Monthly Archives: September 2014

The Midwife of St. Giles Cripplegate

This week, I have been a guest blogger for the Perceptions of Pregnancy Network.  Here is a link to the blog post – thank you for inviting me to contribute!

The Midwife of St. Giles Cripplegate.

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“I grew weary of my toil”: the brutality of difficult births

WARNING: THIS BLOG POST IS NOT FOR THOSE OF A SQUEAMISH DISPOSITION!

Whilst on a research mission in Leeds over the summer, I stumbled across the case notes of William Hey. Hey was a surgeon in Leeds, and campaigned for the establishment of the Leeds General Infirmary in which he served as a surgeon from its temporary incarnation in 1767 until his retirement in 1812.[1] His entry in the Oxford Dictionary of National Biography emphasises his role as a surgeon-apothecary but says very little about his obstetric practice.

Portrait of William Hey        

The Blue Plaque that is displayed on William Hey's house in Leeds.
The Blue Plaque that is displayed on William Hey’s house in Leeds.

 

He clearly maintained a reasonably-sized obstetric practice evidenced by his ten notebooks of difficult deliveries, held at the Brotherton Library. Today, I’d like to blog about case five in his notebooks dated August 15th 1759. Hey was only 23 years old when he was called to attend this birth but he was already an experienced medic. He had recently returned from two years studying under William Bromfield at St Georges Hospital in London. Prior to that, he had spent seven years apprenticed to William Dawson (a surgeon-apothecary in Leeds) not to mention any informal training he may have received from his grandfather who shared this profession. He had a reputation of being a particularly determined and able student. Keep this experience and training in mind as you read the following extract from his case notes.

Case 5

Augst 15th 1759 I was sent for to deliver the Wife of Josp. Fowler of Pudsey of a second Child, the former being born the Day before. The Shoulder presented with the Arm in the Vagina. The Waters were almost entirely evacuated, tho’ the Membranes only broke abt 3 Hours before I got to her. After getting at ye Feet with Difficulty, I brought one of them down, fasten’d a Noose above ye Ankle, and endeavoured to push up the presenting Part at the same Time that I pulled by the Garter: but all my Efforts were in vain; for I could not move the presenting Part in the least. I tried so long to extract the Child in this Manner that I separated the inferior Epiphysis of ye Tibia & Fibula. I grew sick with my Toil, & was obliged to sit down & rest myself. After making another attempt with the like success I resolved to carry up my Hand again to the Fundus Uteri to seek the other Foot, which I effected with no small Difficulty; And no sooner had I laid hold of it, & attempted to bring it down, but the Child turned with all imaginable Ease, and was delivered speedily. The Child was dead, but ye Mother recovered pretty well, only had sore Breasts thro’ improper Application.

I warned you that this blog post was not for the squeamish! The first thing that hits me (quite literally) upon reading this passage is the sheer violence of the experience. Hey notes that he experienced difficulty ‘getting at ye Feet’. It is not surprising given the mechanics of this operation. When fully dilated, the cervix opens ten centimetres and, in this instance, the arm of the undelivered infant had come through the cervix and into the vaginal passage.

Anatomical drawing by William Smellie
Anatomical drawing by William Smellie

I can hardly bear to think whereabouts in the womb the feet were in relation to the cervical opening. Eventually, Hey got hold of one foot and fastened a noose of some description around it. He then pulled so hard on the attached cord that he separated the baby’s leg bones. He pulled so hard that he had to sit down and have a rest before repeating the process. When this didn’t work, he put his hand into the womb again to feel around for the other foot – but this time the cervix was not only blocked by an arm, it also had the leg upon which he had been tugging restricting his access. With ‘no small difficulty’ he got hold of the other foot, after which it was easy to heave the child out into the world. Unsurprisingly, the child was dead.

Yet Hey was well-educated and experienced. Nor was he old, or out of touch with obstetric developments. He was newly arrived from London where, I presume, he kept abreast of scientific developments in surgery and obstetrics. Whilst this delivery was certainly difficult, his matter-of-fact tone suggests that such brutality was not extraordinary. Indeed, many of his other cases record similar attempts to bring down feet, alongside accounts of painful ‘turns’ for breach babies and heaving on the umbilical cord in order to facilitate the delivery of the placenta.

In Hey’s account, Mrs Fowler is barely mentioned. He notes that she ‘recovered pretty well.’ I am a little suspicious of this statement. I find it hard to believe that she did not experience some tearing as a result of the violence of her delivery, and I also wonder about her continence and future childbearing capacity as a result of the impact of this delivery on her pelvic floor and womb. Her experience of this birth does not interest Hey – he is interested purely in the mechanics of her delivery. The result is a very clinical depiction of a difficult eighteenth-century birth. In my next blog post, I am going to try and build a picture of the scene in more detail looking at the lived experience of the participants. Watch this space!

 

[1] Oxford Dictionary of National Biography, William Hey 1736-1819, Margaret DeLacy.