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Birth attendants and birth outcomes in the Victorian and Edwardian eras

Birth attendants and birth outcomes in the Victorian and Edwardian eras

This research page gathers together work by Dr Alice Reid relating to birth attendants (midwives and doctors) and their relation to perinatal and maternal mortality in Victorian and Edwardian England and Scotland.

Jump below to:

  1. Birth attendants and Birth outcomes in Derbyshire
  2. The geography of maternal mortality in England and Wales in the early twentieth century
  3. Doctors and the certification of maternal mortality in late nineteenth century Scotland

Birth attendants and Birth outcomes in Derbyshire

Puerperal fever notifications

Puerperal fever notifications, per 10,000 deliveries to each attendant type, Derbyshire
Source: Derbyshire MOH Reports

These records, which were made machine-readable as part of a Wellcome Trust funded PhD, consist of registers of notifications of birth for Derbyshire between 1917 and 1922, covering all notified births and supplemented by un-notified births which were then registered. The name of the delivery attendant is given, together with any mortality of mother or child, and a variety of socio-economic and demographic information. Midwives have been traced to the Midwives Roll which provides their address and any qualifications.

Two papers have been published using these data:

Alice Reid (2012), 'Birth attendants and midwifery practice in early twentieth century Derbyshire', Social History of Medicine, 25(2): 380-399, doi:10.1093/shm/hkr138.

Abstract: The 1902 Midwives Act introduced training and supervision for midwives in England and Wales outlawing uncertified-and-untrained midwives (handywomen), and phasing out certified-but-untrained, bona-fide midwives. This paper compares the numbers and practices of these two different types of birth attendant with qualified and certified midwives and doctors in early twentieth-century Derbyshire during this period of change, and examines the spatial and social factors influencing women's choice of attendant. It finds that the new legislation did not entirely eliminate continuity in traditional practices and allegiance, and that both social and spatial factors governed the choice of delivery attendant, with fewer midwives available in rural areas and a surviving network of untrained bona-fide midwives in mining communities. Within this spatial pattern, however, wealthier women were more likely to have chosen a doctor, doctor and handywomen combination, or a qualified midwife.

Alice Reid (2012), 'Mrs Killer and Dr Crook: birth attendants and birth outcomes in early twentieth century Derbyshire', Medical History, 56(4): 511-530. DOI: 10.1017/mdh.2012.30.

Abstract: After the passing of the 1902 Midwives Act, a growing proportion women were delivered by trained and supervised midwives. Standards of midwifery should therefore have improved over the first three decades of the twentieth century, yet nationally this was not reflected in the main outcome measures (stillbirths, early neonatal mortality and maternal death). This paper shows that there was a difference in the risks associated with delivery by the different attendants, with qualified midwives having the best outcome, then bona-fide (untrained) midwives, and lastly doctors, even when account is taken of the fact that doctors were called in cases of medical need and may have been booked where a problematic delivery was expected. The paper argues that the lack of improvement in outcome measures could be consistent with improving standards of care among both trained and bona-fide midwives, because increased attention to the rules stipulating when midwives called for medical help meant that a doctor was called into an increasing number of deliveries (including less complicated ones), raising the chance of unnecessary and dangerous interventions.

The geography of maternal mortality in England and Wales in the early twentieth century

Percentage of midwives trained, 1911-14
Percentage of midwives trained, 1911-14
Maternal mortality rates, 1911-14
Maternal mortality rates, 1911-14

This paper is due to be published in Communicating population change: maps, graphs, models and literary imagery, edited by Bill Gould and Philip Rees, a tribute to Professor Bob Woods.

Abstract: Before its major decline in the 1930s, one of the most striking characteristics of maternal mortality was its geographical pattern, with deaths per 10,000 births much higher to the North and West of the Tees-Exe line than to the South and East of it. The factors underlying this pattern have never been systematically explored, and this paper uses maps and regressions with data for administrative counties and county boroughs to investigate the roles of the availability of doctors and of trained and untrained midwives, infection in urban-industrial areas, background mortality, and registration issues on the geography of maternal mortality. It finds that industrial structure, background mortality and the provision and training of midwives were important explanatory variables, and suggests that both finer grained variations in midwifery services as well as local differences in the quality of cause of death recording might also affect the regional pattern.

Doctors and the certification of maternal mortality in late nineteenth century Scotland

Work done under the Wellcome funded project Doctors, deaths, diagnoses and data: a comparative study of the medical certification of cause of death in nineteenth century Scotland.

Maternal deaths per 10,000 births, for different causes

Maternal deaths per 10,000 births, for different causes: comparison between Skye doctors, Skye uncertified and Kilmarnock doctors, 1861-1901

This paper explores the effect of medical provision and medical certification of death on recorded rates of maternal mortality. Taking registered causes of death, maternal mortality in the town of Kilmarnock was about 55 per 10,000 birth events, whereas that on the Isle of Skye was nearly 80. This discrepancy, however, can be almost entirely explained by poor death registration on Skye and paradoxically shows that higher levels of non-certification were associated with more complete capturing of maternal mortality. In Kilmarnock, where almost all deaths were certified by a doctor, around half of all deaths within 6 weeks of childbirth and due to causes directly attributable to or indirectly associated with pregnancy and childbirth were 'hidden' among other causes such as peritonitis or haemorrhage. On Skye, where the causes of a large proportion of maternal deaths were suggested by the informant without medical certification, deaths after childbirth were more likely to be so attributed (although with less precision as to the exact mode of death). Differences in maternal mortality rates may therefore reflect certification practices as much as care during and after the birth.