Powers of life and death: aspects of maternal welfare in England and Wales between the wars

Mrs Killer and Dr Crook: birth attendants and birth outcomes in early twentieth-century Derbyshire

After the passing of the 1902 Midwives Act, a growing proportion of 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.

Birth Attendants and Midwifery Practice in Early Twentieth-century Derbyshire

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 each other, with qualified and certified midwives and with doctors in early twentieth-century Derbyshire during this period of change, and examines the spatial and social factors influencing women's choice of birth 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, although wealthier women were more likely to have chosen a doctor or a qualified midwife, familiarity and loyalty allowed bona fide midwives to maintain their case loads.