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The Early Modern Birthing Room and Interprofessional Collaboration

 

Image credit: Wellcome Apocalypse. Source: Wellcome Collection. 38v

 

Studies into maternal perceptions of the experience of modern childbirth indicate that “[p]oor interprofessional collaboration [is] detrimental to the quality, safety, and experience of maternity care.”[1] Labouring women suffer when communication between their practitioners is poor, a problem that has been attributed to medical “organisation culture, for example, hierarchy and failure to function as a team.”[2]

What evidence is there to suggest that early modern medical practitioners practiced interprofessional collaboration while overseeing births? While tensions between midwives and surgeons may have negatively influenced outcomes in the birthing chamber,[3] we can still find shared moments of collaboration and consensus on the procedures to be followed to ensure the safe delivery of both the mother and the child in professional accounts of childbirth. Using the definition proposed by A. A. Schulz and M. A. Wirtz according to which medical collaboration can be understood as “[t]he purposeful linking of profession-specific knowledge and skills,”[4] we can extend previous discussions of the early modern birthing room that have considered dynamics of blame and mistrust between practitioners in the management of childbirth.[5]

Two early modern midwives show engagement with interprofessional collaboration in their printed practical manuals. Louise Bourgeois indicates in Observations diverses sur la stérilité, perte de fruict, foecondité, accouchements et maladies des femmes et enfants nouveaux naiz, first published in 1609,[6] that such cooperation was central to the best interests of the patient. One such instance involves the care of a young woman in Paris who could no longer feel movement in her womb in the seventh month of pregnancy. Although it was the physicians Monsieur Le Febvre and Monsieur Elin who were enlisted to “ease her pain and discern if the child was alive,”[7] it was Bourgeois herself who carried out the physical examination of  “the orifice of the womb [which] was the size of a small ring [and] had no fold or wrinkle that could show any sign of ever dilating.”[8] The evaluation led those involved in the case to believe that the child had died. The diagnosis suggests some form of communication among the practitioners which facilitated a mutually informed approach in deciding how to proceed with patient care.

Bourgeois subsequently convened “the late Monsieur Marchand fils, a surgeon with expertise in childbirth, along with the surgeon Monsieur Pietre, a very capable and experienced man, along with Madame Françoise, a former midwife”[9]. These three practitioners joined with the two doctors previously mentioned. There were thus six practitioners, including Bourgeois, engaged in the care of this patient, combining the knowledge of midwives, surgeons, and physicians. At least one conversation was held between these practitioners where, as Bourgeois explained, they “consulted as to what might have happened with the child,” to the effect that “everyone concluded that the child was dead.”[10] The prognosis was thus preceded by a collective negotiation hinging on the expertise of the different types of practitioner present, each with their specific knowledge set. In this specific case, however, upon reexamination of the woman a few weeks later, Bourgeois correctly identified the onset of labour and “that same day [the woman] gave birth to a very beautiful, sound, and healthy daughter.”[11] Although this case was presented as having a positive outcome only due to the intervention of Bourgeois herself who treated the woman alone after an interval of two months, we can still identify a collaborative encounter between these practitioners in the preceding care provided to the patient.

Another midwife, Jane Sharp, writing in The Midwives Book (1671), referred to moments of interprofessional consensus regarding the roles and duties of each practitioner present. She documented situations where the mother had died in labour but the child survived the birth. In one case, she dictated that “the Midwife must keep the womb open that it [the child] be not stifled till the Chirurgeon cuts it out.”[12]Physical manipulation of the female body was the remit of midwives in the early modern period, as Ophélie Chavaroche,[13] amongst others, has demonstrated. In this case, then, we can read Sharp’s instruction as evidence of clearly demarcated responsibilities, where profession-specific activities are carried out to facilitate the provision of optimal care to the patient(s), in this case the baby.

Sharp also related another case where an illness affected a patient’s womb by making it extremely narrow, leading to a complication during childbirth. Sharp explained that “the midwives […] discovered the difficulty; and a Chirurgeon made the Orifice wider, and she was by that means happily brought a bed of a Son.”[14] We can assume that this difficulty was communicated to the surgeon orally by the midwives, suggesting the value placed on their insights by the surgeon. The positive patient outcome was thus facilitated by professional collaboration between the practitioners present at the birth.

While this post has explored only these two texts, further study on this topic could include a consideration of different sources such as male-authored obstetrical treatises and physicians’ case notes, as well as family correspondence and private journals of those present at births.

ÚNA FALLER

[1] V. Watkins et al. “Labouring Together: Women’s experiences of ‘Getting the care that I want and need’ in maternity care,” Midwifery 113 (2022): 103420. doi:10.1016/j.midw.2022.103420.

[2] A. Romijn, P. W. Teunissen, M. C. de Bruijne, et al. “Interprofessional collaboration among care professionals in obstetrical care: are perceptions aligned?”, BMJ Quality & Safety 27 (2018): 279–286.

[3] See, for example, M. Phillips,“Midwives versus Medics: A 17th-Century Professional Turf War,” Management & organizational history 2:1 (2007): 27–44.

[4] A. A. Schulz and M. A. Wirtz. “Assessment of interprofessional obstetric and midwifery care from the midwives’ perspective using the Interprofessional Collaboration Scale (ICS).” Frontiers in psychology 14 (2023): 1143110. doi:10.3389/fpsyg.2023.1143110.

[5] See, for example, L. McTavish, “Blame and Vindication in the Early Modern Birthing Chamber.” Medical History 50:4 (2006): 447–464.

[6] The 2017 translation (edited by A. Klairmont-Lingo and translated by S. E. h O’Hara) used in this post is based on the 1626 edition.

[7] L. Bourgeois, Midwife to the Queen of France : Diverse Observations, ed. A. Klairmont-Lingo, trans. S. E. O’Hara, Toronto: Iter Press, 2017, 169.

[8] Ibid.

[9] Ibid.

[10] Ibid, my emphasis.

[11] Ibid.

[12] J. Sharp, The Midwives Book or the whole Art of Midwifery Discovered. Directing Childbearing Women how to behave themselves in their conception, breeding, bearing and nursing of children, London: S. Miller, 1671, 197.

[13] O. Chavaroche, “Toucher le corps des femmes au XVIIe siècle : empirisme, soin et savoir dans les écrits médicaux de Louise Bourgeois dite Boursier,” in Enfanter dans la France d’Ancien Régime, ed. by L. Dion et al., Assas: Artois Presses Université, 2017. Openedition: https://doi.org/10.4000/books.apu.10956.

[14]Sharp, The Midwives Book, 269.


OpenEdition suggests that you cite this post as follows:
Úna Faller (January 24, 2025). The Early Modern Birthing Room and Interprofessional Collaboration. NOTCOM. Retrieved July 17, 2025 from https://doi.org/10.58079/135jt


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