Childbirth in Regency England

by Donna Hatch
www.donnahatch.com

In Regency England, childbirth was one of the most dangerous threats to a woman’s health and life. Most sources I read claimed that up to 20% of all women died either in childbirth, or immediately following birth, most often due to infection. Many accounts place the infant mortality rate at about the same level. That’s a sobering reality.

After giving birth six times to six healthy babies, I have a deep appreciation for the medical practices of modern-day America. There were complications during two of my deliveries which might have threatened the life of my child and myself but for the intervention of knowledgeable doctors and nurses, as well as technology to provide early warning signs of problems. Unfortunately, our historical counterparts were not so lucky. In fact, in many of the cases I read, including the tragic and fatal “lying in” of Princess Charlotte, the lucky ones were those who gave birth without the interference of doctors, midwives, and accoucheurs.

Based on today’s standards, medical treatment was barbaric, and obstetrics was no exception. Common prenatal care included purges, bleedings, starvation diets, and induced vomiting in misguided attempt to keep the baby from getting too large for the mother to deliver. Such practices were surely factors in the death of Princess Charlotte hours after she delivered a stillborn son in 1817. Charlotte was the only legitimate child of Prince George “Prinny” who later became King George IV.  Princess Charlotte’s death and her stillborn child rocked the country and caused such public outrage that the medical community took a good hard look at common practices and make some key changes. But it took time to create any real improvements.

One such common practice for prenatal care that eventually changed included “lying-in” where the expectant mother remained in bed for a period of time ranging from a few weeks to a few months before giving birth, even if the birth seemed normal with no early labor signs. Though Princess Charlotte was told to get some exercise by walking, this did not appear to be the normal practice. 

Once the mother was in labor, the birthing or lying-in rooms were heated and completely shut up to prevent the flow of air. Fear of drafts causing the mother to catch cold created the practice of building up the fire, putting blankets over all the windows and doors, and covering every crevice. Not only would have that been uncomfortable and not allowed for adequate oxygen but it would have been a breeding ground for bacteria so it likely caused the very problem they were trying to prevent.

Many accounts report the mother lying in bed directly on her back, while only a few cite having the mother lie on her side. Apparently, the upper classes were more likely to lie in beds more than the poor who are generally depicted sitting in birthing chairs. This may have been due to the desire to keep the lady more modestly covered but certainly would have made it difficult to push effectively.

If the mother seemed to be having trouble pushing out a baby, some doctors and midwives during the Regency used forceps. However, forceps were a new invention and few doctors in England accepted their use. Some believe that if forceps had been used for Princess Charlotte, as was originally determined but never carried out, her baby might have lived.

Cesarean sections had been in practice for many years, but generally only if the mother had died and the doctor believed the baby could be saved. This may have been partially due to the fact that people claimed that were was no anesthesia available. However, laudanum and opium were in use many years before for chronic pain and the surgery so I don’t know why it couldn't have been used during a Cesarean for a live mother. Maybe it didn’t matter, because the mother would likely develop infection and die. It makes me wonder how any one survived surgery of any kind considering their lack of knowledge about cleanliness. I have not discovered how successful a C-section was in those days to the baby but I suppose with nothing to lose once the mother died, the doctors were willing to try to save the infant.

If a woman were lucky enough to have survived birth, the next few weeks could still prove fatal. A new mother’s diet for was often limited to warm tea and/or wine for the first several days. A lack of solid food could cause a dysfunctional intestinal system, a condition aggravated by the mother remaining lying in bed for days and sometimes weeks. 

Infection was one of the most common reasons for a woman dying after childbirth. Medical personnel seemed tragically unaware of the need for washing their hands and instruments. The practice of washing hands and instruments, and providing clean linens did not become common until about the 1840’s which lowered the mortality rate from 20% to about 6%.

Childbirth in Regency England was risky enough that two out of ten women and babies failed to survive it, which means most women would have known someone who died during or immediately following birth. Some have speculated one of the reasons Jane Austen never married was due to the potential disaster for mother and child. Three of Jane’s sisters-in-law died in childbirth, according to JOAN AUSTEN-LEIGH in her article My Aunt, Jane Austen. With such a grim family statistic, I might have thought twice about marrying and having children, too.

Once again, researching Regency England serves the dual purpose of providing the information I need for a book I’m writing, as well as making me really, really glad I live in a western nation in today’s world. But I still wish I could visit Regency England :-)

Sources:

http://www.janeausten.co.uk/developements-in-childbirth-in-regency-and-victorian-england/

http://austenauthors.net/really-scary-medicine-in-the-regency-era-2

http://www.jasna.org/persuasions/printed/number11/austen_leigh.htm

History of Childbirth

While Childbirth itself hasn’t really changed over the years, those who care for women in childbirth and the techniques used has undergone many changes. There are significant differences between how male accoucheurs and midwives handled birth. One of them is that male accoucheurs were trained in the use of forceps. By the Regency period, the vast majority of midwives only used their hands. Midwives generally supported old traditions of giving birth (female friends and relatives being present at the birth, stopping up doors and windows, darkening the room, the drinking of caudle) and men were beginning the move away from these rituals and many of them went on at length about "dirty and ignorant midwives". There was a gradually escalating conflict between male-dominated medical institutions and the tradition of midwifery that started before the Regency period and extended to the Twilight Sleep of the early 20th century. Originally there were arguments that it was indelicate for men to preside at a birth, eventually it was argued that it was indelicate for women to do so. Whatever!

By the Regency, most women of the aristocracy and even the gentry were using a male accoucheur rather than a midwife. Women who were of lower classes or very old-fashioned might still use a midwife. The very wealthy sometimes had an accoucheur live with them in the weeks before the due date (the Duchess of Devonshire did so) or they went to London to give birth. They also employed a month nurse whose job it was to take care of the mother before and after the birth. Month nurses often knew how to deliver the baby in case the accoucheur couldn't get there in time.

An excellent book on this subject is IN THE FAMILY WAY by Judith Schneid Lewis.

The ladies in IN THE FAMILY WAY are all either royal or from aristocratic families (many well-known names like Lady Jersey and Princess Charlotte). Adrian Wilson's book indicates well-to-do tradesmen were starting to hire male doctors for their wives, following the trend started by the aristocracy. Remember, these ladies are ones about which a great deal is known because they were prominent, educated, and leaders in Society. These are ladies who would go the more expensive route. Your average middle class and gentry class lady would not have a doctor, especially not in the country. Doctors with skills were rare in the country, and most women were still uncomfortable with a man not their husband touching them so intimately.

The issue of cleanliness applied especially to hospital births. Most women gave birth at home before the 20th century but there were teaching hospitals and maternity wards for the poor. Until the advent of proper antiseptics, puerperal fever claimed many lives. Even those doctors who washed between cases (and a few were smart enough to advocate this) found it was not 100% effective. Midwives who carried a smaller case load were less likely to spread disease because they were more likely to have washed before seeing the next patient.

Even in Russia, they were using doctors amongst aristocrats. But these were few and far between in reality, so one can't conclude from a handful--relatively speaking--of women using doctors instead, that all women used doctors instead. Hospitals were not healthy for births. Doctors went from autopsies to deliveries without washing.

Language about childbirth was changing during the Regency, with "accoucheur" superseding "man-midwife" about the same time "in the family way" and "confinement" were replacing "breeding" and "lying-in". But midwives were still called midwives.

Giving birth is a natural act and, unless something goes wrong, women were able to manage this, even by herself. There are women even today who give birth unassisted, even some who do it on purpose. _http://www.unassistedchildbirth.com/_ (http://www.unassistedchildbirth.com/) although I, for one, was glad to have plenty of help!

A special room was designated for the birth that was not necessarily the bedchamber. The mother-to-be often had lots of visitors (female relatives and friends) during the birth and during the month or so period afterward might receive a bunch more, so the room might be chosen to suit that purpose. But some couples preferred to do things more privately in the country.

Birthing chairs they were popular with midwives but not with the male accoucheurs who were becoming fashionable by the late eighteenth century. My sources indicate aristocratic women were tending to go with male doctors by this period. They advocated birth in bed but Dr. Charles White also designed a "Lady's Ease Chair" that is semi-reclining. While giving birth to my six children, I have to say, semi reclining sure seemed to work better than flat on my back!

Midwives often had birthing chairs but some families owned chairs that were handed down between generations--presumably falling into disuse when male doctors advocated birth in bed. For more information regarding the midwife/birth chair I recommend Birth Chairs, Midwives and Medicine by Amanda Carson Banks. Lots of good pictures there.

For more information, I recommend http://www.elenagreene.com/childbirth.html. there are some rough sketches of birth chairs along with some notes and a bibliography on the history of childbirth.