This is a big week for the
history of obstetrics, gynaecology and midwifery in Edinburgh… May 1st
saw the 120th anniversary of the opening of the Edinburgh Royal
Maternity and Simpson Memorial Hospital; May 2nd marked 83 years
since the death of Dr James Haig Ferguson, founder of the first hospital
outpatient antenatal clinic in Britain As today is also the International Day
of the Midwife, we’re taking the opportunity to look back at the history of this
discipline in Edinburgh…
Midwifery in Edinburgh as a ‘medical’
(as opposed to community) practice dates back to 1726, when Joseph Gibson was
appointed Professor of Midwifery by the Town Council. It wasn’t until the 1740s
that Midwifery was taught to students of the University of Edinburgh by
practising surgeon Thomas Young. Young believed that practical clinical
instruction was crucial for a full understanding of midwifery, and in 1781 he
tried to rally support for the building of a general Lying-in Hospital in the city
that would allow his students this close-up experience. Young died in 1783
before his vision could be realised, and his successor Dr Alexander Hamilton took
up the mantle after him.
Hamilton outlined a General
Lying-in Hospital as constituting “a proper building, erected in an airy
healthy situation, capable of containing twenty-five patients”, but advised
that it “should be constructed in such a manner, that it may be enlarged when
the funds can afford it”. [5/6] His appeal was successful. The General Lying-In
Hospital, opened in 1793 at the site of what is now Teviot Row House, aimed to
provide “women in low life” with the “management during child-bearing that
opulence can produce”.
Hamilton’s hopes for the Hospital
to be extended were less successful, however, and it wasn’t until 1879 that a
purpose-built maternity hospital was opened. Named after one of Edinburgh’s
most famous medical sons, the Simpson Memorial Hospital honoured Sir James
Young Simpson’s many contributions to midwifery. He had succeeded Hamilton in
the Chair in 1840, and in 1847 his infamous private experiments into the
anaesthetic effects of chloroform led to it being used to relieve pain during labour.
In 1905, John Halliday Croom was
appointed to the Chair, but being a specialist in obstetric alone, additional
expertise had to be sought and Alex Hugh Freeland Barbour was appointed as lecturer
in Gynaecology. This dualism reflected a general attitude towards the care of
pregnant women at the time - as R.W. Johnstone puts it “any special care
deliberately devoted to the object of preserving the health of the expectant
mother [or of] forestalling dangers likely to arise in her labour … was
virtually unknown”.
Portrait of James Haig Ferguson, from the collection of the Royal Medical Society |
And so, Britain’s first
ante-natal clinic opened its doors in 1915. This coincided with the Midwives
(Scotland) Act of 1915, which made training, examination and registration for
midwives compulsory. Prior to this, many women working as midwives had become
‘certified’ - that is, obtained a certificate confirming their training in a
hospital - but most were still without formal training.
The Midwives (Scotland) Act also
saw the introduction of the Central Midwives Board in Scotland (CMBS), which
recognised three categories of midwife at first: those who had taken and passed
the CMBS examination; the ‘certified’ midwives who had previously obtained a
certificate; and the ‘bona fides’,
women who were enrolled “by virtue of bona
fide practice”. This last category covered women of good character who had
been in practice as uncertified midwives or howdies for at least a year.
Although they could be enrolled without examination, one third of those taking
the first CMBS exam were already on the roll as bona fides. As Dr Lindsay Reid explains in her book Midwifery in Scotland: A History,
midwifery before 1915 was “alegal”, with no qualifications to meet, and no
regulations or licensing requirements. The passing of the Midwives (Scotland)
Act of 1915 gave new status to this group of women, some who had been formally
trained, some of whom had been working with the benefit of knowledge passed
down through generations.
The theme for this year’s
International Day of the Midwife is ‘Midwives, Mothers And Families: Partners
For Life’. By moving the focus away from the act of labour itself and onto the
general health of the mother leading up to birth, Dr Haig Ferguson put in place
the approach to maternity care that has led to this partnership; similarly, the
decision by the CMBS to acknowledge the role that uncertified, locally-respected
howdies occupied in the community ensured that those who might otherwise be
reluctant to seek formal medical care were still being seen by an ‘approved’
practitioner. These partnership have now extended beyond the moment of birth,
and in the words of the ICM, “midwives everywhere understand that by working in
partnership with women and their families they can support them to make better
decisions about what they need to have a safe and fulfilling birth”.
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