I'm currently reading a book published in 1903 called The Wife's Handbook: How a Woman Should Order Herself during Pregnancy, in the Lying in Room, and after Delivery. (N.B. Only married women were fortunate enough to benefit from the wisdom of Dr. H. Arthur Allbutt, D.C.L., L.L.D., trained in Paris, Athens, Oporto, New York, Madrid and God knows where else. Illegitimate babies and their wanton mothers could clearly go screw themselves.)
This modest ‘little work’ penned by Arthur ‘to save the lives of thousands of women’, and to remove from the young wife’s mind ‘the popular ignorance in which she may have been reared’, is a stark reminder of the male-dominated world our current system of obstetric care originates in and, arguably, still inhabits. Reading it, you are, of course, struck by how much has changed, and for the better! But the book reveals a number of turn-of-the-century attitudes and habits which, worryingly, still survive.
For example, it contains an all too familiar mix of both reassurances that birth is a natural process not to be feared, as well as threats of the calamity that will ensue if medical advice isn’t followed: ‘Ignorance of health matters transforms the lying-in room into a chamber of suffering, and makes that which is a perfectly natural process, easy and in most cases entirely free of danger [that’s ok then] - a proceeding painful, lengthy and often highly dangerous.’ [Oh.]
Arthur also offers a lot of advice which appears to have little or no foundation in evidence: 'Here let me warn my readers that no woman can be healthy who takes a large quantity either of tea or coffee […] Cocoa is by far the best morning and evening drink for a pregnant woman.’ The bold statements continue: ‘Bread must be old’ … ‘Cheese had better be avoided’… ‘Heavy suppers are bad’, and one of my favourites, ‘A woman making her morning meal of porridge and milk will rarely ail much during her pregnancy’. Put that one in your pockets, ladies, take it away with you!
Certainly, we have more research to draw on today than old Art would have had in 1903, but there are still many cases where, in the absence of clear evidence, women are simply advised to go without, ‘just to be on the safe side’. What is perhaps most striking about Arthur's advice is not that it is flawed, but the absolute confidence with which it is shared. At the same time, he has no qualms about dismissing the advice of 'old women' (presumably the experienced mothers, midwives and lay healers who supported pregnant women until doctors like Arthur came along and blew them out of the water), although they were probably the source of much of his knowledge and so-called expertise.
In the chapter on labour care, the needs of the pregnant woman are marginalised in favour of those of the baby and, most pressingly, the doctor. Regarding appropriate clothing in the first stage of labour, Arthur writes,‘The being confined in the clothes worn during the day is a dirty habit, and is a hindrance to the last stages of labour, besides interfering with the doctor’s examinations; and the clothes are in the way when the baby is born.’
But the passage that disturbs me the most is this: ‘We will now suppose that labor has fairly commenced, and that the doctor has entered the room […] The woman must not get flustered at his presence. After taking a few minutes he will propose to the woman that he make an ‘examination’ in order ‘to see how things are going on.’ This must not be objected to, as the examination is necessary, and by making it the doctor is able to form an opinion as to how the labor will go on.’ Has anyone ever tried turning down a vaginal examination in the 21st century? How did that go? Of course, women now have the right to decline investigations and treatment, and might reasonably hope their decisions will be respected, but it still takes a rare and strong woman to go completely against medical norms, and there are many stories of women being talked or bullied into procedures they initially decline.
19 pages into this book, and what alarms me the most is not how dreadfully women used to be treated, but how much of its rhetoric is still echoed in practice today.
To conclude, and lest their be any doubt, ‘It is a sin, before a child is three years of age, to feed it like its parents’. Glad we cleared that one up.