(This post originally appeared on Geri Walton’s Unique Histories of the 18th and 19th Century blog.) 

Clockwise from top: Woman’s stool (birthing chair); fetus in uterus, head down, marked “This is the naturall [sic] and best way of birth”; fetus in uterus, feet down. Courtesy of Thomas Raynalde/ Tradition of Science/Leonard C. Bruno/Library of Congress http://www.slate.com/articles/health_and_science/science_of_longevity/2013/09/death_in_childbirth_doctors_increased_maternal_mortality_in_the_20th_century.html

I am writing a new Regency era novel in which a forceps birth is required. To write the scene and the ramifications of the procedure, more research was required into such a difficult delivery. Having written about a less complicated delivery in a previous book, I held some knowledge of the history of forceps dating back to William Chamberlen and his two sons, both named Peter, Francois Mauriceau, and Van Roonhuysen, but the first story was set before the tragic death of Princess Charlotte in 1817 and the controversy which followed.

In Princess Charlotte’s case, she was some two weeks past her due date when she went into labor. The labor lasted some 50 hours, and she was pronounced dead 5 hours after the stillborn was delivered. The princess’s physician, Sir Richard Croft, removed the placenta after a difficult uterine examination. Three hours later, Princess Charlotte hemorrhaged and passed. This left Prince George (the future George IV), without an heir. Sir Richard committed suicide because of the criticism of his treatment of the princess. The use of forceps were more acceptable after this incident.

Two images of childbirth. Plate 23 (left) shows a child in the womb with the umbilical cord. Plate 24 shows forceps being used to deliver the child. Courtesy of William Smellie and John Norman/Library of Congress Rare Book and Special Collections Division http://www.slate.com/articles/health_and_science/science_of_longevity/2013/09/death_in_childbirth_doctors_increased_maternal_mortality_in_the_20th_century.html

The history of forceps include William Smellie’s advancements. He is often considered the proponent of forceps delivery. In the mid 1700s, he designed his own forceps. His “English lock” permitted the blades of the forceps to be inserted into the woman’s vagina separately. He originally covered the blades with leather, and they were lubricated with hog lard. Smellie published the ‘Treatise on the Theory and Practice of Midwifery’ in 1752. (Studd J. “Pioneers in obstetrics and gyanaecology 1: William Smellie.” Diplomate 1994; 1: 153–4.)

https://en.wikipedia.org/wiki/ Elizabeth_Nihell

Elizabeth Nihell, a leading midwife of the period, opposed Smellie’s methods. Nihell trained at Paris’s Hôtel Dieu, a hospital which taught midwifery. In the two years of her residence she witnessed 2000+ births. When she moved to London, Nihell advertised as a midwife in the London Evening Post. In 1760, Nihell published ‘A Treatise of the Art of Midwifery,’ a public statement against Smellie’s development of forceps delivery and opposing the idea of male midwifery, in general. Nihell claimed that few deliveries required the use of forceps.

Obstetrical Forceps, by Smellie (1792) – Public Domain https://en.wikipedia.org/wiki/Forceps_in_childbirth#/media/File:Forceps.Smellie.jpg

But forceps were not the only changes from the late 1700s to early 1800s saw. For example, in the 1700s most births were under the care of a midwife. Even Queen Charlotte employed the services of a midwife for the delivery of her fifteen children. The theory of humors, bloodletting, and purging were still common practices of “medicine.” There were some advances: A well-lit, airy birthing chamber replaced the heated lying-in chamber of the early part of the 18th Century. This was to ward off puerperal fever. Specialized birthing beds were seen in wealthier homes. Modesty was achieved by placing the woman on her side with her knees curled up during the delivery. The doctor would be behind her during this process. Even with these improvements, women were still expected to withdraw from society and from any duties for at least a month before her delivery.

Drawing of childbirth with use of forceps by William Smellie – Public Domain McLeod – Historical Medical Books at the Claude Moore Health Sciences Library, University of Virginia William Smellie (1697-1763): A Sett of Anatomical Tables with Explanations and an Abridgement of the Practice of Midwifery, 1754. https://en.wikipedia.org/wiki/Forceps_in_childbirth#/media/File:Smellie_forceps.jpg

The early 19th Century saw a more “scientific” birth approach in medicine. In addition to instruments to aid in difficult births, there were changes in birthing chairs. Ironically, most experts of the period speak to the fact that men waited to around age 30 to marry so they might be financially sound, but girls made their debut in Society as young as 16. Often it is heard that men married young girls because it was thought that the younger females could more easily withstand the rigors of childbirth. But even 200 years later, childbirth is the sixth most common cause of death for women aged 20-35. No matter the advances in medicine, women still die of postpartum sepsis (known as puerperal fever in earlier times), hemorrhage, eclampsia, etc.

Yet, before forceps, doctors ripped babies in breech or stuck in the birth canal from the woman’s vagina. Do you recall these lines from Shakespeare’s Macbeth (Act 5, Scene 8)?

MACBETH

     Thou losest labor.

As easy mayst thou the intrenchant air

With thy keen sword impress as make me bleed.

Let fall thy blade on vulnerable crests;

I bear a charmèd life, which must not yield

To one of woman born.

MACDUFF

     Despair thy charm,

And let the angel whom thou still hast served

Tell thee, Macduff was from his mother’s womb

Untimely ripped.

Sometimes those attending to the delivery cracked the baby’s skull, killing the newborn in order to spare the mother. Other times, the woman’s pubic bone was broken, which often killed the mother but saved the baby. Doctors had a collection of resources, including tools to hook a hard-to-deliver baby and drag it from the womb. Ironically, most of these gadgets resembled medieval torture tools.

Excellent Sources on the Subject Include:

Bull, Thomas. Hints to Mothers, For the Management of Health During the Period of Pregnancy, and in the Lying-in Room: with an Exposure of Popular Errors in Connexion with those Subjects and Hints Upon Nursing, Wiley & Putnam, New York, 1877.

Dewhurst, Jack. Royal Confinements, Weidenfeld and Nicolson, 1980.

Leavitt, Judith Walzer. Brought to Bed: Childbearing in America 1750-1950, Oxford University Press, New York.

Lewis, Judith Schneid. In the Family Way: Childbearing in the British Aristocracy, 1760-1860, Rutgers University Press, New Brunswick, New Jersey, 1986.

Loudon, Irvine. Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950, Clarendon Press, Oxford, 1992. (available on Google Books)

Ulrich, Laurel Thatcher. A Midwife’s Tale: The Life of Martha Ballard, Based on her Diary, 1785-1812, Knopf, New York, 1990.

Meet Regina Jeffers: Regina Jeffers, an award-winning author of historical cozy mysteries, Austenesque sequels and retellings, as well as Regency era romances, has worn many hats over her lifetime: daughter, student, military brat, wife, mother, grandmother, teacher, tax preparer, journalist, choreographer, Broadway dancer, theatre director, history buff, grant writer, media literacy consultant, and author. Living outside of Charlotte, NC, Jeffers writes novels that take the ordinary and adds a bit of mayhem, while mastering tension in her own life with a bit of gardening and the exuberance of her “grand joys.”

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