_MIDWIFERY AS A CAREER FOR EDUCATED WOMEN._
MY DEAR SISTERS (or rather, Chers et très-honorés Confrères),
While all that we women think about is to have the same education as men
in medicine, must we not feel the women’s medical movement to be rather
barren when it might be so fruitful?
But public opinion in England is not free enough for a coward to dare to
say what she thinks, unless at the risk of having her head
(figuratively) broken.
Is there not a much better thing for women than to be ‘medical men,’ and
that is to be _medical women_?
Has not the cart been put before the horse in this women’s medical
movement?
Here is a branch so entirely their own, that we may safely say that no
lying-in would be attended but by a woman if a woman were as skilful as
a man—a physician accoucheur.
Yet, instead of the ladies turning all their attention to this, and
organising a midwifery school of the highest efficiency in both science
and practice, they enter men’s classes, and lectures, and examinations,
which don’t wish to have them, and say they want the same education as
men.
Then, is there not an immense confusion as to whether they are ever to
be called in as medical attendants to men?
‘No,’ say those lady doctors who have at all thought out the question.
‘We wish to be educated as if we were going to attend men, but we should
think it an insult to be called in to attend men.’
Why not adjourn for a century, or for half a century, the question
whether _all_ branches of medical and surgical practice shall be
exercised by women, even upon women? It is a question which may safely
be left to settle itself.
But here is a matter so pressing, so universal, so universally
recognised, viz., the preferable attendance of women upon women in
midwifery, that it may really be summed up thus:—Although every woman
would prefer a woman to attend upon her in her lying-in, and in diseases
peculiar to her and her children, yet the woman does not exist, or
hardly exists, to do it. Midwives are so ignorant that it is almost a
term of contempt.
The rich woman cannot find fully qualified women, but only men to attend
her, and the poor woman only takes unqualified women because she cannot
afford to pay well qualified men.
But why should the midwives be ignorant? and why (in the great movement
that there is now to make women into medical men) should not this
branch, midwifery, which they will find no one to contest against
them—not at least in the estimation of the patients—be the first
ambition of cultivated women? Is there any rational doubt that, suppose
there were a man and a woman, both equally versed in midwifery art and
science, the woman would be the one sent for by all lying-in women?
There is a better thing than making women into medical men, and that is
making them into medical _women_.
Surely it is the first object to enable women, by the most thorough
training, practical and scientific, to practise that branch of the art
of medicine which all are agreed should be theirs, _not_ ‘like men’—for
nearly all the best men are agreed how deficient are the practical
training and opportunities of medical students, especially in midwifery,
which deficiency yet does not prevent them from obtaining diploma,
license, all they want, in order to practise—_not_ ‘like men’ then, but
like _women_, like women who wish to be real physician accoucheuses;
that is, to attend and to be consulted in all deliveries, abnormal as
well as normal, in diseases of women and children, as the best
accoucheurs attend and are consulted.
Sensible women say, ‘But the only means to obtain a scientific education
_is_ to enter men’s classes.’
_Is_ that the case?
Is the student’s scientific and practical education all that could be
wished?
Could there not be given (and _is_ there not given, in some Continental
schools?) a far more thorough and complete scientific education, as well
as practical, where there are none but women, in a midwifery school,
without all this struggle and contest, which raises questions so
disagreeable and ridiculous that a woman of delicate feeling shuns the
indelicacy of the contest—_not_ the indelicacy of the occupation?
The parody, the _qui pro quo_, is a curious one.
The indelicacy of a man attending a woman in her lying-in is by
necessity overlooked.
The indelicacy of a woman attending with men in medical classes is made
much of.
Would it not be far better to get rid of both at once? to have
women—trained with women, by women—to attend women—trained in all
branches of a scientific and practical midwifery education?
But let no one think that real midwifery education can be less complete
and thorough for a woman than it ought to be for a man, if women are
really to be physician accoucheuses.
And let no one think that two or three courses of lectures—a month,
three months, six months at a lying-in institution, conducting twenty,
thirty, or one hundred labours—will make a woman into a (real) midwife.
One hundred labours may be normal, requiring no interference but that
which a good midwifery nurse can give. The one hundred and first may be
abnormal and may cost the patient her life or health, the attendant her
reputation and peace, if her education has been nothing but the few
lectures, the few weeks, the few labours.
Let us suppose for a moment that, leaving aside the ordinary talk of
giving a woman a ‘man’s medical education,’ good or bad, we imagine what
a college might be to give the whole necessary training—medical,
scientific and practical—to make real midwives, real physician
accoucheuses.
There must be first, of course, the lying-in institution, the deliveries
conducted by fully qualified head midwives, of whom enough perhaps exist
already for this purpose, who will give practical instruction to the
pupil midwives at the bedside.
There must be a staff of professors, to give scientific instruction in
midwifery, but also in anatomy, physiology, and the like; in pathology
and pathological branches; above all, in _sanitary_ science and
practice.
Dissections and post-mortem examinations will have to be practised. It
need not be said that these must be at a quite different time and place
in the ‘course of education’ from the training about the lying-in
patients.
Probably all these professors, or nearly all, must at first be men.
Probably in time all these professors, or nearly all, will come to be
women.
The course of education, before the end of which no pupil can receive
the certificate of a fully qualified midwife, must certainly not be less
than two years.
_Is_ this merely an ideal? _Is_ it an Utopia? Have we never seen it in
practice? Could it not be put in practice in practical England?
Seen it in practice we have—save and except the _sanitary_ practice,
which is wofully deficient—on the continent of Europe.
And lady professors there have been in midwifery on the Continent quite
equal to the most distinguished physician accoucheurs in this or in any
other country; who took their place among these, among the Sir James
Simpsons and the Sir Charles Lococks, as _of_ them, and not outside of
them, in all midwifery matters, scientific as well as practical.
The names of Madame Boivin and Madame Lachapelle, of Paris, are known to
all Europe. And there are many other names of lady professors in
midwifery and of midwives, not known in England at all, who take their
uncontested places on the continent in practice, in consultation, in
teaching, as a Sir James Simpson here. They teach in midwives’ colleges,
and imperial and royal ladies _are_ sometimes, and often wish to be
always, attended by them.
_Note._—A society has already existed for several years, the object of
which, according to its programme, is ‘to provide educated women with
proper facilities for learning the theory and practice of midwifery, and
the accessory branches of medical science.’
The programme states most justly that, for want of these, for want of
‘proper means of study,’ of ‘any public examination,’ ‘any person may
undertake the duties of a midwife.’
Let us look what the ‘proper means of study’ are which it provides.
They are—1. Attendance upon lectures during two winter sessions. 2.
Attendance ‘during the intervening summer’ upon clinical practice at
‘_a_’ lying-in hospital or maternity charity, with personal attendance
upon at least _twenty-five_ deliveries!
[It is easy to make a rough calculation how many cases of abnormal
parturition occur to how many normal. Is it likely that among
‘twenty-five deliveries’ there will be abnormal cases enough to practise
the pupil-judgment, the pupil-hand?]
These ladies have not even the advantages which the idlest student can
hardly help availing himself of—and _his_ minimum is ‘three years.’ Yet
this is the course proposed to enable a woman to ‘practise midwifery,’
even in the sense in which we understand a man to ‘practise
midwifery,’—to enable a woman to become a physician accoucheuse (for
these ladies are expressly styled ‘accoucheuses’) in the sense in which
we understand a man to be a physician accoucheur.
The paper states, doubtless with truth, that these ladies ‘are the best
taught accoucheuses hitherto accessible to the English public.’ May we
not hope that, in future years, the society will be enabled to give
‘accoucheuses’ still better taught ‘to the English public’?
LONDON: PRINTED BY
SPOTTISWOODE AND CO., NEW-STREET SQUARE
AND PARLIAMENT STREET
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Footnote 1:
Exclusive of the case of a poor woman who was delivered in a cab, and
died in the hospital of _post partum_ hæmorrhage.
Footnote 2:
‘So was confined in No. 4 ward.’
Footnote 3:
Patient died 48 hours after delivery.
Footnote 4:
Patient died on her way to the hospital: not included in the
calculated rates.
Footnote 5:
One case had gastric fever on admission, and in two cases puerperal
peritonitis came on after instrumental delivery.
Footnote 6:
In 1868, 69, 70, there were in Liverpool workhouse, 1,416 deliveries,
including 20 premature, and 6 deaths from all causes, of which 3 at
least were non-puerperal. The _total_ death-rate was only 4·2 per
1,000. There were 13 London workhouses in which, in 5 years, 2,459
deliveries, but no deaths in childbed, took place.
Footnote 7:
Exclusive of a fatal case delivered in a cab.
Footnote 8:
One delivery took place in a cab, and the woman died in hospital.
Footnote 9:
Husson, ‘Étude sur les Hôpitaux,’ p. 254.
Footnote 10:
Tables XI., XII., XIII., abstracted from the ‘Statistique médicale des
Hôpitaux de Paris.’
Footnote 11:
This drain was shown on the Plan from which Plate I. is taken.
Footnote 12:
Premature births: Seven months, 8; deaths, 5; six months, 6; deaths,
6; five months, 1; death, 1.
Footnote 13: