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Thursday, April 28, 2011

A Midwife on Midwifery

Centerpiece of a book by Thomas Chamberlayne,
1656, Compleat Midwifes Practice, with image of Boursier.
Image courtesy of the Folger Shakespeare Library, Wash. D.C.

Perhaps you have read the book Diverse Observations on Sterility; Loss of the Ovum after Fecundation, Fecundity and Childbirth; Diseases of Women and of Newborn Infants?  If you were literate and lived in the 17th century, you may have.  This was the first book on childbirth and midwifery written by a woman. Few texts like this existed at the time; it had practical information on obstetrics.  It was used until the 18th century, and was translated into Latin, German, Dutch, and English.

The author, Louise Bourgeois Boursier, expanded her book in 1617, and added a section titled "Advice to my Daughter".  The 1626 edition was expanded with more treatments, such as using doses of iron to treat anemia.  Her 1634 Collection of Secrets, included knowledge which was afterward widely assimilated among midwives and physicians, such as repositioning the fetus in certain situations (such as when the fetus is lying transversely) so it will be delivered feet first, called podalic version.  This is still a medical option, however modern medicine prefers delivery by Caesarean section.

She was born to a wealthy family in a rural area outside of Paris circa 1563. Although there has been little written of her, historians have garnered what is known from her writings, even though she never wrote a formal memoir.  She did write a summary of her career in defense of a malpractice charge.  She was taught to read, but only knew French and not Latin as French nobles did.  In 1584 she married an army surgeon and barber, Martin Boursier, who had studied with Ambroise Paré, a well-known surgeon.  They had three children.

In a civil war that occurred when Henry of Navarre became King Henry IV, Louise had to quickly leave her home with her children and only the belongings they could carry.  Her husband was away, and they found safety within the walls of Paris.  When he returned they had very little money, and she took to needlework and managed to eke out a living.  A midwife that attended Louise in birth commented that if she had been literate she'd have had a much more lucrative career as a midwife.  This got Louise thinking, and she started reading about childbirth.  She started out assisting the wife of a local porter and began attending the births of working-class women in Paris.

1875 sketch by unknown artist.
Image courtesy Wikipedia.

Midwifery was generally passed down from midwife to midwife orally at this time. Louise took a more studied approach.  She prepared to pass certification as a midwife from the city of Paris, which would enable her to attend aristocratic women and hence be paid well for her services.  She was examined by a panel composed of a doctor, two surgeons, and two certified midwives.  On November 12, 1598, she passed the exam and was admitted to a guild of midwives.

King Henry IV married Marie de Médicis, and Louise was retained as midwife, having been recommended by some of the ladies of the court.  Between 1601-1610 she attended the births of their six children.  She received 900 livres for each birth; the going rate for midwives was 50 livres.  After their last child she was given a lump sum of 6,000 livres, and the official title of royal midwife, which made her much in demand among the aristocratic families.  It is thought she attended three-four births a week until she retired.  In 1609 she began to write down her accumulated knowledge of childbirth.

She was so influential in the field that she began to train midwives, including her own daughter.  Although she initially extolled the work of doctors and stressed the cooperation between physicians and midwives, as time went on her opinions changed, and she began to write more negatively about doctors and observed that they often treated with an eye on what they could get away with charging.  (Sound familiar?)  When a noblewoman died of what we know today as peritonitis, an autopsy was ordered.  Although Louise was not mentioned, and the death was blamed on a piece of placenta that was left inside the uterus, she responded by publishing a pamphlet denouncing the doctors involved in the autopsy.  They responded with their own pamphlet, and her influence was ended.  She died in 1636.

Several of her offspring became involved in medicine and midwifery.  One of her descendants was Marguerite Le Boursier du Coudray, born in Paris in 1712. She was a royal midwife in the court of Louis XV of France.  She invented the first life-size obstetrical mannequin, used in practicing mock births.  This was a life-size female torso.  The invention is often attributed to an Englishman, William Smellie, but her model was approved in 1738 by the French Academy of Surgeons, giving her prior claim.  She published a textbook on midwifery in 1759 - The Art of Obstetrics.  She was commissioned by the King to travel all over rural France and teach midwifery to poor women - she is estimated to have trained 4,000 women.

Marguerite Le Boursier du Coudray.
Image courtesy the Brooklyn Museum.

Louise Bourgeois Boursier described herself as the first practicing woman to write about midwifery.  She helped raise the art from folklore to actual science.  She asserted the value of midwives' knowledge against that of male surgeons, who controlled the field of childbirth.  She was a prodigious writer, whose methods were based on common sense.  She was an anomaly for her time and is a woman to be celebrated.

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