeit that the sample of deliveries traced there equated to only 10 per cent of the Shropshire material.

82 For example those of Schofield in ‘Did the mothers really die?’.