1. Birth and the body

In 1780 Elizabeth Shackleton, a Lancashire gentlewoman, wrote to her daughter-in-law Betty Parker, who had recently given birth to a boy. The infant was large and healthy and, having had ‘all the particulars’ of the birth from the infant’s maternal grandmother, Elizabeth observed, ‘My sister Parker tells me she never saw so large a child it is half brought up – you wo’d feel for that. I often think how you went on.’1 She went on, ‘Thank God it is over. I Hope this child will be a comfort & make amends by grace & every Virtue what you suffer’d for him.’ Her response offers a glimpse into the shared bodily sensibilities that existed around childbirth, and the way women talked about them. Not only had Elizabeth been reflecting on her own physical experiences of birth while waiting for news of her daughter-in-law and grandson, but she had considered the bodily impact of delivering a child so large ‘it is half brought up’. Indeed, simply by offering information about the size of the infant Mrs Parker implies that she too had been considering the physical impact of delivering a large child.

The physicality of birthing children is largely absent from eighteenth-century accounts of birth. The vast majority of these accounts were written by accoucheurs, who were keen to establish themselves as experts in the new and exciting discipline of obstetrics. Driven by the Enlightenment ideals of observation and enquiry, they focused on the body as a medical object – an assembly of muscle and bone to be manipulated so that a live infant could be extracted. This emphasis on the delivery of the infant is evident in printed texts on midwifery, the bulk of which focus on the final stages of labour and the moment at which the infant arrived. Yet, as we shall see in this chapter, the same emphasis on delivery is not present in women’s accounts of birthing. For the women in this book birthing was a process, shaped by the body and by their experiences of that body.

Embodied birthing

Attempts to explore birthing from an embodied perspective have generally focused on hierarchical encounters between accoucheurs and patients, using case notes or consultation letters.2 These accounts emphasize the relationship between medical ways of ‘knowing’ the body and the ways in which patients responded to those ways of knowing. As Severine Pilloud and Micheline Louis-Courvoisier noted, these embodied accounts of illness or of birthing are an account of the doctor–patient relationship and the way bodily experiences of illness might be articulated in a medicalized framework rather than of how those experiences felt.3 In such accounts, the body remains a slightly shady entity in the experience of birthing as we seek to avoid the potential traps and pitfalls of assuming a shared physical experience. Iris Clever and Willemijn Ruberg have suggested that emphasizing the materiality of the body risks undoing ‘the important work of deconstructing seemingly fixed notions of biological difference’.4 They explore the value of Annemarie Mol’s praxiographical methodology of studying the enactments of a body in practice and its engagements with techniques, materials, actors and sites. Doing so, they argue, ensures that ‘bodies, objects and techniques are no longer treated as silent objects but as important actors during encounters’.5 Yet reinserting the body back into the history of birthing runs the risk not only of biological essentialism but also of projecting one’s own bodily assumptions and experiences onto the bodies of the past. As Barbara Duden cautioned, ‘I cannot be too careful not to use my own body as a bridge to the past.’6 The physical element of birthing is partly what makes it such a seductive topic of historical study. There is a beguilement in knowing that one’s body has undergone, or could undergo, the same physiological shifts and sensations as the women who wrote to their friends to announce the birth of a child over 200 years ago. Yet the sensations of birthing are interpretive, individual and culturally prescribed. We are culturally trained to think of childbirth as painful, for example, yet precise descriptions of the sensations of birthing range from pain to discomfort through to pleasure.7 Accessing historical accounts of birthing therefore requires sensitivity to this range of potential sensations and the way in which historical bodies ‘felt’ them.

Letters provide us with an insight into everyday, or lay, notions of embodiment inasmuch as they can tell us about an individual’s perception or experience of the body, despite the potentially distorting nature of the epistolary genre.8 The emphasis on the bodily impact and physicality of birth in the accounts of childbirth studied in this book is striking. The use of words such as ‘large’, ‘sharp’ and ‘groaning’ bring a very physical dimension to the process of birthing. If, as Lyndal Roper has argued, language is our chief evidence for subjectivity, then the physicality of these words indicates the prominence of physical experience and sensation in the way these women organized their birth experiences.9 What may be a ‘natural’ or ‘ordinary’ birth to an observer may be emotionally or physically traumatic for the woman at its centre. Moreover, the experience of each birth will alter the physical and emotional experience of the next, both for the birthing woman and for the women who surround her. At the heart of birthing is the intensely physical act of expelling a child from the birth canal, but this physical act is wrapped up in a package of social, cultural and emotional experiences that are difficult to discern from medical literature.

The sensations of birthing are mediated by the body and by bodily processes, however, and it is therefore important to consider the influence of the body on birthing. Hormones are central to all physiological elements of birthing. Thinking about hormones in historical bodies is, however, hugely problematic. Hormones were not part of the physiological landscape until the beginning of the twentieth century and, even then, were understood simply as chemical messengers between the brain and the organs. When the English physiologist Ernest Starling first discussed hormones in 1905 he perceived them to be chemical messengers that circulated around the body to communicate between its parts.10 Hormones were thus conceived in a similar manner to Enlightenment understandings of nerves, spirits and fibres. Subsequent studies of hormones in the 1920s and 1930s focused on the ‘sex hormones’ testosterone and oestrogen and their role in defining or confirming biological difference between genders – a topic that continues to be controversial.11 Hormones continue to defy clear categorization and definition despite being active in bodies of all sorts, as endogenous chemicals, as medications and to describe and explain the body across numerous and varied discourses.12 For the men and women discussed in this book, then, hormones did not exist. To apply hormonal understandings of the body to historical bodies when hormonal function in the modern body continues to be a point of debate requires extreme caution and is rightly open to criticism. Yet, I would suggest, it is almost impossible to consider the birthing body in history without at least attempting to understand the physiological importance of birthing hormones, methodologically difficult as it is. Hormones are now understood to have a huge physiological role in preparing the body to give birth. These endocrinal shifts are the result of long-term evolutionary changes and are observable in other mammals. They are, as biomedical obstetrician Sarah Buckley has observed, ‘intertwined and continuous with the biologic processes of parturition’.13 Hormones therefore influenced eighteenth-century birthing bodies to the same extent as they influence modern birthing bodies, though these influences might not necessarily be felt in the same ways.

Four key endocrinal systems are influential during birthing. These systems all have functions beyond reproduction and are present in male and female bodies. Moreover, they are inter-orchestrated, meaning that they prohibit and inhibit each other’s activity, and can be disrupted by external events and emotional shifts.14 Oxytocin is the most studied and therefore most widely understood birth hormone. Instrumental in softening the cervix in the days before labour begins, it also promotes rhythmic uterine contractions. Surges of oxytocin at various stages during labour and delivery are thought to reduce excessive bleeding and to promote the let-down reflex to facilitate breastfeeding.15 Beyond birthing, oxytocin is also associated with social-affiliative behaviour; social engagement; reduction of stress, anxiety and fear; pleasure and reward; and healing and growth.16 Beta-endorphins are natural painkillers, directly associated with reward and pleasure. They rise during pregnancy, peak during labour and delivery, and drop sharply over a period of days after delivery, offering what has been described as ‘neuro-protective effects’ when the body is under stress.17 For this reason, beta-endorphins are attributed with the altered state of consciousness described by some women during birthing.18 Epinephrine and norepinephrine control many biological functions, including food intake and metabolism, blood pressure, pain and wound healing. Epinephrine and norepinephrine, produced in excess, have the potential to stop early labour, shifting blood supplies away from the uterus and foetus to major organs to ready the body for a fight-or-flight response to danger.19 They are linked to the production of cortisol, which may promote contractions and enhance the effects of oxytocin.20 Finally, prolactin levels increase in early labour, and again as delivery approaches. In non-birthing bodies, prolactin is associated with homeostasis, controlling appetite and regulating weight and the immune system. During birthing, prolactin is known to play an important role in milk production and maternal attachment.21 The important physical impact of these hormones on the reproductive body is evolutionary and is observed across different groups of mammals.22 Without resorting to biological essentialism, we can assume that they were also present and influential in eighteenth-century bodies.

Hormones do not just have physiological influence in the body. They are also implicated in the physical expression of emotion. Each of the endocrinal systems that are physiologically influential during birthing is triggered not just by physiological systems but also by perceptions of the body and the environment in which it is situated. In modern studies, perceptions of being safe and calm are known to increase levels of oxytocin in the body.23 In birthing, this is thought to be achieved by offering a safe and secure environment in which to give birth. We will examine the relationship between the body and the birthing environment in more detail in Chapter 2, but it is necessary when considering embodied birthing to think about this interplay between culture and biology. Modern studies on ‘bound space’ and the positive impact it has on birthing emphasize the importance of closed and enveloping spaces, likening them to caves. Darkened, secure and quiet birthing chambers, it is suggested, dissipate anxiety, stimulating the release of oxytocin and facilitating physiologic birth.24 Studies of other mammals have shown a similar desire for darkness, warmth, privacy and security when giving birth, dictated by responses in the endocrinal system.25 Is it possible, then, to ascribe the arrangement of the eighteenth-century birthing chamber to an innate physiological need? Descriptions of the darkened, enclosed birthing chamber heated by fire even in the height of summer map neatly onto modern ideas of the birthing ‘cave’. However, hormonal responses to people and places are entangled in learned behaviours and expectations. Birthing bodies may have sought out ‘safe’ spaces in which to give birth, but their perceptions of ‘safety’ were very much grounded in culture and expectation. This is, however, a reciprocal process, with culture being shaped by physiological responses. Despite the occasional complaints of accoucheurs, the persistence of the darkened, warm birthing environment across the eighteenth century, and indeed our modern return to it, suggests that the material body and its autonomic endocrinal systems shaped eighteenth-century birthing practices.

Pregnancy and confinement

Identifying pregnancy was fraught with missteps and uncertainty. In a body still strongly influenced by humoral ideas of flow and balance, the physical indications of conception could also indicate a stoppage or obstruction. While menstrual regularity was perceived as important for health, it was not necessarily a signifier of conception.26 Women relied on their experience and their own bodily knowledge to differentiate between pregnancy and illness. As newly married women in the top tier of late eighteenth-century society, the sisters Judith Millbanke, Sophia Curzon and Eliza Burges (daughters of Edward Noel, Viscount Wentworth and Judith Lamb) wrote regularly about possible indications that they may have conceived. In 1777, for example, Judith wrote to her aunt Mary Noel that ‘I am still in the same State of uncertainty as when I wrote last … was I not so very well I should be apt to entertain hopes’.27 She was no more certain three weeks later when she complained that ‘No alteration has happened since you saw me, but within this last week I am certainly larger, but alas! it may be fat’.28 By 28 December it transpired that she had indeed been mistaken. Similarly, Eliza wrote to Judith in 1779 that ‘I must now subscribe to the information you have recvd of my situation as a true Bill, but could not have been justified in saying the same when I saw you in Town, because I myself had hardly a suspicion of it’.29

Obstetric manuals skirted round the issue of identifying pregnancy by assuming that women would be in possession of at least some informal knowledge of pregnancy and birth. John Aitken wrote in his widely circulated treatise on puerperal physiology, ‘The early state of pregnancy, or its existence for the first three or four months, is not always easily detected.’30 His Dutch counterpart Hendrik van Deventer, who was hugely influential on the writings of the celebrated Scottish obstetrician William Smellie, declined to discuss the ways in which pregnancy might be detected, noting: ‘It is most certain, even by Experience, that the Signs of Impregnation are uncertain, and fallible in the first Months, wherefore we shall not give them a Place in this Book.’31 The 1652 edition of the popular medical treatise A Rich Closet of Physical Secrets, widely recognized as an amalgamation of previously published works on childbearing, anticipated that the mother would recognize the early signs of pregnancy.32 It suggested that the pregnant woman change her lifestyle ‘So soon as the woman shall begin to be with child, which she shall easily know’.33

Smellie complained that

the minutiae or first principles of bodies being without the sphere of human comprehension, all that we know is by the observation of their effects; so that the modus of conception is altogether uncertain, especially in the human species, because opportunities of opening [dissecting] pregnant women so seldom occur.34

For Smellie, the identification of pregnancy was possible only when the uterus ‘distended in proportion to the augmentation of its contents’.35 The impact of pregnancy on the mother’s body is entirely absent from professor of midwifery Alexander Hamilton’s account of conception, though he conceded that ‘it is exceedingly difficult to ascertain the proportional growth or progress of the foetus in the womb’.36 Margaret Stephen, a practising midwife and teacher of midwifery, took a more holistic approach to the body in her description of early pregnancy, citing nausea, an increased frequency of urination and food cravings as indicative of conception, though she qualified her observations by noting, ‘yet many of these symptoms may exist when a woman is not with child’.37 These texts implied that early signs of pregnancy should be recognized by the woman through changes in her personal health since her condition would be almost undetectable to a medical practitioner.

Women acquired the reproductive knowledge necessary to identify their pregnancies from a mosaic of sources. The births of brothers and sisters, the pregnancies of neighbours and even their experience of animal husbandry all fed into the creation of women’s practical knowledge about childbirth.38 While young, unmarried women were excluded from the birthing chamber during the delivery of a child, they were not absent from the wider social and cultural processes that surrounded pregnancy and birth. The conversations and encounters that facilitated the acquisition of reproductive knowledge are difficult to access, but there are echoes of them in written sources.39 One of these echoes is the way in which women identified their own and other women’s pregnancies. Unmarried women and men were not excluded from conversations about childbirth. Participating in such conversations undoubtedly informed young women’s understandings of reproductive processes, as did the sights and sounds around them.40 The case against Nanny Hollingworth, a Yorkshire woman who was accused of murdering her twins in 1799, shows how young women might regularly share and acquire information about pregnancy and birth. Nanny’s unmarried friend deposed that she ‘remembers that about five weeks ago she was in Company with her … when they all joked with the said Nanny Hollingworth about her being with Child’.41 Molly Bradbury, who was also unmarried, testified ‘that the said Nanny Hollingworth put her the witnesses hand upon her Belly, which felt very hard’.42 Sarah Heywood, a sixteen-year-old witness who was at Nanny Hollingworth’s house to buy milk, deposed that ‘she [Nanny] complained of being ill … and [the] witness thought that she was or had been with Child or in Labour’.43 Despite being young and unmarried, the witnesses in this case were sufficiently knowledgeable about the signs of pregnancy and birth to discuss it among themselves and to give statements to the parish authorities.

Elite women, for whom the production of an heir was important, also watched each other’s bodies for signs of conception. The letters between Frances Ingram and Susan Stewart regularly included news about the fertility and birth experiences of women they knew. In a letter dated 8 November 1787 Frances wrote to her friend that ‘Many of my friends have mentioned Lady Bol as being in a Quandary, but what it is about I do not very well know’; she continued, ‘except a Country Neighbour’s report is true that she has increased the St. John family without any connivance of my Lord’.44 Lady Bol’s alleged infidelity made her pregnancy particularly newsworthy, but Frances’s letters are full of similar details of pregnancy and birth. In another letter between Frances and Susan dated 14 January 1777, following Susan’s delivery of a daughter, Frances wrote: ‘No soul told me you was brought to bed till at last Miss Finch came from Mrs Sneyds & informed me you was possessed of another little girl and had been ill.’45 In this particular instance, the information about Susan’s delivery and subsequent illness had passed through at least two women (one unmarried) before it reached her friend. Birth and its associated complications were clearly not unusual topics of conversation for Frances and her contemporaries, both married and unmarried.

The close proximity of eighteenth-century life allowed pregnancy and childbirth to be easily observed. For those of lower social status, shared accommodation and thin partition walls meant that neighbours could hear sexual activity, any subsequent morning sickness and, eventually, the groans of childbirth. Changes in eating patterns might also be observed and pregnancy-related cravings commented on. When Elizabeth Woodman, a servant, was accused of murdering her newborn infant in 1768, for example, her mistress pointedly deposed to the investigating coroner that ‘she never refused her vituals (excepting one Sunday)’.46 Elizabeth’s unaltered eating patterns appear to have gone some way to alleviate her employer’s suspicions that she was pregnant. Betsy Ramsden’s husband, William, commented on her pregnancy-related cravings in a letter that he wrote to Elizabeth Shackleton in 1767. He complained that ‘My wife is so dear a lover of Venison that had not a Haunch most fortunately fallen in our way … my next little Boy might have come into the World with a Cloven Hoof’.47 The tone of his letter was jovial, but he was repeating long-standing beliefs that foods that were craved or eaten to excess during pregnancy might imprint themselves on the body of the infant.48 Even the frequency with which shifts were washed might be subject to scrutiny as an indication of a change in menstrual regularity.49 This information might then be shared and discussed between family members, neighbours and acquaintances.

The moment at which the mother felt the infant move was known as quickening. Among the uncertainty of the early signs of conception, quickening was a milestone in pregnancy, as one of the few certain indications that the infant existed.50 It represented what the seventeenth-century midwifery author Jane Sharp called the ‘ensoulment’ of the infant – the moment the foetus became human.51 While it was widely accepted that this happened in the third month of pregnancy, it was common for first-time mothers not to recognize the sensation.52 Once the movement of the infant had been felt, the mother could make an attempt to predict the date of her delivery. As a matter of some uncertainty, it is unsurprising that this was also a popular topic of conversation between friends and neighbours. Quickening was also the beginning of what Sarah Knott described as the ‘inner touch’ – that persistent and growing sensation of having a body growing within.53 Yet women’s embodied experiences of this inner touch were not always described in such benign terms. When she was pregnant in 1764 Frances Ingram described her quickening as having ‘a certain little thing of the smallest dimensions’ take ‘possession of my internals’.54 Her use of the term ‘certain’ not only refers obliquely to the foetus but also implies her bodily experience of birthing and her certainty that the sensations were an indication of pregnancy. The idea that the foetus had taken physical possession of her body forms part of a narrative of maternal bodily sacrifice that characterizes birthing during the eighteenth century.55

From the point of quickening, women’s embodied experiences of birthing were rapid and constantly changing. Joanne Begiato has shown the importance of the language of size in women’s descriptions of pregnancy in the eighteenth century, particularly the term ‘increase’ or ‘encrease’.56 This term was sometimes used figuratively to refer to the increasing size of the family, and also to discuss the changing physicality of women’s bodies. Jane Scrimshire described her pregnancy as a ‘complaint … of the Encreasing kind’ in a letter to her friend Elizabeth Parker (later Shackleton) in 1756.57 Similarly, Sophia Curzon referred to ‘us fatning Ladies’ in a letter to her aunt complaining about Lady Gould’s frightening appearance in 1778.58 For pregnant women, the changing shape of their bodies was only one element of the gradually intensifying physical and psychological experiences of birthing. The gentle inner touch of quickening would give way to more distinct physical sensations as the infant grew. Mrs Ramsden, a correspondent of Frances Ingram, complained in 1761 that ‘my little thing begins to be troublesome & moves rather violently at times’.59 Her physical discomfort created a conflicting emotional response, for ‘I wish from my Heart it was safely arrived’. Before the discovery of foetal heartbeat monitoring in 1819, foetal movement was the only way to know whether the infant remained alive in utero.60 The violent movements to which Mrs Ramsden refers could cause her to meditate on the outcomes of birthing for the infant.

Women also expressed concerns for their own safety during pregnancy.61 Sarah Wesley, who was married to the co-founder of Methodism Charles Wesley, had clearly expressed her fears of death during childbirth to her husband, for he later wrote to her: ‘You shall not die, but live & declare ye works of the Lord. My dearest Sally [Sarah] cannot but be some times afraid, yet put yr trust in the Lord – who hath delivered and will deliver.’62 He sought to reassure her by adding that ‘Mr Bridge’s daughter I left in yr condition. She is now a Mother: & as hearty as you was 2 months after ye Delivery. So is her son and Heir.’ Jane Scrimshire wrote with grim resignation to her friend Elizabeth Parker about her plans ‘If I Live till Spring’.63 Rebekah Bateman, the wife of a Manchester cotton merchant, experienced similar concerns. Towards the end of her first pregnancy, she wrote a will ‘in case I am call’d away in giving birth to another’.64 Using a combination of parish registers and bills of mortality, Irvine Loudon has argued that provincial maternal mortality reduced steadily by around 30 per cent between 1700 and 1850, to a figure of only fifty deaths per 10,000, or 0.5 per cent.65 Yet, as Loudon acknowledges, women’s fears of birthing were shaped not by the maternal mortality rate but by their perception of it. He notes that birthing accounted for one death in every five women of childbearing age, that is, between twenty-four and thirty-five years.66 It is therefore highly likely that pregnant women knew at least one woman of a similar age to them who had died giving birth. The changing pregnant body could be a source of both comfort and fear.

Confinement

Confinement marked the beginning of giving birth, physically, psychologically and socially, making it an important point of transition in the female life cycle. The term was not used solely to describe childbirth nor was it particularly associated with female bodies, being broadly applied to instances where illness or incapacity made it difficult to leave the house. Confinement was, however, an important element of birthing, and its prominence can be inferred through its use as an umbrella term to describe the entire process of giving birth. Elizabeth Shackleton’s ‘Aunt Pellet’, for example, wrote to her niece about her ‘approaching confinement’, anticipating that ‘[I] shall be much Delighted to hear of your Health on the Dear Charmer’s safe arrival’.67 Elizabeth Wilson, who was married to a London silk dealer, used the term in a similar context when she wrote to her sister in Manchester pitying ‘Mrs Goode … confined again of [an]other 2 so she has 4 children in 15 months’.68 Pauper letters also used the term ‘confinement’ to describe a birth. William Bateman of Bury St Edmunds, for example, wrote to the overseers of the poor in Thrapston, Northamptonshire, that ‘my wife was confined … and it has taken a great deal of caoles [coals] as we were obliged to keep good fires the weather being cold’.69 The use of the term across all social strata of eighteenth-century society suggests that restriction and confinement were important elements of birthing, despite hugely varied material experiences.

Confinement was used as a catch-all term to describe not just pregnancy, but also the later stages of pregnancy when leaving the house became difficult. It was dictated by the experiences and restrictions of the pregnant body. The context in which the term ‘confinement’ was used by pregnant women and their families suggests that it began with their labour pains, yet women of middling social status and above had often withdrawn from their social obligations, essentially confining themselves to the household some time before they anticipated giving birth. The Manchester merchant George Heywood, for example, noted in his meticulous diaries that his wife had ‘expected her confinement every day not been [being] able to come downstairs’ in 1828, before clarifying that, not only had she been waited on within the household for three weeks by Mrs Law, but he had also been confined to the house for ‘2 or 3 weeks’ in anticipation of the delivery.70 Predictably, his seventh child (and fifth son) was born at 5 a.m. on the morning of a long-planned business trip to Liverpool that he had not postponed, having ensured that he ‘could be of no further service’ to his wife. Similarly, Mrs Addison, a Liverpool merchant’s wife and correspondent of Elizabeth Parker, wrote that ‘I was so entirely confined to the house for the two months before that I could not even walk around the garden & I have always been active to the last before’.71 Women’s withdrawal from their social networks was dictated by their physical experiences of pregnancy, and its length was often adjusted to take account of the size of the pregnant body. It could therefore vary between pregnancies. As we saw in the Introduction, Betsy Ramsden, the schoolmaster’s wife and regular correspondent of Elizabeth Parker wrote: ‘I am determined not to stay at home any longer till I take to my [child] bed.’72

Betsy’s use of the term ‘any longer’ implies that her movements had already been somewhat restricted, despite her only being around the sixth month of pregnancy. Yet, the Ramsdens’ letters also discussed a visit they had received from Mrs Jones of Snow Hill who, they noted, ‘is by the way, both in Shape and Size somewhat resembles one of her Husband’s Brandy Butts being got above a month beyond her reckoning [due date]’.73 Confinement in social terms was therefore dictated not just by size or by the imminence of a delivery date; it was highly subjective.

When deciding to withdraw from their social obligations, Georgian women did not just take account of their physical experiences of pregnancy. Their emotional well-being was also a factor. Elizabeth Wilson, the Manchester-born wife of a London silk merchant, expressed apprehension about social events from around the seventh month of her first pregnancy in 1792. In a letter to her sister Rebekah Bateman, asking her to be present at her delivery and confiding in her about her low mood, Elizabeth expressed vexation about a friend’s upcoming wedding and the expectation that she ‘must be obliged to go to the wedding dinner if I am well’.74 Her apprehension was, in part, a ‘dread of going among so may fine Folks as there are among her Friends’, but her use of the phrase ‘if I am well’ indicates that her pregnancy was a factor in her concern, as being ‘ill’, or ‘poorly’, was often used as a euphemism for labouring in the second half of the eighteenth century.75 There is no subsequent mention of the wedding in Elizabeth’s correspondence, so it is impossible to know whether she went, but she was clearly looking to reduce her social responsibilities from a fairly early stage in her pregnancy. Physical sensation and ideas of wellness therefore dictated the point at which these women restricted their activities. Size and shape, emotional well-being, notions of respectability and previous experiences of birthing were all influential in deciding the point of confinement.

The luxury of choosing the point at which confinement started was, however, dictated by social status. While elite and middling women could choose to withdraw from society early should they feel that their health required it, those at the lower end of society often found that their confinement was dictated to them by the commencement of their labour pains. Much of the scholarship on poor women’s birthing experiences is found in subsequent accusations of infanticide or concealing a birth, which makes it difficult to draw conclusions about usual confinement practices among this social group.76 Sarah Harrold, the wife of a Manchester wig-maker and bookseller, Edmund Harrold, was confined for only one day before she began to labour. On 21 November 1711 Edmund recorded in his diary that he had ‘Stay’d at home tonight, wife ill’.77 The following day, he noted that his wife was preparing to give birth, and the day after that he wrote: ‘At 3 in ye morn: she brought forth a daughter.’78 The importance of Sarah’s role in keeping the family’s shop, and their precarious economic status, meant that she could not afford the luxury of a lengthy confinement. A similarly pragmatic attitude was expressed in the letters of Sophia Curchin, a poor woman requesting assistance from her parish of settlement in Northamptonshire. On 10 December 1824 she wrote that ‘I expect now every day of being confined and I am sorry to say that I am in want of everything’.79 Women with little or no income neither expected nor experienced a gradual withdrawal from their duties. For these women, a long period of confinement before the birth was of less importance than the rest and recovery of the lying-in period.

Labouring

During labour, muscular contractions in the uterine wall open the cervix and begin the process of pushing the infant into the birth canal, with increasing regularity and strength. This can be a long and slow process, as indicated by the etymology of the words used to describe it in eighteenth-century texts. Midwifery manuals often referred to it as ‘labour’ or ‘travail’, while women’s letters tended to describe labour in more bodily terms as a ‘groaning’, or a ‘grumbling’.80 Betsy Ramsden, for example, promised to send Elizabeth Shackleton a ‘History of my Groaning’, while Frances Ingram wrote to a heavily pregnant Susan Stewart that ‘Miss Pelham sends me word that you are in a grumbling way’.81 These audial terms, while not exclusive to childbirth, encapsulate the embodied perspective of birthing women, in contrast to those of the medical establishment. The word ‘groaning’ is particularly evocative of the noises made by women as their contractions strengthened. These groans mapped and communicated the physical sensations of childbirth, giving way to shouts or cries as the infant entered the birth canal and the contractions became more painful.82 Finally, the cries of the infant indicated a successful delivery, while the absence of cries suggested that the infant was stillborn or had suffered during the birth.83 As a result, women’s voices (or their silences) transmitted the progress of the birth beyond the walls of the birthing chamber, particularly in lower-status households where life was lived in close proximity to one’s neighbours.84

These physical sensations were enhanced by the touch of others. During labour, women were encouraged to walk around and to adopt positions that felt natural to them. The experienced midwife Sarah Stone, who published a collection of unusual midwifery cases, complained on several occasions of arriving at an obstetric emergency to find that the ‘Midwife deliver’d her [the birthing woman] standing on her feet’.85 William Clark’s educational text aimed at female midwives noted that ‘many in the Country choose to be on their Legs or Knees, supported by a Woman on each Side, or lean on a Chair or Bed’.86 George Heywood’s memoirs record the birth of his daughter Elizabeth while his wife was ‘on her knees at the Bedside and could not raise herself and the child was born in that situation’.87 Some midwives carried a birthing stool, or birthing chair. This specialized piece of furniture had a horse-shoe shaped seat allowing the midwife full access to the infant while supporting the birthing woman in a sufficiently upright position to use gravity to assist the birth.88 These were more common on the continent than they were in England, yet the existence of these ‘groaning’ chairs in museum collections suggests that some were in use in England throughout the eighteenth century.89 None of the women studied in this book mentioned a birthing stool or chair in their accounts of birthing. Midwives would massage and manipulate the birthing woman’s labia, which was thought to make the final stages of birth easier. The prominent Leeds man-midwife William Hey recorded a case in 1760 in which his patient ‘had been in regular Labour from the Evening of the 19th till I saw her first wch was about 10 a:m [on the 20th]’. He noted that ‘the Midwife kept continually harassing her ’till she had made her quite sore’.90 These practices were widely discredited in manuals of midwifery yet regularly appear in collections of case notes, suggesting that they remained common practice throughout the eighteenth century. While these practices are often described in negative terms by writers seeking to secure their own midwifery careers on the grounds of modern practice, the longevity and persistence of their complaints suggest that such physical interventions by midwives were not necessarily unwelcome to birthing women.

In circumstances where a birthing woman or her family had decided to retain an accoucheur, it was generally accepted that their services would not be required until the later stages of labour. The Lancashire-based medical writer and accoucheur Henry Bracken boasted in his 1737 treatise that ‘I only desire to be within hearing of a Woman in Labour, and I dare venture my Life I come to her Assistance within five Minutes of the Time which requires our help’.91 He then proceeded to relate an anecdote about ‘a very famous Man-Midwife in France who used to sleep near the Woman in Labour and was so accustomed to it that he could wake just as the Child was in the Passage’.92 William Hey often noted the presence of midwives and birth attendants at the labouring stage of births that he attended. His case notes from his attendance at the sixth labour of Isaac Wood’s wife on 6 December 1763 recorded that ‘the Midwife had been with her from the 4th [December], the greatest part of wch Time she had been in pretty strong Labour’.93 This was a regular occurrence. When Hey attended the labour of Jonathan Crowther’s wife in Pudsey in April 1760, for example, he noted that ‘the midwife had been with her all day’.94 Labouring was women’s work and was generally overseen by a midwife.

The perceived risks and dangers of labouring were directly tied to the length of time the woman laboured. Almost half of the cases that William Hey recorded in his casebooks were instances in which labour was prolonged owing to the unusual presentation of the infant.95 Protracted labour increased the possibility of infection, led to a greater chance that the infant would be born dead and weakened the mother. Sarah Stone recorded her attendance with one woman whose labour lasted four days. She noted: ‘I found the woman bolster’d upright, breathing very short, her Nostrils working, and her Pulse very quick and irregular, as tho’ Life was departing.’ She asked the midwife, ‘How long she had been in that manner? She told me from Thursday, and this was on the Monday morning following.’96 Stone subsequently delivered the woman of an infant which she recorded as being ‘putrefied’. This episode was not the only one of Stone’s cases in which a lengthy labour was thought to have endangered the life of the mother. Stone regularly claimed to have delivered women whose labour had been retarded by the infant becoming lodged behind the pubic bone. This was commonly attributed to the prevalence of rickets in youth, which could alter the shape and formation of the pubic bone, making birthing extremely dangerous. William Hey attended a woman whose pelvis ‘seem’d to be more concave than usual; and at the Brim of each side was a considerable Protuberance of Bone; which with the Sacrum formed a Triangle’. After a difficult delivery, Hey questioned his patient, who claimed to ‘never [have] heard her Mother or any one else say she was rickety when A Child’. Hey theorized in his case notes that the family may have ‘a Tendency to a Rickety Habit’, based on the appearance of her previous children.97 While it was widely acknowledged that labouring was a process best ‘left to nature’, it became necessary to intervene if the labour did not progress to prevent the death of both mother and child.98

Notably absent from women’s accounts of labouring are detailed descriptions of pain. That is not to say that pain was absent from the process of birthing in the eighteenth century. The terms ‘groaning’ and ‘grumbling’ both imply some physical discomfort during labouring. George Heywood’s account of his wife’s first birth noted her having ‘frequent pains in her belly and thighs’, which ‘toward evening these pains became more frequent’. Labour, he noted, was confirmed by ‘some stains of blood’.99 In his accounts of subsequent births, he mentioned ‘violent pains’, usually in what appears to be the final stages of labour (the infant was usually born soon after he recorded them).100 Pain is therefore not absent from labouring, yet it is absent from women’s accounts of labouring. As a hugely individual and interpretative concept, pain is difficult to communicate. It is therefore common for those in pain to use metaphors or similes to convey the nature of their experience.101 Yet pain metaphors are also absent from the accounts of childbirth studied here. Women’s letters focus on the size of the infant, the speed of the labour and the wellness (or illness) of the birthing woman and her infant. Elizabeth Wilson, for example, wrote to Rebekah Bateman that a mutual acquaintance, Mrs John, ‘came [went into labour] a week or two sooner than she expected but a most amazing large boy she has got for all that she had a very good time’.102 A later letter between the sisters reported the birth experience of another friend, Mrs Mills, who ‘had a pretty good and quick time, I believe’.103 Conversely, Jane Scrimshire reported that she had experienced ‘a very severe Time’, which led her to be ‘very weak and low’.104 In the only direct reference to pain in these letters, Shackleton’s daughter-in-law was reported to have had ‘a sharp [painful] but a good Time’ by her mother.105 Pain was perhaps expected if labouring could be described as ‘sharp’ and ‘good’. Speed was clearly valued, and individual experience was prioritized in the use of words such as ‘good’ or ‘severe’. What women communicated to each other in their letters were the variables of birthing rather than the sensation of birthing itself. The size of the infant and the length of the labour had implications for the physical experience of birthing and, indeed, for the mother’s recovery. The absence of discussions of pain in these letters speaks to an assumption of shared bodily sensibilities and experiences. These women knew what birthing felt like. Birthing was what Joanna Bourke has called a ‘pain event’ and was therefore was part of a birthing woman’s life story.106 They had no need to describe it to each other. Instead, the information they sought and provided was linked to the physical impact of the birth on the body and how that would in turn affect the prospects of both mother and infant.

Delivery

Where the birth be progressing as expected, the woman’s cervix eventually dilates enough to allow the infant to enter the birth canal. While the delivery stage of birthing was the focus of many pages in eighteenth-century books on midwifery, it is rare to find descriptions of a delivery in letters. That is not to say that women did not write to each other about their deliveries. Elizabeth Shackleton’s diary entry dated 7 January 1781 refers to an account of her daughter-in-law’s delivery that she had received from her maternal counterpart after she ‘desired Mrs Parker would give me all the particulars of her Daughter’s Labour and her Recovery’.107 Similarly, Betsy Ramsden’s promise to send Elizabeth a ‘History of my Groaning’ suggests that she provided her friend with details about her delivery, though neither account remains in the archive.108

Modern accounts of childbirth suggest that delivery marks a distinct change in physical sensation. The cramping sensation of muscular contractions gives way to a sharper pain as the infant moves through the birth canal. The progress of the infant through the birth canal can be clearly felt, particularly as the head begins to crown and the infant recedes into the birth canal between contractions. These physical sensations are often described in almost primal terms, the physicality of delivering an infant overwhelming the body and mind.109 There is no comparable description of the sensory experience of delivery in eighteenth-century accounts of birthing. It is, however, possible to infer changing sensations during this stage of birthing. George Heywood’s references to his wife’s ‘violent pains’ towards the end of labouring intimates an intensification of the sensations that she was experiencing.110 Similarly, the progression of audial descriptions of birthing from ‘groans’ to ‘cries’ suggests a change in bodily experience, but no written account of delivery supports this supposition. This absence is perhaps surprising, particularly given women’s tendencies to describe their birthing-related ailments in some detail. Breast tenderness, in particular, is present in many accounts of birthing, as are aches and pains associated with increased size and foetal movement. Complaints about vaginal pain, however, or general references to the pelvic area are conspicuously absent in women’s accounts of birthing. Garthine Walker and Sarah Toulalan have noted a similar absence of references to the vulva and vagina in eighteenth-century rape cases.111 Angela Muir, in discussing this absence in cases of infanticide in rural Wales over the same period, has suggested that there was simply no vernacular to describe the vagina other than the vague references to ‘privy parts’ or a selection of cruder terms.112 Breasts, she suggests, lacked the problematic associations with sexual activity and promiscuity that were inherent in discussions of women’s reproductive organs. This reticence around descriptions and discussion of reproductive organs in the formal environment of the court is mirrored in women’s letters to each other.

Natural deliveries were generally considered women’s work.113 As Henry Bracken summarized at the end of his chapter on ‘What is to be done when a woman is in labour’: ‘When Labour is natural and the Child comes right, little or no help is requisite; a very ordinary Midwife or even a simple Nurse-keeper being sufficient to perform the Office.’114 Indeed, Frances Ingram’s second daughter was ‘in such a Hurry that the performer [midwife] could not arrive time enough’. The nurse who had been employed to care for the infant delivered her instead, and she was commended for acting ‘the part of Sage Femme [midwife] with the utmost skill and propriety’.115 One of the desired skills in a midwife was the capacity to recognize the point in a delivery when the intervention of a more experienced practitioner was needed. That these accoucheurs had to be summoned in cases that were thought to demand their expertise suggests that they were not always retained in anticipation of a birth but were called upon only if required. Bracken prefaced his work on midwifery by complaining that ‘it is a never-to-be-forgiven Fault in a Midwife, when she fancies ’tis a Scandal to have a Man-Midwife called in’.116 William Smellie differentiated between the skills desirable in an accoucheur and a midwife in his widely published Treatise on the Theory and Practice of Midwifery. Crucial in his requirements of a midwife was that ‘she ought to [a]void all reflections upon men practitioners, and when she finds herself difficulted, candidly have recourse to their assistance’. In return, the summoned accoucheur, ‘instead of openly condemning her method of practice, (even though it should be erroneous) ought to make allowance for the weakness of the sex and rectify what is amiss without exposing her mistakes’.117 These accoucheurs expected to work alongside female midwives of varying capabilities throughout deliveries.118 These women continued to be in attendance at most deliveries and often remained after the male practitioner had departed. The services and expertise of midwives were not supplanted by their male counterparts; however, their status could be relegated in the hierarchy of the birthing chamber at particular moments.

The idealized figure of the knowledgeable, submissive midwife who deferred to the authority of the accoucheur was not necessarily a common figure in manuscript accounts of childbirth. Midwives had usually been with the birthing woman and her attendants for several hours before the accoucheur arrived. In most instances, the midwife was a local woman who already knew the expectant mother and the other women present in the birthing chamber. Therefore, she probably wielded no small authority in the way the birth was managed. John Gibson, a pupil of William Smellie, who claimed to have delivered over 2,000 women during his career, clearly found that the midwife and her attendants could be intimidating figures to a young accoucheur. In his publication directed to ‘young’ or inexperienced practitioners of midwifery, he emphasized: ‘let me caution you, young gentlemen, never to let the sufferings of the patient, nor the importune solicitations of the women about her, so far get the better of your judgement, as to tempt you to give untimely assistance.’119 William Hey noted an instance in 1760 in which assertive birth attendants forced him to take action that they believed was necessary, despite his opinion to the contrary. Hey’s patient had been labouring for around seventeen hours when her midwife summoned him. The infant had advanced slowly and the midwife had made several unsuccessful attempts to accelerate the delivery. Hey attended, examined the woman and ‘resolved to see what the natural Efforts would effect’. The following day, twenty-four hours after he had been summoned, he noted that ‘Her Relations were so unsatisfied with my keeping her in this Manner that they were on ye Point of Sending for another Man-Midwife’, but he persuaded them to wait.120 Eventually, he resolved to use forceps to deliver the child, which, he noted, ‘was alive, but languid, and died about an Hour & half after its Birth’.121 Hey’s case notes do not record any other attendances on this woman, although he often attended other families on multiple occasions. Where accoucheurs were engaged to attend a delivery, they were not expected to replace the midwife. Instead, there was a clear division of labour, which anticipated that the accoucheur would handle complications that required the use of medical instruments such as the forceps or the crochet. In summoning a male practitioner, the midwife and birth attendants had made the decision that the infant needed to be extracted. If the accoucheur did not then perform what they considered to be the necessary operation, it was essentially a professional challenge. Despite theoretically being in control of the birthing chamber, accoucheurs often found themselves under scrutiny from midwives and neighbours who were not afraid to challenge what they felt were inappropriate decisions or actions. Rather than upturning the traditional experience of childbirth, accoucheurs were expected to operate within the familiar structures of birthing.

Bad management of a complicated birth could have an impact on the physical and emotional health of the mother. This could, in turn, extend and complicate the lying-in period and, in some instances, affect future pregnancies and births. The women present at the delivery and, indeed, throughout the birth process attempted to mitigate these dangers. The widely varied experiences and knowledge of the individuals in the birthing chamber could prevent the unnecessary use of medical instruments, identify changes in the mother’s or infant’s health, and offer suggestions on ways to handle difficult deliveries. An important advance in the way difficult births were handled in the eighteenth century was the widespread use of forceps. These displaced the widely feared ‘crochet’ used to dismember infants in utero, and the use of forceps is thought to be at least partly responsible for the increased popularity of the accoucheur during this period.122 William Hey’s casebooks show, however, that the crochet was still in regular use throughout the eighteenth century. Although Hey was a highly trained and respected accoucheur, his unpublished notes record several instances in which he was forced to dismember an infant in the birth canal. His accounts emphasize the brutality and danger of this operation. On 6 February 1760 he was summoned to attend the delivery of Isaac Wood’s wife, which had clearly been a challenging one. Hey noted that ‘the Child was dead and the Head firmly pressed against the Brim of the Pelvis, I thought it best to delay the Delivery no longer’. He therefore ‘introduced two Fingers of my left Hand into the Vagina, and along them passed the long Scissors which I plunged into the Head’, before using a blunt hook and his hands to break down the infant’s skull’.123 Hey’s use of language suggests that this operation required no small amount of force, which in turn increased the risks of accidentally injuring the mother as well as the infant. Internal injuries received during difficult deliveries could lead to complications in future births.

The risk of severe internal injuries made labouring women and their birth attendants alert to the possible use of crochets during a difficult birth. In his 1772 book of advice directed at provincial accoucheurs, John Gibson recounted an incident in which the rattling of his scissors led to panic in the birthing chamber. He wrote ‘I once put a room into great confusion and disorder by only taking out of my side pocket a red leather pouch, in which I carry my common pocket instruments’. To prevent such a commotion, he suggested that, ‘Whenever you are necessitated to make use of any instrument, you must carefully conceal it from the patient and bystanders. For the very name of an instrument, though ever so simple, carries terror along with it.’ As a result, ‘it was reported next day that the woman had had a terrible labour, and that I was forced to deliver her with instruments’.124 The rattling of Gibson’s scissors did not just upset his patient: it provoked a strong reaction from her birth attendants and threatened his reputation as an accoucheur. Far from being passive observers, the ‘bystanders’ in the birthing chamber described by Gibson were assertive and alert to the potential for physical injury to the birthing woman and her child.

The delivery stage of a successful birth was not complete until both mother and infant had been cleaned, dressed and placed in their beds. After the umbilical cord was cut, the infant was passed to a waiting birth attendant. The attendant’s first job was to wash the infant clean ‘from that scurf which sometimes covers the whole skin’.125 While some accoucheurs recommended using soap and water for this, many others approved the traditional use of alcohol to cleanse the infant.126 Once clean, the child was checked for marks and injuries.127 The infant’s limbs and head were massaged to encourage them to straighten, and salve or pomade might be applied to protect the skin. These actions essentially removed all traces of the womb from the child – even its foetal posture – and rectified any bodily defects.128 The umbilical cord was then ‘wrapped in a soft linen rag, and folded up on the belly, over which is laid a thick compress’.129 The infant was swaddled to varying degrees of tightness to fix its shape, as newly born bones were believed to be waxy with moisture from the womb.130 This binding solidified the infant’s body, completing its separation from its mother. The infant could then be laid in its cradle to recover from the ordeal of birth.

While the birth attendants washed and massaged the infant, the midwife performed similar tasks on the mother. Of immediate concern once the placenta had been extracted was the placement of warmed soft cloths on the mother’s labia.131 This was thought to soothe soreness and, by closing the mother’s body, to reduce the chance of infection. She might be encouraged to lie on her side with a pillow between her legs to recover.132 The sheets or straw on which she had given birth were removed from the birthing chamber and often destroyed. The mother’s strength and any injuries she had incurred during the delivery dictated the manner in which she was moved to her bed. Those who were very weak were carried to their beds by their attendants, preferably using a sheet so that they could remain lying down. It was common throughout the century for the mother’s stomach to then be bound. This was thought to support the traumatized uterus and to prevent the stomach from ‘continuing bulky after delivery’.133 This binding could be done using the easy stays that had supported the stomach in the final weeks of pregnancy, with a ‘table napkin pinned moderately firm’, or with bandages or strips of fabric called ‘rollers’.134 Stomach bindings had an important practical application but they also reinforced the boundaries of the mother’s body, as swaddling did for the infant.

Lying-in

Once the mother and infant had been settled in their beds, the lying-in stage of birthing began. As a period of rest and gradual recovery, the lying-in month followed many of the familiar prescriptions and practices of recovering from illness.135 Lying-in encompassed a series of substages that were intended to ensure the mother’s return to full health before resuming her usual social and domestic duties. These were directed entirely by her physical and emotional health. Total rest was advocated in the hours and days that followed the delivery. If the woman regained her strength and did not experience any post-delivery complications, she was moved to a reclining position in bed several days later. Around halfway through the lying-in period, she was allowed to sit up or, if her strength allowed, leave her bed. Once she was feeling fully recovered from the birth, the mother could move freely about the house, though she could not go outside until she had given thanks for her safe delivery at the local church (sometimes called ‘churching’).136

The safe delivery of an infant did not mean that the birthing woman’s recovery was assured.137 Indeed, where health or strength was a concern following the labour and delivery, lying-in could deliver the final blow. Thomas Noel compared the health and strength of his sisters Sophia and Judith in a letter to the latter on the 3 October 1781: ‘I agree with you totally as to my Sister’s [Sophia] Health, & heartily wish you partook of part of her present complaint. Tho’ (joking apart) I dread the consequences of her lying-in, as she is weaker than [you].’138 Many women died before the end of their lying-in month. A letter in the archive of Ellen Parker, the wife of Elizabeth Shackleton’s grandson, describes such a death with a tone of resignation and acceptance. The letter informing Elizabeth of his wife’s death is the only one in the archive signed by J. M. Whallon. He wrote: ‘I never myself entertained any other thoughts from the very first week, that a recovery could be accomplished.’ He added: ‘neither could any one else who was in the constant attendance that I was, imagine anything, but a miracle almost to accomplish a cure.’139 Similarly, Elizabeth Wilson referred to the difficult delivery of her friend Mrs Joseph who, she wrote, ‘looks rather poorly she has not been very well since her confinement’. She added that ‘some are ready to condemn her already but she hopes better things’.140 Rest was an important method of managing the postnatal body. Hannah Newton’s scholarship has demonstrated the importance not just of removing the illness itself but of effecting a full physical and emotional recovery.141 Childbirth, like disease, left the body weak, and so the lying-in period was an indispensable part of giving birth. Without time to recover physically and emotionally from the rigours of birthing, women risked their long-term health and their ability to carry children in the future.

Despite an emphasis on rest and recovery, the lying-in room was also a sociable space in eighteenth-century society. This sociability was bound up in caring for the mother and her infant as well as in regulating their behaviour. As Chapter 5 will show, lying-in chambers were important spaces for communities and families to meet, talk and share information and knowledge. The traditional lying-in chamber full of food, drink and conversation was so embedded in the way society functioned that it remained a recognizable part of birthing despite the disapproval of many obstetric authors, who advocated a more calming and restful environment. These authors argued that sociable lying-in traditions upset the delicate emotional state of the recently delivered woman and, by accommodating lots of visitors, increased the risk of both mother and infant contracting an infection. William Smellie suggested extreme methods to ensure that his patients were not disturbed as they recovered from their labour and delivery. He advised that ‘the patient must be kept as free from noise as possible, by covering the floors and stairs with carpets and cloths, oiling the hinges of the doors, silencing the bells, tying up the knockers, and, in noisy streets, strewing the pavement with straw’.142 The material elements of his recommendations make it clear that he had written this advice with his wealthy patients in mind, but other authors made similar recommendations for their poorer clients. Alexander Hamilton recommended that ‘all visitors for the first ten or fifteen days ought to be denied access, for besides the hazard of their mentioning some piece of news, which may hurt the patient, the fatigue of talking &c. might be productive of the most serious consequences’.143 To prevent any upset caused by accidental noise, Hamilton suggested stuffing the newly delivered woman’s ears with cotton. Along with silence in the birthing chamber, these writers advised that women be kept still and remain lying down for several days after their delivery.144

While women were encouraged to lie down and to rest in the hours that followed the birth, they expected to be visited by their friends and neighbours once they heard that the infant had been delivered. In 1784, for example, an unmarried Rebekah Bateman wrote to her friend Mary Hodson that ‘Mrs Buckley was brought to bed last Saturday, I saw her yesterday, & little Girl, they both seem very well for the time’.145 That a young, unmarried woman was one of the visitors to Mrs Buckley’s lying-in room within five days of her delivery shows just how sociable the lying-in space was. It was not restricted to nurses and family, or even to married women. Rebekah’s assessment of her friend’s health also suggests that she had some knowledge of childbirth and of the expected stages of recovery. Furthermore, she appeared confident that the unmarried friend to whom she was writing had a similar understanding of birthing and reproduction. This knowledge was acquired precisely through these types of visits to women who had recently been delivered, from hearing news about mutual acquaintances and by listening to the talk of other women. Rebekah Bateman and her contemporaries probably had regular opportunities to visit lying-in women. A letter from Rebekah’s sister Elizabeth many years later emphasized the ubiquity of pregnancy and birth for women in the eighteenth century. The letter first reminded Rebekah that ‘you remember hearing of Mrs Goode having two [twins] a month or two before I had Rebekah [Rebekah’s niece]. She is now confined again of other 2 so she has had 4 children in 15 months’. In the same letter, Elizabeth noted that ‘Yesterday Mrs William Wilson was brought to Bed of two fine girls’ before cautioning her sister that ‘you may think well that you have not had 4 in 4 years as Mrs Greaves has – who is now lying-in of a daughter. This is the second time she has been confined since I was.’146 For most eighteenth-century women, visiting a lying-in friend or acquaintance was a regular event. These visits therefore provided a backdrop not just to daily life but also to the way in which women socialized during the eighteenth century.

While William Smellie and his contemporaries suggested a ten- to fifteen-day period of total rest following the delivery, many women appear to have been participating in family life during this early part of the lying-in month.147 Birthing women were generally released from epistolary conventions during the final weeks of their pregnancies. Eighteenth-century familiar letters often began with a declaration of obligation and duty.148 Excuses and explanations for delayed replies, or complaints for lapses in obligation, were common in the very first lines of this genre of letter writing. As women reached the end of their pregnancies, however, these responsibilities were relaxed. Most appear to have ceased writing as their pregnancies advanced. They did not resume writing until around two weeks after the birth. Jane Scrimshire wrote to her friend Elizabeth Shackleton in 1756, only twelve days after giving birth, that ‘as this is early days for me to write I shall be as concise as possible’.149 Frances Ingram was similarly succinct in the letters written following the delivery of her third daughter in 1762. She commenced her first letter to Susan Stewart with ‘you will easily believe my dear Lady Susan that I have not lifted a pen since I was brought to bed till this instant the first fruits of my ability to write I dedicate to you’.150 In some cases, it seems that regular correspondents stopped sending letters to heavily pregnant women in anticipation of the birth. Following Stewart’s delivery of a daughter in 1769, Ingram waited to send her congratulations for fear that she would ‘make myself the object of hatred to Lord Gower [Stewart’s husband] and his whole family by writing sooner than you ought to read’.151 For elite and middling women, the resumption of their letter-writing duties signified their capacity to resume their social obligations. It was approached in much the same manner as their other obligations, with a gradual reintroduction of their usual duties over the course of the lying-in month.

Within two weeks of the delivery of his second child, the Reverend William Ramsden, husband of Betsy, wrote to Elizabeth Shackleton that ‘By her Ladyships order I took the Pen, (which but for the absolute Forbidding of Mrs Nurse would have been so much better employ’d in your services by Herself)’.152 Not only did both he and his wife think that she was sufficiently recovered to resume her writing duties, but his letter was full of her interjections and news of her visitors. The letter suggests that, far from reclining in bed to recover from her labour and delivery, Betsy Ramsden was fully engaged in the activities of the nursery and in receiving visits from her friends. It would appear that she had a traditional lying-in, during which she was frequently visited by friends and neighbours, to the occasional chagrin of her husband. William Ramsden’s descriptions of his wife’s lying-in room would have been recognizable to his correspondent. When Elizabeth had given birth almost twenty years earlier, she was warned by her aunt ‘to take the Greatest Care of your Dear Self – nor lark at all about your entertainment which may prove of very bad consequence and desires you’ll go to Bed earlier than ordinary that the Hurry of Company may not incommode you’.153 Despite the efforts of midwifery writers, the traditions of a busy and sociable lying-in were difficult to displace.

Lying-in was therefore an integral part of giving birth and was not optional even for women of low status, though very poor women might truncate this stage of birthing to two weeks. David Davies, the rector of Barkham in Berkshire, included the costs of lying-in in his book setting out The Case of Labourers in Husbandry Stated and Considered. His calculations assumed that a poor woman would give birth once every two years, and he estimated lying-in costs to be as high as twenty shillings.154 Court records also indicate that women of low status expected to lie in following the delivery of their infants. When Mary Thorpe of Brightside, near Sheffield, gave birth to an illegitimate child in 1800, she had a lively and sociable lying-in until she drowned the infant in the river around fourteen days after her delivery.155 The records of the London Foundling Hospital further emphasize the importance of lying-in to postnatal women. While the hospital would admit children from birth up to the age of two months, Alysa Levene’s detailed analysis of eighteenth-century foundlings has shown that the majority were abandoned between the second and fourth week following their birth.156 This is generally attributed to the financial and emotional struggles of the parents or parent to keep the child. Yet these ages coincide with the completion of the lying-in period for mother and baby as a crucial part of birthing. As with recovery from illness, the lying-in period returned the birthing woman to the physical and emotional state necessary for her to resume her domestic and economic duties and, at the same time, allowed the infant time to gain weight and strength.157 This was at least as important among poor women as it was among those from higher social levels.

The way the term ‘lying-in’ was employed in these letters emphasizes the perceived importance of this period of rest and recovery following a delivery. Like the term ‘confinement’, it was used extensively as a shorthand to describe birthing by women across social classes. In 1833, for example, Frances James of Leicester wrote to the overseer of the poor in her home parish of Uttoxeter, Staffordshire, to request financial relief. In her opening lines she wrote: ‘I have had a Lying In & Buried two Children within six months.’158 At the opposite end of the social spectrum, Frances Ingram, the Viscountess Irwin in Yorkshire used the same language to congratulate her friend Susan Stewart on the delivery of a daughter: ‘I hope I shall hear that you have had a good lying-in & are in the full enjoyment of all the happiness you can wish yourself.’159 The language used in these letters reinforces the idea that women had a sense of shared understanding of what constituted giving birth, despite hugely varied social and economic circumstances.

The point at which the mother was strong enough to sit up or to leave her bed has been referred to in the historiography as an ‘upsitting’ or ‘uprising’, and is described as a cause of celebration among the new mother’s friends and family.160 These terms are used by some accoucheurs, notably the seventeenth-century authors Percival Willughby and John Pechey.161 None of the women whose letters have been referred to here (or their correspondents) refer to the substages of the lying-in process using these words, nor are they found in the 1755 edition of Samuel Johnson’s Dictionary of the English Language. Despite experiencing each substage as they recovered from their delivery, the terms ‘upsitting’ and ‘uprising’ do not appear to have been in common use among this group of women during the later eighteenth century. Instead, their letters speak about the improvement of health and movement around the house, presenting lying-in as a gradual process of recovery in which the various substages were flexible and dictated by the body. These stages could therefore be tailored to take account of the general health of the mother, any physical injuries she may have sustained during her labour and delivery, and her emotional state.

Lochial bleeding (the vaginal bleeding that follows the delivery of the placenta) is a prominent bodily experience in the hours and days after delivering an infant. In the immediate aftermath of a delivery, this discharge is bright red owing to its high blood and oxygen content, and is heavy in flow. Over the next few days, the lochia changes to a brown or pink colour, more closely reminiscent of menstrual bleeding, and reduces in flow before becoming yellow or white in the final stages of recovery.162 Leah Astbury has shown that lochial bleeding was intricately tied to notions of recovery following delivery in seventeenth- and early eighteenth-century medical accounts of birthing, often discussed in terms that mirror the lexicon of menstruation. She notes how, in medical texts, lochial discharge maps neatly onto the lying-in period of four weeks, though this was an ideal rather than a proscriptive period.163 Both lack of bleeding and excessive discharge were extremely problematic in a medical landscape that still prioritized humoral understandings of bodily flow and balance. It can be assumed that all the women discussed here bled within acknowledged parameters, at least in the first weeks of their lying-in. It is notable, however, that none of them refer to it in their letters; instead, they refer to concepts of ‘wellness’ to describe their overall bodily condition. This again may be evidence of a general reluctance to name or discuss the pelvic area. Alternatively, bleeding within accepted parameters may not have been considered sufficiently problematic on its own to require comment or discussion. Lochial flow was, therefore, one of the many variable bodily factors that dictated the duration and nature of the lying-in period.

The lying-in month allowed time for internal injuries to heal. Such injuries might lead to miscarriages or fatal complications in subsequent pregnancies and births, and it was therefore important to give them opportunity to mend. William Hey documented a case in which his patient had suffered from uterine haemorrhage in the early stages of her lying-in. He noted that ‘I had not Opportunity to visit her again ’till the tenth Day’, when he was ‘greatly surprized to hear her Mother say she feared her Daughter was torn quite thro’, that is, she had sustained a substantial tear to the perineum, which separates the vagina and the rectum. It is clear that his patient’s mother had physically examined her daughter in his absence, and had the knowledge and confidence to challenge his assessment that her condition was ‘tolerable’. The discovery of such an injury indicates a variety of possible physical experiences following the delivery. Was it part of routine nursing care to check the vagina and vulva for damage, or had Hey’s patient found the injury herself, either through touch or physical sensation? The feeling of tearing during birth is specific and identifiable for many women and may have been supplemented by ongoing sensations of emptiness or looseness in the pelvic floor. These bodily sensations may have led Hey’s patient either to investigate her perineal tear herself, using her fingers or a mirror, or to ask her mother to examine her. There may have been external indications that the birthing woman had suffered a substantial internal injury. Perineal tears can lead to the production of more blood than the lochial after-effects of birthing, and that blood can be of a different colour and texture to that produced by the womb. Hey duly examined his patient and found that ‘the divided Parts being skinned over, it was impossible to remedy the Complaint without making a fresh Wound, which I was unwilling to do’. As his patient was almost halfway through her lying-in by the time she was examined by Hey, her internal injuries had begun to heal. Hey therefore ‘told her I hoped she would in a little time be free from any great inconvenience in Consequence of this Misfortune’.164

It was important, then, that women observed the lying-in period. If they did not do so, they risked not allowing their bodies time to heal and recover from the intense physical work of birthing. Alongside the healing of internal injuries and the cessation of lochial discharge, the lying-in month allowed time for the resolution of any infirmities that had arisen during pregnancy or as a result of the birth. Betsy Ramsden, for example, complained of blindness and difficulties with her vision throughout the birth of her third child, despite otherwise having had ‘a very Good Lying-in’.165 Elizabeth Shackleton and Jane Scrimshire both suffered from lameness towards the end of their pregnancies, which was resolved during their lyings-in. Newly delivered women needed time to recover from the physical toll of their travail. The sociability of the birthing chamber meant that there were plenty of people to help with caring for older children, providing food, changing sheets and other domestic duties. Their presence also ensured that the mother could be closely watched for signs of physical or psychological illness or injury. This time to heal was, however, dependent on a women’s wealth and social status. For women at the very bottom of the social scale, time to lie in was a luxury that was ill afforded.

Some women, however, found this close attention and enforced rest stifling.166 To a certain extent, this was governed by their health and that of their child. Women who felt they had regained their strength were more likely to find the lying-in room tedious than those who were recovering from a traumatic delivery or an infection. Betsy Ramsden complained that ‘The Lying in Bed … makes me not clever and my head aches not a little’ in response to Elizabeth Shackleton’s enquiries about her health and the health of her infant in 1777.167 Betsy’s restricted lying-in was brought about by her son’s frail health and refusal to take milk from a bottle. This is the only birth after which she complained about the restrictiveness of the lying-in room. It is therefore possible that her experience from previous births had led her to expect to be out of bed and active within her household much sooner after her delivery. When Frances Ingram first wrote to Susan Stewart after the delivery of her fifth daughter in 1766, she noted that ‘I have been on my hind feet a great while, have dined below a week, & have gone on as usual except going out’.168 Despite her feeling physically and psychologically recovered, it was not socially acceptable for Frances to leave the house during her lying-in because she was essentially still navigating the process of birthing, but she was moving around the house and actively participating in her usual household duties long before her lying-in month ended. Where the new mother had recovered quickly from her delivery and was active, she could choose to resume running her household. For women whose recovery was slow or whose child was ill, the lying-in period could be more restrictive, ensuring that they remained in bed or were confined to the lying-in room until they were considered strong enough to resume their usual domestic duties.

The lying-in month was important not just to the physical strength of the new mother but also to her emotional well-being. Emotional regulation was one of the six ‘non-natural’ ways in which eighteenth-century individuals could maintain and monitor health.169 Physical recovery from childbirth and emotional well-being were therefore intimately linked, with one not being truly complete without the other. The lying-in period allowed time for an emotional recovery or, where the infant had died, for grief to be experienced. When Elizabeth Wilson gave birth to her second daughter, her sister Rebekah Bateman was one of her birth attendants. The pregnancy had been Elizabeth’s third and she had continually expressed her anxieties about the birth in her letters to Rebekah. Elizabeth’s daughter was successfully delivered but was unwell, and concern for the infant’s well-being prolonged Elizabeth’s emotional recovery. Rebekah’s letters to her husband Thomas while she attended her sister emphasize the perceived importance of an emotional, as well as physical, recovery from childbirth. On 20 August 1792 Rebekah thanked her husband for his permission to stay in London for a further two weeks in anticipation of a lengthened birth process. She acknowledged that her sister would probably not be fully recovered within the usual lying-in period of four weeks, agreeing with her husband that ‘if well reckoned it might make 6 weeks’.170 The infant was ill and refused to breastfeed, which caused Elizabeth to become increasingly upset. Rebekah was sufficiently concerned about her sister’s emotional health to request her husband’s permission to stay in London, which he granted, apparently with some reluctance. Ten days later Rebekah wrote to Thomas that ‘I waited with some impatience for your last … & observe the liberty given to stay upon conditions’.171 She then emphasized her sister’s poor emotional health, telling him that ‘yesterday was the first day we dared say we thought the Child better, for some time there has been very little prospect of life’. ‘The Mother’, she continued, ‘is so low at times that she does little but cry.’ Rebekah’s presence appears to have soothed her sister’s distress, and she was careful to emphasize this in her letters. She wrote to her husband of an outing she had taken for her own health, after spending so much time confined with her sister, adding: ‘when I was gone she spent the afternoon in tears, so you see I am of some uses & I assure you I fancy more thought of than before’.172 In using her sister’s emotional state to justify her lengthy stay in London, Rebekah’s letters show just how important the emotional recovery from birthing was perceived to be. Elizabeth’s recovery from birthing could not be completed until she was emotionally as well as physically well. Rebekah’s letters are full of descriptions of her sister’s emotional well-being, with references to tears and low spirits rather than her physical progress. In a letter to Thomas the following day, Rebekah reported that her sister ‘is still very bad & is so much altered that you would not know her’.173 Elizabeth’s emotions kept Rebekah away from home for some time. Her recovery from childbirth, her embodied experience of birthing, could not be completed until she was emotionally as well as physically well.

When Rebekah wrote to Thomas indicating her intention to return home, she informed him that Elizabeth ‘dined with us for the first time tho’ she was down to tea yesterday’.174 Her comment suggests that Elizabeth had remained confined in, or close to, the birthing chamber for over six weeks. Her lengthy confinement in one room contrasts sharply with Frances Ingram’s rapid return to the dining table within weeks of her delivery, highlighting the adaptability and flexibility of birthing from women’s perspectives. While the idealized lying-in described in medical literature was organized neatly into substages that could be identified by various physical and material indicators, these milestones were not rigidly observed by birthing women. Instead, lying-in was dictated by the embodied experiences of the new mother and the opinions of those around her.

Conclusion

Women’s embodied experiences shaped birthing practices in eighteenth-century England. Each time a woman gave birth it was slightly different, shaped by her body, her social status and the ways in which she perceived that body.175 Placing the female body at the centre of birthing and giving it agency allows us to see birthing as a dynamic and flexible process, adaptive and responsive to both physical and emotional experiences, to notions of wellness and illness, and to the social and cultural traditions of birthing in this period. This flexibility allowed the process of birthing to absorb the shift from humoral understandings of the body to a body that was bound by its anatomy. It allowed for the assimilation of the accoucheur into birthing practices without displacing the more familiar figures of the midwife and the birth attendants. It also allowed the process of birthing to encompass a vast range of women’s experiences while retaining a recognizable format and purpose. Indeed, the process of birthing was so efficient at encompassing difference that it was observed by women of all social classes. Paupers, merchants’ wives and duchesses all observed the stages of birthing in conceptually familiar though materially very different ways. As we shall see in Chapter 2, the environment in which the birth took place and the traditions that surrounded it became important factors in the embodied experience of birthing. The way the birthing body was clothed, the smells and sights of the birthing chamber and the spatial organization of the household all had an impact on the embodied experience not just of the birthing woman but also of her gossips, friends and neighbours.