Friday, 5 May 2017

Midwifery in Edinburgh

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…
LHB3A/15/1 - Certificate awarded to Margaret Reid, Midwife by Thomas Young, 1768.
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.

GD1/1/1 - Midwifery lecture notes, n.d.

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
The concept of antenatal care was introduced into Edinburgh by Dr James Haig Ferguson. Haig Ferguson had served as Assistant Gynaecologist at the Royal Infirmary of Edinburgh since 1896, and in 1899 had founded a home for unmarried women expecting their first baby. Encouraged by the impact that routine antenatal supervision had on the health of the women treated there, he successfully petitioned the managers of the Edinburgh Royal Maternity Hospital to allow him to open an out-patient clinic for married women, so as to offer them the same levels of supervision. Due to the fact that most married women gave birth at home at the time, the Hospital had somewhat of a reputation: Johnstone recounts how “to protect these respectable women from embarrassment, entrance to the clinic was arranged from an unfrequented side street, and I well remember the great consideration that had to be given to their modesty in putting up an unobtrusive and discreetly worded direction-board.”
LHB3/7/71 - Annual report, 1915

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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