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Male delivery: the domain of the man midwife

Obstetrical forceps 1773 from a lecture introductory to the theory and practice of midwiferyby john leake edit

The early man midwife was able to escape the barber surgeon shop and penetrate the domestic sphere, masculinising the delivery room

Dr Peter was one of a long line of man-midwives from the Chamberlen family, and (confusingly) the third Peter. His grandfather, William Chamberlen, probably a surgeon, had arrived in England from France in 1569, fleeing Huguenot persecution. Two of his sons (the first two Peters) – Peter the Elder (1560-1631) and Peter the Younger (1572-1626) – were both barber surgeons practising in London. Disdainful of rules and common practices, they were frequently in trouble with the Barber Surgeons Company and the College of Physicians for failing to attend lectures, for practising as physicians, and for mis-prescribing medicines. 

Until 1745, barber surgery was less a profession than a trade; surgeons learning by apprenticeship rather than a medical education. Lower in rank in medical terms, the barber surgeon’s shop was a notoriously sordid space, with poor lighting and facilities. Without anaesthetic, the surgery they performed was crude and haphazard. The surgeon’s tools were: sharp-bladed knives, used to shave hair, cut flesh for bleeding, and amputate limbs; pincers, surgical forceps and pulleys, to extract teeth and bladder stones; and needles for stitching wounds. They were often imprecise and fashioned by the surgeon himself, and were rarely washed between patients. With no knowledge of germ theory or even basic hygiene, the space of the barber shop and the surgeon’s tools were undoubtedly rife with bacteria.

Midwifery drawing architectural review

Midwifery drawing architectural review

The male midwife – ‘midwife’ meaning ‘with woman’ – emerged in the 16th century and brought with him various previously unused implements

Barber surgeons sold medicines but were not allowed to practise as physicians. Physic was considered the superior profession and only accessible to those with an Oxford or Cambridge education. Physicians were, on the contrary, free to practise surgery. Despite this restriction, the Peters practised very successfully as man-midwives. 

Male physicians, and later, man-midwives, were called by midwives to assist during the final stages of difficult births. Yet they could usually do little to help except resort to the crochet tool – a brutal sharp instrument used to perform craniotomies – to remove an obstructed foetus that would otherwise kill the mother; use caesarean section, as championed by Scipione Mercurio in the 1590s, performed either on an already dead mother, or sacrificing her in favour of saving the child; or employ podalic version which involved putting a hand into the uterus and turning a transversely lying baby and drawing it out by the foot. The only other recourse was ergot, known to midwives for centuries. In large doses ergot was an abortifacient, yet in small doses at the end of pregnancy it would accelerate childbirth. The Chamberlen sons went further. At some point they invented, and kept secret, an instrument they claimed resulted in more live births, and fewer maternal deaths: midwifery forceps. The first set of these are attributed to Peter the Elder but they remained a family secret for over a 100 years, and the details remain unclear. 

‘Only the Chamberlens were allowed in the locked room, from which terrified relatives heard peculiar noises, ringing bells, and other sinister sounds as the Secret went to work’

The third Peter (born 1601), was Peter the Younger’s son. Educated at Cambridge, Heidelberg and Padua, he was (unlike his uncle and father) awarded the degree Doctor of Medicine in 1619 at the age of 18 and henceforth known as Dr Peter. Elected a Fellow of the College of Physicians in 1629, Dr Peter had been accompanying his uncle and attending births at court, undoubtedly learning to use the secret forceps along the way. He was probably the one attending Queen Henrietta in 1630 when Charles II was born. Upon his uncle’s death in 1631 he officially took up the role of court physician-accoucheur. Reputedly flamboyant, and arrogant about his skills, Dr Peter successfully attended the court and upper-class women during childbirth for a number of decades. He died in 1683, with the secret of the forceps still only known to the family. 

Forceps was a material object that emerged from the relationship between the spaces and activities of the barber shop and the domestic bedroom. Both Peters were ambitious and, by 1600 at the latest, desired to penetrate the revered world of the physician who inhabited the university on the one hand and the home on the other. One way to do so was to become a man-midwife and gain immediate access to a number of patients in the upper-class domestic setting, rather than in the public shop. Although the man-midwife would be called to ordinary homes only when there was some danger and need for surgical intervention, his presence became desirable throughout labour to middle- and upper-class patients, who were also willing and able to pay more. With a foot now in the domestic space, one of the Chamberlens (probably Peter the Elder) saw an opportunity to refashion his instruments to suit. 

Physicians and surgeons transported their tools from house to house in a bag or box, often made specially for the particular instruments it held. The Chamberlens were no different and used the idea of the box not only to keep their secret, but to develop its sense of mystery and bravado.

Birthroom architectural review

Birthroom architectural review

Source: Wellcome Collection

A wood engraving after a woodcut of 1711 depicts a woman giving birth. The male midwife, shrouded by a sheet, cannot actually see what he’s doing but relies on his sense of touch. This sheet safeguards the woman’s modesty at the same time as preventing her from glimpsing his crude contraptions

As Harvey Graham describes in 1950: ‘They are said to have arrived at the house of whichever woman it might be in a special carriage. With them was a huge wooden box adorned with gilded carvings. It always took two of them to carry the box and everyone was led to believe that it contained some massive and highly complicated machine. The labouring woman was blindfolded lest she should see the Secret. Only the Chamberlens were allowed in the locked lying-in room, from which terrified relatives heard peculiar noises, ringing bells, and other sinister sounds as the Secret went to work.’ 

These descriptions are surely overstated. Graham and subsequent male writers, in their enthusiasm to believe that the forceps were the ‘key to the lying-in room’, as Walter Radcliffe stated, and that the Chamberlens were heroic inventors, were willing partners in the promotion of the mystery and continuing reverence for the brothers’ invention. They colluded in the inflation of a rather humble, if sometimes useful, object into a ‘great’ progressive one. Each generation of the Chamberlens was known to be confident and flamboyant, and must have been adept at managing their appearance – self-promotion was essential to the rise from lowly barber surgeons to successful man-midwives to the court.

‘In the end, the man-midwife left the home as swiftly as he arrived, with his boxed instruments smeared and sodden with new fluids’

The arrival of the box, whether large and ornate or plain, effected an immediate change to the spatial dynamics of the home and the lying-in chamber. Carried into the home by the man-midwife, it signified an emotional turn to the birthing scene. Although scorned by the College of Physicians and distrusted by midwives and the public, by the time of Dr Peter, man-midwives were on the rise. A servant, or the husband himself, rushed off into the town to fetch him. He would arrive as a potential heroic protagonist, fresh to the scene; his role to save mother, baby or both. As he entered the exhausted household, noise and bustle would accompany him, his outer coats and layers of clothing swiftly removed before he ascended to the lying-in chamber. 

Once there, the room was cleared of most or all of the ‘gossip’ (the helping women), and sometimes the midwife, for practical reasons as much as anything. The women were exhausted and in need of sustenance and sleep; a birthing woman often laboured for many hours, even days, before male assistance was thought to be needed. More importantly, he was the only man admitted to the dark and airless bedchamber. Whether or not women assistants remained, the gender of the space was hence masculinised. In a space that was essentially female, and had been for centuries, there was now a single man in total authority. The birthing woman was probably now repositioned on the bed, candles lit or extinguished. The man-midwife’s sleeves rolled up, he swiftly performed his task, almost certainly with unwashed hands, and unwashed instruments.

Despite this authority, questions remained around his presence. A woodcut from 1711 shows the labouring woman seated at the end of the bed, a huge sheet thrown over her and tied around the neck of the man-midwife who is at work underneath it. He cannot see what he is doing, and works by touch alone. This may have been a true reflection of the events in the room, designed to hide the crude instruments of iron and bone tied together with cloth, or merely an image taking into consideration her modesty. 

Male midwives ad architectural review

Male midwives ad architectural review

Having been banned from practising in 1951, it wasn’t until the Sex Discrimination (Midwives) Order of 1983 that once again men were allowed to practise midwifery, as captured in a 1983 issue of Midwives’ Journal 

The stories of the arrival of the large box, its ornamentation, the pretended weight of it and the rituals of blindfolding and locking doors developed a theatrical imagery around a Chamberlen, coding and masking the realities of his arrival and presence in the lying-in chamber. The flamboyant sequence of events, or even the repeated story of them, enabled him to control the spatial narrative. By setting up a show through the elements described, he installed a sense that he was in control and that, if the rituals were followed, his presence and instruments would be successful. The same 1711 woodcut shows a scene with an invisible line bisecting the man from the women. The labouring mother and her helpers are one side of it and he the other. The curtains to the bed look like stage curtains. In one sense the labouring mother is the performer, of course, but in another sense this can be switched and the man-midwife seen as performer and the women an audience to his work (in a later version the birthing mother is looking less to the heavens and more towards him). If he is the performer, as suggested by the flamboyant sequence of events leading up to this moment, the women become passive onlookers. And the unhelpful sheet around his neck would not be necessary if one had confidence in the performer. Modesty could be bypassed by other senses of control and ritual in the space. A Chamberlen would have had more chance of success this way, and there must have been some reason for his success. After all, even once forceps were known about and various new types developed throughout the 18th century, they had a reputation for leaving a trail of destruction in their wake and raising the incidence of puerperal fever, a virulent infection undoubtedly introduced by them. Some considered the forceps so unsuccessful it was likened to the crochet tool used for craniotomy. 

In the end, the man-midwife left the home as swiftly as he arrived, with his boxed instruments smeared and sodden with new fluids. Whether or not he washed them later, the cloth and bone materials of some tools could not be properly sterilised. He left the midwife to clean up the woman and baby, and her gossip to perform the emotional and domestic care, including calling in a priest if there had been a death after all.

Lead image: The Chamberlen family invented forceps in the 1600s, but they remained a family secret until the 1730s. John Leake’s A Lecture Introductory to the Theory and Practice of Midwifery of 1773 was illustrated with obstetrical forceps

Source: Wellcome Collection

Further reading:

JH Aveling, The Chamberlens and the Midwifery Forceps (1882)

Peter M Dunn, ‘The Chamberlen Family (1560–1728) and Obstetric Forceps’, in Archives of Disease in Childhood. Fetal and Neonatal Edition (1999) 

Adrian Wilson, The Making of Man-Midwifery: Childbirth in England, 1660-1770 (1995)

This piece is featured in the AR March 2020 issue on Masculinities + W Awards – click here to buy your copy today