Only for Readers with Strong Nerves: A Manual for Midwives

Men – in particular – associate birth either with a hospital or with a terrifying film scene where a woman gives birth in a car stuck in traffic or far away from any kind of infrastructure and somebody desperately calls for a newspaper (unread if possible to avoid germs!), clean towels and warm water. Once the hyperventilating father in the making brought all these things, a confident woman usually takes care of everything else.

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Experts in Giving Birth: Midwives

In fact, since the beginning of human history, women have been specialised in the delicate task of giving birth. Midwives already existed in ancient times and the knowledge about how one should ideally proceed when giving birth to a small human being was passed on by word of mouth. However, in the 18th and 19th century, the state began to organise this profession by means of schools for midwives like the ones that still exist in Germany. From then on, midwives did not only learn what to pay attention to during childbirth and in the days following the birth from experienced women. Doctors intervened in the matter as well in order to teach midwives basic medical knowledge so that they were able to cope with complicated childbirths in an ideal way for both mother and child. 

Short Lessons for Midwives in the Flat Country

The book we discuss in this article was written during the period in which the education of midwives was re-organised. It was printed in 1796 in Berlin and, as the introduction states, was supposed to be a manual for midwives. As such, it marks the beginning of a tradition that is still followed today: Scientifically trained doctors teach midwives practical knowledge. Today, this seems to be a given, but in the past things were completely different. Let’s have a look at the history of this profession.

The Salvation of the Soul Is the Primary Duty of a Midwife

As early as in the 11th century, some kind of professionalisation began when the (female!) doctor Trota of Salerno wrote a textbook on gynaecology. Back then, however, one of the most important tasks of a midwife was to bring the new-born to the priest for baptism. The midwife was responsible for the salvation of the child’s soul. And since the infant mortality rate was rather high, the Church authorised midwives to perform emergency baptisms in case the child was likely to die on the way to the priest.

A Profession Is Born

In the 15th century, the first professional codes for midwives were established – Regensburg was the pioneer in 1452. The code determined that a midwife was only entitled to work after passing a specialist examination held by a doctor. In order to do so, midwives had to study an illustrated textbook written by doctor Eucharius Rösslin in 1513.

Women and Men in Competition

In the 17th century, several new manuals for midwives were published – by women! The hands of Marie Louise Bourgeois gave birth to Louis XIII, the heir to the throne; Justine Siegemundin, an autodidact, served as midwife at the Brandenburg court. These women laid the methodical foundations of later manuals.

Now, we are arrived at the time our book “Kurzer Unterricht für die Hebammen auf dem platten Lande” was published. At the end of the 18th century, the process of modern nation-building, including administrative bodies and institutions, gathered pace. The state started to take charge of the education of midwives and centralised it. In 1779, a birth centre opened in Jena. One generation later, in 1817, women in Eisenach could go to a school for midwives in order to be trained professionally. In that school, future midwives received medical education from experts of the field.

But many doctors were afraid of this new class of medical professionals. The Marburg professor of medicine Georg Wilhelm Stein stated as early as in 1801 that midwives must also be taught about the limits of their profession. Adequate education? Yes, please. But doctors are and will always be superior.

A Book That Covers All Instances

Our book from 1796 is a testimony to this conception. It states that it is true that the state provides instructors that teach the specialist knowledge in schools for midwives. However, the author goes on, this book has the intention of brushing up on the learned skills, particularly regarding midwives “in the flat country” – that is to say, they lived so far away from any kind of infrastructure that they would have probably been happy about poor mobile telephone reception.

The issuer is no other than the Royal Prussian Collegium Medicum.

Before talking about “examining by tactile perception”, “observations” and “naturally easy childbirths”, the manual tells us the answer to the question of what was expected of a midwife at that time. For – as the introduction states – “not every woman shall be admitted to the profession of a midwife”. The preconditions are “a mature mind” and basic reading skills, “a good temper and honourable behaviour” combined with a strong physique and a robust condition.

If you read the instructions given by the manual, you will agree that this work requires strong nerves. Those who don’t have them don’t want to know about the steps a midwife needs to take in order to push the child back in case an arm comes out first. If the midwife doesn’t do it the right way – read the following sentence only if you are a doctor, butcher or wrestler – “there is no other way than to twist and detach it [the child’s arm], which often does not only cause the death of the child but of the mother as well”.

This manual for midwives drastically shows that life was hard, especially for those living far away from hospitals, doctors and the modern possibilities of gynaecology. 

But even if giving birth takes place on a completely different medical level today, midwives still shoulder a huge responsibility. As one of the last European countries to do so, Germany will turn the training for becoming a midwife into an academic education in 2020. The professional associations are pleased about this step. The students will probably no longer be able to graduate with the help of a 124-page manual. However, I would recommend them to read it anyway in order to recall the eventful history of their profession.

The website of the Berlin State Library provides you with a digitalised version of the book for midwives.