Introduction

In November 1767 a heavily pregnant Betsy Ramsden, the wife of a Surrey schoolmaster and clergyman, wrote to her cousin Elizabeth Shackleton in Lancashire:

I am determin’d not to stay at home any longer till I take to my bed … I give it out to my friends that I shall not give caudle [birth] till the first week in Febry but they say it is impossible I should waddle about till that time I am such a monster in size and indeed I am under great apprehensions I shall drop to pieces before I am ready for the little stranger.1

Betsy’s letter depicts a lively and sociable pregnancy. Her refusal to stay at home despite her increasing size suggests that she remained active, visiting her friends and neighbours notwithstanding the intimation that she was starting to find it difficult due to her size, over halfway through the pregnancy. The tone of her letter is jovial and light, suggesting that she had informal conversations with her friends about not just her size, but also the duration of her pregnancy and her calculations of the anticipated delivery date. Betsy’s depiction of childbirth as a sociable event and topic of casual conversation is common in the archives. Her references to ‘giv[ing] caudle’ identify the birthing chamber as an important social space in eighteenth-century society, bound by food, drink and interaction. The birthing chamber was a space where new life might be celebrated, information exchanged and important community bonds built and maintained. Using an eclectic and innovative range of sources, this book explores the rich and important social history of birthing in eighteenth-century England.

The central premise of this book is that, across the eighteenth century, birthing was a process – a series of linked and flexible stages – rather than an event. The history of midwifery has focused primarily on the moment at which the infant was delivered as ‘giving birth’. The delivery attracted the attention of accoucheurs2 and subsequently became the focus of both their published works and their technological innovations. Indeed, as we shall see in Chapter 1, many accoucheurs boasted of their ability to arrive at a birth at precisely the correct time to deliver the infant. Yet accounts of birthing rarely mention the delivery of the infant. Childbirth, at least from the mother’s perspective, was characterized by labouring and by their physical and emotional recovery. This book therefore adopts the same approach. The term ‘birthing’ will be used throughout to describe an elongated time frame of up to six weeks, encompassing the late stages of pregnancy, labour and the subsequent month of rest and recovery known as the ‘lying-in’, as well as the physical delivery of the infant. Broadening out our understanding of what it was to give birth in the eighteenth century allows this book to explore childbirth from a perspective that more closely mirrors the experiences described in men and women’s letters and diaries. This shift in perspective allows the book to make two important interventions in the histories of birthing and of midwifery. First, it challenges narratives of the rapid professionalization of childbirth during the eighteenth century by revealing a high degree of continuity in traditional birthing practices. That is not to say that childbirth was not professionalized and medicalized but that these developments are somewhat diluted when considered within the framework of a longer process of birthing. Second, this approach reveals the significance of practices that, from a medical perspective, appear peripheral to the delivery of an infant but were of great significance to the family and the community into which the infant was born. The reconceptualization of birthing as a process allows us to see the importance of food and feeding, for example, and of the allocation of domestic space during birth. This approach redirects our attention to the birthing woman and the rich networks of friends, family and neighbours that were crucial to the management of birthing in eighteenth-century England.

Extending the field of study to include the people, places and practices that surrounded birthing highlights the central place birthing occupied in the creation of community and in the operation of eighteenth-century society more broadly. Birth, as this book will show, reached out far beyond the confines of the birthing chamber. Birthing and its rituals and practices created communities of neighbours, focused on the new infant and the household into which it had been born.3 Growing bellies allowed the community to anticipate a birth, while the broadly observed rituals and practices of birthing provided a well-worn and familiar rhythm of visiting and socializing. The visibility of birth meant that these social practices could be manipulated by neighbours through their presence (or absence) at crucial moments. Communities were built around concepts of inclusion and exclusion and were therefore slippery and constantly changing as individual reputations, actions, arrivals and departures shifted the ranks, hierarchies and relationships in which they were rooted. Each birth involved a slightly different manifestation of the neighbourhood, recreating and reshaping the community and revealing it as it was at a precise moment. The eighteenth century was a period of far-reaching and transformative social change. Demographic movement, rapid population growth and a huge increase in the division between rich and poor saw the stratification of society and the physical removal of the upper social strata to grand Palladian mansions set in great estates and to London townhouses. Such dramatic social change was sure to fundamentally change the community of neighbours that was so important to birthing. Certainly, it would appear that midwives no longer had guaranteed and assumed authority over their social superiors in the birthing chamber, and visitors to birthing chambers increasingly reflected the social status of the household in which the birth had taken place. Despite these broad-reaching social changes, however, the birthing chamber retained its central role in shaping eighteenth-century society. As this book will show, the birthing chamber functioned as an important associational space. It defined communities, offering them opportunities to see and be seen, to practise and perform Christian notions of neighbourliness and to build and maintain the networks that were so important to survival in this period. The birthing chamber, I suggest throughout this book, was a crucial space in a rapidly shifting social landscape that both shaped and maintained communities.

Historiography

In studying the history of bringing infants into the world, I am treading a well-worn path. Thirty years ago, Adrian Wilson published his widely cited exploration of the man-midwife and his ascension to prominence during the seventeenth and eighteenth centuries. In his book, Wilson detailed a ‘ceremony of childbirth’ with roots in a collective culture of women seeking to disrupt patriarchal structures as they recovered from the physical and emotional efforts of giving birth.4 His most recent monograph on the social relations of childbirth develops this point, arguing that the ceremony of childbirth was constructed and maintained by women because it was in the interests of women to demand a period of rest, recovery and celebration following a birth.5 So embedded was the ceremony of birth and so successful at subverting power and gender relations, Wilson suggests, that men barely thought to challenge it despite the inconvenience it caused.6 In this book, however, I suggest that the ‘ceremony of childbirth’ was of far-reaching importance beyond the collectivities of women that Wilson identified. Instead, I shall argue, the birthing chamber and the practices and traditions of birthing were integral to the building and maintaining of community relationships. It was therefore in the interests of both men and women to ensure that they were perpetuated and preserved.

The rise in popularity of the accoucheur has been noted as a peculiarly British phenomenon and has been linked to changing social and medical discourses across the course of the eighteenth century.7 Lisa Forman-Cody linked it to the location of emotional difference in the body, suggesting a shift from the perceived value of bodily experience to an idea that the reproductive body made women unsuitable to be midwives.8 Wilson suggested that the success of the accoucheur lay in cultures of consumption and emulation rooted in rapid social change.9 Doreen Evenden argued that the accoucheur took advantage of the gradual erosion of female expertise during the period as a result of the rise of midwifery accreditation schemes in the 1720s and the establishment of lying-in hospitals from 1739.10 Roy Porter and Jean Donnison suggested, alternatively, that it was the accoucheur’s ability to build an emotional connection with their patients that led to their being preferred by middling and upper-class women.11 These arguments present a story of the gradual but inevitable triumph of accoucheurs over their counterparts, yet even at the end of the eighteenth century many birthing women chose to maintain the familiar elements of birthing, such as giving birth at home, having a female midwife in attendance and summoning birth attendants (also referred to as ‘gossips’12). In broadening out the field of enquiry beyond the birthing chamber, this book traces a remarkable continuity in the practices and practicalities of birthing despite, or perhaps because of, the rapidly changing backdrop of the eighteenth century. The accoucheur, where they were engaged, did not supplant the traditional midwife but, rather, they worked alongside each other, overseen by the family members and birthing assistants who were present in and near the birthing chamber.

The eighteenth century was not only a period of rapid social and demographic change: it was also the focus of shifting understandings of the body. New scientific methods of observation and enquiry, and multiple theorizations about the make-up of the human body had overtaken older understandings of the humoral body. This shift from the humoral body of Galenic medicine to the anatomically bounded body that emerged in the nineteenth century was well underway during the period covered by this book.13 The eighteenth-century body was therefore a body in transition. It was no longer understood as a body of flux and flow as it had been in previous centuries, yet holistic ideas of health preservation and management remained an important framework for understanding the body and managing childbirth throughout the period.14 Recent scholarship has emphasized the tenacity of humoral theory in the treatment of ill health and the maintenance of good health. Sandra Cavallo and Tessa Storey’s work on healthy living, Sasha Handley’s monograph Sleep in Early Modern England and Hannah Newton’s scholarship on recovery from illness have all shown that health and well-being continued to be discussed within the framework of the six non-naturals (six environmental factors that were thought to influence bodily health) throughout the eighteenth century.15 Where the six non-naturals (air; motion and rest; sleeping and waking; food and drink; excretion and retention; and passions or emotions) were correctly balanced, the body would be healthy. Illness or the after-effects of childbirth, it was thought, could be prevented or corrected by attending to these six elements. This attention to the interaction of external and internal stimuli on the body was discussed by the later eighteenth century using the language of ‘regimen’. Regimen is often discussed in relation to diet and nutrition, but it also encompassed the key impact of environment on the body through sleep, routine and exercise. Regimen was, in essence, the maintenance of a healthful lifestyle that not only displayed proper bodily government but also acted as a prophylactic against future ill health.16 The Scottish physician William Buchan emphasized the importance of what he called a ‘proper’ regimen covering food, drink, sitting up, clothing, temperature in the room, circulation of air and the regular changing of bed-linen in his hugely popular text on Domestic Medicine.17 So important was regimen in the management of the body that Buchan suggested that medicine ‘will seldom succeed where a proper regimen is neglected’.18 Regimen worked alongside medicine to heal ill bodies, providing bodily balance and a healthy baseline on which medicine could work. Yet, despite being a thoroughly contemporary concept, regimen also echoed humoral understandings of the body, particularly in its categorization of heat and cold as active elements in the provision of treatment. As late as 1779, the author of The Complete English Physician, George Gordon, recommended a ‘cooling regimen’ as part of the treatment for earache and, when counselling his readers on the treatment of fevers, warned against too hot a regimen.19 The familiarity and flexibility of regimen as a framework for understanding the body, linked as it was to both non-natural medicine and understandings of the anatomical body, meant that care remained centred in the household throughout the century. Regimen therefore accommodated the domestic health care that had been so important to birthing practices in the second half of the eighteenth century, while also recognizing the development of new physiognomies of the body.

In recent years, there has been a renewed interest in non-medical narratives of pregnancy and birth. Leah Astbury’s research used life-writings and midwifery manuals to examine the ways in which seventeenth-century elite women interpreted and understood their experiences of pregnancy and birth.20 Her work emphasized the importance of family and of religious belief in shaping women’s experiences of generation and reproduction. These frameworks worked both in concert and in conflict with women’s physical experiences to create highly individualized timelines of recovery and wellness after birthing. Karen Harvey’s recent research into the case of Mary Toft – a woman who caused a national sensation in 1726 when she reportedly gave birth to rabbits – has shown that the community could also be hugely influential in the way women experienced pregnancy and birth, particularly where the wider family was embedded in that community.21 In prioritizing Toft’s voice in her work, Harvey explores the link between bodily and emotional pain in childbirth, and the way in which Toft’s family and neighbours took control of her body. Her close reading of Toft’s narrative of the affair identifies fear as a driving motivation behind the hoax and, furthermore, locates that fear in the shadowy group of neighbours who attended Toft’s births. Harvey’s work develops the scholarship of Laura Gowing and Linda Pollock, both of whom have challenged the long-standing and widespread assumption that female collectivity is always supportive. Pollock cautioned against the use of ‘sisterhood’ as an analytical category by highlighting the role of birth attendants in ensuring conformity during childbirth.22 Lending childbed linen and giving advice could, she argued, be seen as part of the ‘regulatory nature of female culture’ rather than as evidence of a supportive female network.23 Laura Gowing’s work on secret births led her to caution against the assumption of female solidarity and support during childbirth. Her research emphasized the role of the community in seeking out secret births, often quite aggressively.24 As a result, Gowing’s depiction of giving birth, based on infanticide records in the north of England between 1642 and 1680, painted a starkly different image from Wilson’s scholarship on the ceremony of childbirth and collectivities of women.25 This book continues this tradition of questioning collectivities of gender in favour of those based on geographical location, family or social status. It takes advantage of increasing levels of literacy and bureaucracy throughout all levels of late eighteenth-century society to build on and extend the scholarship on narratives of birthing, and offers some new narratives to examine as we seek to understand what it was like to give birth in eighteenth-century England: those of the birthing woman and her family, of the neighbours who provided both support and censure, and of the household that relied so heavily on such neighbours for survival and information.

Scope

The majority of the sources used in this book date from between 1750 and 1800, though sources from outside this date range contribute to my arguments for continuity in childbirth practices. They engage directly with the period in which accoucheurs were consolidating their popularity and status. The rapid increase in published titles on midwifery and infant care, the popular and well-attended lectures on the subject and the exponential increase of obstetrically trained accoucheurs in the second half of the eighteenth century changed the social and medical discourses around the topic of childbirth. Yet, as Chapter 1 will show, even where an accoucheur was employed he attended only the delivery in the majority of cases. The other elements of birthing – confinement, labour and lying-in – remained unaffected by his involvement. Despite the development of obstetric medicine in the eighteenth century, the widespread medicalization of the birth process was deferred until the end of the nineteenth century. The chronological scope of this book therefore encompasses a period in which individual accounts of birthing become superseded by those of accoucheurs.

The second half of the eighteenth century was also the heyday of the familiar letter. Linked to ideas of polite sociability that were influential throughout the middling and upper levels of eighteenth-century society, the familiar letter prioritized an easy, conversational style of writing that had the potential to mask both tensions and real intimacy.26 Familiar letters were written in a style that was markedly different from those that had gone before. In mimicking conversational styles, familiar letters focused on descriptions of family and surroundings, and expressed emotion in a more immediately accessible manner than the writing styles that had been more prevalent in the seventeenth century. Despite still being subject to the methodological restrictions of all life-writings, they provide a rich vein of evidence on birthing practices. After all, letters form part of a dialogue, and the person to whom the letter is addressed must be afforded agency in the content. The studied familiarity of the later eighteenth-century letter was subject to the same duties and obligations between writer and recipient, and that relationship had the capacity to significantly alter the content of a letter.27

The bulk of the sources that I refer to in this book relate to the north of England. My intention was not to restrict the scope of my findings by geographical area, but rather to explore the way in which childbirth was managed in non-exceptional areas. Throughout the eighteenth century, professional training facilities for accoucheurs were located in London and Edinburgh. This did not mean that the women outside these areas did not have access to the skills of an accoucheur. Having trained in one or both of these centres of midwifery, many young men took up residence in provincial towns to establish their practice. Larger towns such as Manchester and Leeds had several resident accoucheurs competing to be selected by birthing women, preferably those who could reward them with access to wealth and status.28 In his 1752 treatise, the experienced accoucheur George Counsell argued for the establishment of local midwifery examinations across the country as ‘there being scarce any City, or very large Town, in which a Practitioner in Midwifery of some Eminence does not now reside’.29 Yet residents in smaller towns also had recourse to an accoucheur should they require it. Jane Scrimshire, the wife of an attorney in Pontefract, West Yorkshire, wrote in her letters about choosing from three local accoucheurs as the end of her pregnancy approached in 1756.30 The northern focus of this study encompasses rural areas, market towns and urban centres of varying sizes. It allows me to draw conclusions about the involvement of the accoucheur in the management of childbirth in areas away from the obstetric centres of London and Edinburgh.

Structure

Chapter 1 sets out the physical work of birthing on the body. From the first awareness of a body-within-a-body to the overwhelming physicality of strong uterine contractions, birthing was an important physical and emotional point in the lives of eighteenth-century men and women. Ideals of clinical detachment cultivated in seventeenth- and eighteenth-century obstetric texts has led to experiential accounts of birthing being suppressed in histories of midwifery and birth in favour of more biologically focused accounts. By foregrounding the words used to describe birthing in letters and diaries, this chapter refocuses attention on women’s bodies and on the sheer physical effort of birthing. It follows the birthing process from late pregnancy and confinement to labouring, the delivery of the infant and the month of rest and recuperation that followed, known as the lying-in period. Contrary to the authors of midwifery manuals, the men and women in this chapter rarely discussed the delivery of the infant, preferring to focus instead on the well-being of mother and child and on their recovery and health. This chapter therefore presents the physical act of birthing from a social perspective to counter and enhance the medical perspectives that have previously dominated the historiography.

Chapter 2 explores the materiality of birthing. While it is widely acknowledged that, even after the establishment of lying-in hospitals at the end of the century, most births took place in a domestic setting in eighteenth-century England, little consideration has been given to the practicalities of this. This chapter looks at the domestic reorganization that was required to facilitate birthing at different social levels. It emphasizes the temporary and transient nature of the material markers of birthing, despite the birthing chamber being a hugely important space in eighteenth-century society. Similar transience is evident in clothing the birthing body and in the newly birthed infant. Where the materialities and spaces of major life-cycle events such as weddings and christenings might be preserved and find their way into the historical record, the materialities and spaces of birthing were quickly subsumed back into everyday life. The birthing chamber would become a sleeping chamber once more, and the side-lacing stays of pregnancy would be transformed into everyday stays with just a few stitches. This chapter presents the birthing chamber as an imagined space of remarkable conceptual ubiquity and equality, despite significant variations in wealth and material environment.

Within the broadened scope of this book, food and drink were central to both the management and experience of birthing in eighteenth-century England. Chapter 3 shows the ongoing dominance of humoral understandings of the body in birthing and of the role of food and drink in managing the birthing body. Just as these humoral conceptions of the body coexisted with new understandings of regimen and anatomy, so older traditions of feeding both mother and infant could be found in conjunction with the recommendations of accoucheurs. The sharing of food and drink delineated community boundaries, the extent of the neighbourhood and the importance of reciprocal hospitality in building community relationships. Food, I argue, was central to building and maintaining good neighbourly relationships right from birth. Food (and drink) therefore fulfilled multiple functions during birthing: social, ritual, nutritional and medicinal. They remained a central element of the practical and symbolic management of birth within the home and the wider community, rooted in established networks of trust, information, knowledge and advice shared between family, friends and neighbours.

Chapter 4 examines the webs of family relationships that were created by birth, and the new life-cycle identities that were imposed on the immediate family of a birthing woman. As family coalesced around an impending birth, they created a transient family structure that temporarily superseded their usual family structures. Husbands, mothers and sisters were the primary members of this birth family. They played an important practical and social role in the domestic management of childbirth, rooted in a perceived heightened emotional connection to the birthing woman and her infant. The birth family was bound together by a shared set of emotions that I characterize primarily as love. This love was focused inwards on the new infant and rippled outwards in concentric circles to encompass the birthing woman and her family.

Chapter 5 sets out the importance of birth to eighteenth-century conceptions and understandings of community. Birth shaped, changed and defined community boundaries, and created a space in which neighbourliness could be practised. This community of childbirth was essentially a community of neighbours – shifting, transient and representative of the community as it was at that moment. The chapter exposes the mutually legitimating relationships between individual, household and neighbourhood that shaped everyday experiences of neighbourhood and community in the eighteenth century. Using folklore records and infanticide cases heard by the Northern Circuit assize court, this chapter examines the ways in which birthing chamber sociability shaped and maintained both individual and group understandings of community and neighbourhood. Finally, the chapter considers situations in which birthing women sought to exclude their neighbours from the birthing chamber and the ways in which communities processed this exclusion.