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An Interesting Condition

Pregnancy and Childbirth During the Regency

This article first appeared in The Regency Plume Newsletter, edited by Marilyn Clay, which ceased publication in 2006. However, you can purchase back issues and related reference materials online at The Regency Plume.

Part I: Society and Medicine, Conception and Pregnancy
Marriage, Family, and the Ideal of Womanhood ~ The Medical Profession ~ Conception ~ Pregnancy

Part II: Labor, Delivery, and Post-Partum Period
Preparations for Childbirth ~ Labor and Delivery ~ Medical Interventions During Childbirth ~ Princess Charlotte’s Ordeal ~ Recovery ~ Churching ~ Christening

Part I: Society and Medicine, Conception and Pregnancy

“All our mothers and grandmothers, used in due course of time to become with child or as Shakespeare has it, roundwombed… but it is very well known that no female, above the degree of chambermaid or laundress, has been with child these ten years past… nor is she ever brought to bed, or delivered, but merely at the end of nine months, has an accouchement antecedent to which she informs her friends that at a certain time she will be confined.”

This quote from The Gentleman’s Magazine (1791) illustrates the changes in language used to describe pregnancy and childbirth which continued throughout the Regency period. The evolution in terminology — from the more robust “breeding” and “lying-in” to the more euphemistic “in the family way” and “confinement” — reflects the changing attitudes and practices of the time.

During the eighteenth and nineteenth centuries, a number of trends were apparent: the gradual decline in the use of midwives, the rise of the male accoucheur (what in modern terms would be called an obstetrician), birth in bed versus in a birthing chair, and increasing medical intervention in the entire process from conception to birth.

Actual practices varied. In earlier times women of all classes gave birth in the same manner, but by the Regency aristocratic women were at the forefront of the changing trends. Women of lesser rank and wealth, those from more conservative families, and those living in rural areas often continued to give birth as their mothers and grandmothers had done.

Please note that the purpose of this article is to describe trends and practices of the time, not to argue for or against natural childbirth versus medical intervention or the use of midwives versus doctors. Then, as now, the subject sparked the hottest debate!

Marriage, Family, and the Ideal of Womanhood

Many historians write of the rise of “domesticity” during the late Georgian through the Victorian periods, of the increasing emphasis on private family life and individual happiness versus community life and public duty. Judith Schneid Lewis, in her excellent book In the Family Way: Childbearing in the British Aristocracy, 1760-1860, explores a number of aspects of domesticity and how they affected childbearing.

According to Lewis, “Whereas in 1760 a quiet mutual regard based on hearsay and a short acquaintance was thought sufficient, by 1860 one needed to be ‘perfectly in love.’” Of course, at any time period there will be marriages based solely on dynastic or financial reasons, marriages based on romantic love, and some that lie in between. However, mutual affection, or at least the appearance thereof, was becoming more the common expectation.

Abstinence or the husband’ adultery became less acceptable as means of limiting family size. In England, public opinion was against contraception within marriage. According to Calder-Marshall, author of The Grand Century of the Lady, it was common in France: “The use of a sponge, soaked in brandy, placed at the entrance to the womb and retractable by a thread may have begun with French prostitutes, but by the eighteenth century this form of contraception was used by women of the aristocracy, the bourgeoisie and peasantry.” There is no documentary evidence in letters or diaries for the use of contraception within marriage among English couples, but they may have discreet in writing about it. Calder-Marshall speculates that “the fact that the size of some families tended to decline towards the end of the eighteenth and during the early years of the nineteenth centuries makes one suspect that the upper and middle classes were beginning to exercise, not sexual, but reproductive restraint.”

However, many aristocrats found large families desirable. While the production of an heir was still of paramount importance, additional children were valued for personal and public reasons. A large family served to demonstrate a family’s prosperity and to extend the family’s influence through appointments, patronage and the forging of alliances through marriage with other influential families. Daughters were increasingly valued, especially as companions to their mothers, though sons were still preferred. “You should not be anticipating boys,” wrote a gentleman to his expectant sister in 1815, “because you subject yourself to disappointment and the poor little girl does not meet with a fair reception. Not withstanding this wise advice, I hope to hear of an heir.”

While some couples still went their separate ways after the production of the heir (and possibly a “spare”), many had large families. Amongst the fifty women studied in In the Family Way, the mean number of children was 7.5. This is higher than the average for the aristocracy of this period, but still the numbers are telling. The most prolific lady studied, the Duchess of Leinster (1731-1814), had eighteen children by the Duke, went on after his death to marry her sons’ tutor and had three more children, for a total of 21 children in 31 years. Eighteen of the women studied had more than ten children.

During this time period, ladies were beginning to be expected to not only bear the children, but also actively involve themselves in their upbringing. Although there were undoubtedly still some pleasure-seeking mothers who preferred to leave their children to the care of servants, this was becoming less acceptable. Motherhood was no longer defined by the mere act of giving birth.

Thus, the physical, carnal aspects of childbirth were de-emphasized, as evidenced by the change in terminology regarding pregnancy and childbirth. Suffering through labor was no longer necessary to define the woman’s role as a mother. Increasingly, the ideal lady was viewed as a delicate creature, full of tender emotions, although actual ill-health had not yet become as fashionable among ladies as it would later on in the Victorian period.

These changes in the view of family and womanhood contributed to the decline in the view of childbirth as a natural process that could successfully be performed by a woman, assisted by other women. Aristocrats in search of “the best” for their wives turned to the newly fashionable male accoucheur. According to Lewis, “For aristocratic families, the conflict between desire for progeny and the concern for women’s health was an intensifying one… This enormously self-confident and optimistic aristocracy wanted both large families and healthy womenfolk. From the end of the eighteenth century, aristocratic families were willing to devote their time and money to finding an answer to this dilemma. And the growing medical profession was increasingly prepared to offer one.”

The Medical Profession

During the eighteenth and nineteenth centuries the practice of medicine began to be influenced by scientific experimentation and observation. However, medical science was still in its infancy, classical theories of bodily “humours” continued, and many practices which we would now consider arcane and bizarre were still in place. Nevertheless, the medical profession was increasing in stature and respectability and this is clearly reflected in the rise of the accoucheur and the decline of the midwife.

Prior to the seventeenth century, midwives assisted laboring women during the vast majority of births. Some doctors attended births at hospitals for the indigent, some wrote manuals for the use of midwives and designed birth-chairs. These early texts on midwifery show a respect for the profession of midwifery absent in later works. At the time doctors trusted midwives to handle normal deliveries, and were not called in to attend private births except in case of an emergency. Some medical historians speculate that the increasing view of birth as a medical crisis as opposed to a natural event may have been due to the fact that doctors tended not to witness normal births.

Another factor that undoubtedly led to increasing participation of men in childbirth was the potential for profit. According to Amanda Carson Banks, in Birth Chairs, Midwives and Medicine, “Whereas doctors had earlier been content to dictate theoretical practices and procedures, the economics of the medical profession made it necessary for them to become more actively involved in the actual practice of midwifery as an entry into family practice. Simply put, doctors had found that babies had become a point of good business.” By the late eighteenth century, increasing numbers of practitioners began to limit their practice entirely to this field.

There was significant opposition to the new “man-midwives”, from those who saw it as immoral to “give the enemy direct access to the very citadel of female virtue” as a pamphleteer in 1779 suggested, and from the medical community. General practitioners resented the competition, and the more elite physicians thought midwifery was an ungentlemanly occupation. As late as 1827 Sir Henry Halford, for many years president of the Royal College of Physicians, and Sir Anthony Carlisle, a prominent surgeon, derided the practice of midwifery by men.

However, during the period covered in Lewis’s book, the aristocracy were “prepared to trust the claims of science, over those of tradition… Moreover, tradition, embodied in the persons of lower-class midwives, seemed far less attractive than the pretensions of science as embodied by ambitious men of gentlemanlike manners such as William Knighton.”

The fashionable accoucheur, unlike the midwife, concerned himself with all aspects of childbearing, from conception onwards. He was formally educated, gentlemanly and discreet, all qualities valued by the aristocrats he served. His gender, his education and the rising confidence in scientific midwifery gave the accoucheur a stature and influence that was impossible for even the most respectable and experienced midwife to achieve.

One of the better-known early accoucheurs was Thomas Denman (1733-1815), who studied in Edinburgh under William Smellie (a Scotsman who designed the curved forceps that bear his name). Denman attended Georgiana, Duchess of Devonshire in 1774, and by 1783 he was the most popular of the aristocratic accoucheurs. Denman wrote an Introduction to the Practice of Midwifery which included the injunction: “Never propose an examination per vaginum but as a matter of absolute necessity” and advised that examinations must be performed with a third party present and “with the utmost care and tenderness, and the strictest regard to decency.”

During the Regency, Sir William Knighton (1776-1836) and Sir Richard Croft (1762-1818) were among the most fashionable and well-respected accoucheurs. Praised by Prinny as the “best-mannered medical man he had ever seen”, Sir William Knighton was said to have been worth £10,000 per annum at the height of his career.

Sir Richard Croft, the son-in-law of Thomas Denman, had a distinguished career that ended sadly with the death of Princess Charlotte after a prolonged labor that resulted in a stillborn child. Sir Richard Croft, blamed by many for his management of the case (which will be described in more detail in the second part of this article) committed suicide not long afterwards.

Sir Anthony Carlisle, mentioned above as an opponent of male midwifery, used this example in an 1827 article in the Lancet, comparing the tragic death of the princess with the experience of her grandmother, who gave birth to fifteen children. “That exemplary Queen was personally attended by good Mrs. Draper without difficulties or misadventures, whereas the contrary result, under male management, in the fatal affair of Princess Charlotte will long be remembered.”

Medical historians have been unable to agree on the cause of Princess Charlotte’s death or whether it might have been prevented. However, the blame that was heaped on poor Croft showed the darker side of the new confidence in masculine, scientific control over the birth process: increased culpability in the case of an unhappy result.

The growth of the obstetric profession was not hindered by this high-profile tragedy. Instead, the incident gave impetus to the movement toward more intervention in the childbearing process.

Conception

Newly married ladies, acutely conscious of their husbands’ and families’ expectations, were anxious to conceive as soon as possible. In 1804, just ten months after her wedding, it was reported that Sarah, Lady Jersey, was “alter’d not to be known it is thought she frets herself at not being grosse, and quacks herself.”

When the production of an heir was at stake, aristocratic couples did not always trust to nature. When concerned, they resorted to their trusted accoucheur for advice. Although the biological processes surrounding fertility were not at all well understood at the time, the accoucheurs endeavored to advise their valued clients nonetheless. The general concept of treatment, in line with the theories of the day, was to attempt to restore natural harmony to the woman’s constitution.

Travel, a change of air and the taking of mineral waters were often recommended, and it is certainly possible that relaxation and a change of scenery might have benefited some couples. The Duchess of Devonshire took the waters at Bath and at Spa in Belgium, where she conceived the son she and the Duke desired.

Oher treatments for infertility were most likely useless or even harmful. Sea bathing and shower bathing (with cold water) were recommended, as was bloodletting. Sometimes sexual activity was blamed for the supposed imbalance in the woman’ system, and abstinence was recommended until the “irritation” was resolved, thus setting up a vicious cycle.

Despite the dubious success of these regimes, ladies continued to seek and follow such advice from their accoucheurs, driven by the need to produce an heir or at least to assure themselves, their husbands and their families that they were making every effort possible.

Of course, it seems to have occurred to no one to question whether the husband may have played any role in the couple’s infertility.

Pregnancy

During the Regency, ladies under the care of a general practitioner might very well have continued or adapted their usual diet and level of activity as they saw fit. However, those seeking the advice of an accoucheur were generally advised to make some changes in their lifestyles. Determined to do anything required to ensure a happy outcome, most ladies obeyed.

According to Lewis, “Human constitutions were diagnosed on a continuum from weakness to plethora; good health was the happy medium.” Pregnant women were believed to suffer from plethora, sometimes called, rather appropriately, “fullness.” For such patients a system of lowering, in other words, weakening, was recommended.

Accoucheurs prescribed a lowering diet, which was often adapted for individual patients. Generally, the diet was based on foods which were considered “cooling” (including fruits and vegetables) and eliminated or reduced foods which were considered “heating” (meat, eggs, and spices). Stimulating beverages, including coffee, tea and alcohol were also banned or reduced. Lady Morley, put on a lowering diet in 1810, complained “I am now living exactly like a Horse on grass food and water… Croft tells me I must not indulge too much in the luxuries of the table, & that I must practice the virtues of temperance and sobriety.”

Although it is unclear whether this diet would have provided the amount of protein and calcium currently recommended for pregnant women, many ladies in Lewis’s study seemed to do well enough on it. Fruits and vegetables would have provided vitamins and roughage to ward off constipation. Limiting caffeine and alcohol was certainly sensible. The lowering diet also served a social purpose: to demonstrate the lady’s dedication to the important task she was called on to perform.

Then as now, women were often advised that morning sickness was a good sign during pregnancy. Sometimes the accoucheur would prescribe some sort of effervescent concoction, but ladies also relied on home remedies. Mrs. Villiers recommended a mixture of cayenne pepper and laudanum; Lady Frances Cole had a potion for “weak digestion” containing oyster shell powder and pounded chamomile flowers.

Other recommendations for pregnant women included removal to the country, sea bathing, taking the waters at a spa, and cold baths. Bloodletting was also performed, though not invariably in the case of a normal pregnancy.

Exercise was also encouraged. Dr. William Buchan, in Advice to Mothers (1803), recommended “slow, short walks in the country, or gentle motion in an open carriage.” Certainly walking would have been beneficial during most pregnancies. Surprisingly, a number of women in Lewis’s study continued to ride. Lady Morley did so even after a bad fall during the early months of her pregnancy.

Elsewhere in Advice for Mothers, Buchan wrote: “Among many improvements in the modern fashions of female dress… is the discontinuance of stays… It is indeed impossible to think of the old straight waistcoat of whalebone and tight lacing, without astonishment and some degree of horror…” He continued, “Let me also very earnestly forbid the use of tight necklaces, tight garters, or any ligatures which may refrain the easy motion of the limbs, or obstruct the free circulation of the blood…” Probably some women followed this sensible advice. However C. Willett Cunnington, in The History of Underclothes describes a pregnancy stay of 1811, “completely enveloping the body from the shoulders to below the hips, and elaborately boned ‘so as to compress and reduce to the shape desired the natural prominence of the female figure in a state of fruitfulness.’” Apparently some women wished to preserve a slender line.

Little is written about the dresses worn by ladies during their pregnancies, but the scarcity of information is telling. There was no specialized maternity clothing as such; ladies merely adapted current styles. According to Linda Baumgarten, in What Clothes Revealed: The Language of Clothing in Colonial and Federal America, “As Buchan had suggested, the high-waisted, uncorseted styles of the period around 1800 were even more convenient for maternity wear. They were often fitted with draw-strings or ties that could be loosened as necessary, and the absence of a natural waistline made camouflage and fit easier than it had been in the past.”

During the Regency, there was no prohibition against pregnant women appearing in public, and many of them led active social lives throughout their pregnancies. While in her ninth month of her third pregnancy in 1805, Frances, Lady Churchill continued to attend parties and went to the opera on June 11. She gave birth on June 28. There was no prohibition on travel, either. During the last trimester of her first pregnancy in 1810, Harriet, Lady Granville, and her husband visited the country seats of his family members in Staffordshire, Gloucestershire and Cheshire.

There were some women who refrained from activity due to reasons of health, for example, when suffering from nausea during the first trimester. They might even make their condition an excuse to avoid unpleasant engagements, but a lady who was too indolent might be criticized. “Lady Jersey is to be confined in March,” wrote Lady Harrowby in 1807, and “to secure this, she does not move off her Couch, nor will she risk the exertion of holding a glass up to her mouth, so that all this is done for her.” Perhaps one might excuse Lady Jersey for her worries, however; her first pregnancy had not been successful.

When a miscarriage occurred, various causes were named. Accoucheurs believed that women who were weak or plethoric were more subject to miscarriage. For the weak, sometimes a strengthening diet supplemented by claret was prescribed, while the plethoric were put on the strict lowering diet. Lewis suggests that the strengthening or lowering regimens may have aggravated the problems of women of less robust health and those weakened by repeated short-interval pregnancies. Miscarriages were often attributed to violent passions, immoderate sexual activity, falls and the like. Ironically, sometimes exercise was believed to be the culprit, although exercise was also generally recommended for most women.

Sadly, women tended to blame themselves for “mishaps.” Unfortunately, their husbands and families sometimes did so as well, rather than admit that the succession depended on natural factors that could not be easily controlled.

However, many of the women in Lewis’s study went on to successfully give birth to large families. Even when their pregnancies progressed normally, however, they were subjected to a great deal of advice from not only their accoucheurs, but also from female family members and friends. Then, as now, childbirth was regarded as a female rite of passage, and a lady expecting her first child might be subjected to horror stories from her more experienced counterparts.

Lady Morley, pregnant for the first time, wrote that Lady Holland, “gave a little specimen of her kind-hearted considerate nature when we females were in the Drawing Room after dinner. Some one asked her when I was to be confined, which turned the conversation on the subject, & she went on I suppose for half an hour describing all the horrors, miseries, terrors, etc. which always assailed her on such occasions — how much worse the whole business was than any one cd imagine, & some more of the same consolatory hints — I am not very apt to have fancies. But it really was enough to make any one feel not very agreeably — poor Lady Harriet (Granville) too is in the same predicament and it must have been equally pleasant to her.”

Some things never change.

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Part II: Labor, Delivery, and the Post-Partum Period

“The full period of pregnancy having arrived, the woman is seized with the pains of labor… Scarcely a minute has elapsed when, to her utmost astonishment and extacy (sic), she perceives that delivery is accomplished. She beholds in her lap a lovely full-sized infant, fresh as the morning dew.”

This account of labor and delivery, from an 1802 translation of a text by German physician Christian Struve, demonstrates the ideological distancing of motherhood from the physical aspects of childbearing that occurred during the era, previously described in Part I of this article.

As will be seen, the reality for most women during the Regency was far different from Dr. Struve’s idyllic description.

Preparations for Childbirth

The location and choice of birth attendants were important considerations, and were based on the family’s means, social status and personal preferences.

Most women gave birth at home (or planned to). Going to a hospital to give birth was unusual. Several lying-in hospitals did exist; however, they were charitable institutions, often with a dual purpose of providing care for indigent mothers and providing subjects for medical training. At a lying-in hospital, normal births were often managed by a matron/midwife, with one or more male practitioners on call to assist in case of emergency.

Midwives continued to deliver many babies, although by 1780 aristocratic women had gone exclusively to the use of a “man-midwife”, or accoucheur. Wives of the gentry and tradesmen were also likely to have their children delivered by an accoucheur or by their general practitioner.

Aristocratic couples owning one or more country houses as well as a town residence often made the fashionable choice: to give birth in London, where the event would generate great interest and many visits from family and friends. The Earl of Banbury complained in 1804: “It is a material difference laying in, in Town or in the country, as to what Regards being more at one’s Pace in seeing People. Our numerous connections find much work for Civility, Bowing-Bowing, Sister by affinity, Law and Connection, Brother-by-Age, Hospitality and Marriage. Lord Help us as where will it all end our mighty etceteras of Blood and Affinity.“

Couples desiring a more private, quiet birth in the country still often invited family members and important friends to visit. They might also pay their chosen accoucheur to take up residence with them.

Wherever the lady planned to give birth, she would also engage a monthly nurse. The monthly nurse’s duty was to care for the mother (not the child) after birth, and she was trained to deliver the child if the accoucheur did not arrive in time. The most popular monthly nurses had to be engaged months in advance. Sometimes monthly nurses worked in association with accoucheurs, thus making scheduling easier for the mother. If the mother planned to use a wet-nurse, she would also be engaged ahead of time.

In large households, the bedchamber was not typically used for childbirth. Instead, a special suite of lying-in chambers would be prepared, consisting of an outer room where friends and family could congregate and an inner chamber where the birth took place. Whatever rooms were most convenient would be commandeered for this purpose. Sleeping arrangements would also be rearranged to provide housing for the accoucheur and the monthly nurse.

The inner lying-in chamber would be furnished with a portable folding bed constructed to allow easy linen changes and access for the birth attendant. These beds were sometimes shared among friends and family members. In her study of the childbearing experiences of fifty ladies (In the Family Way: Childbearing in the British Aristocracy, 1760-1860), Judith Schneid Lewis suggests that this was an act of female bonding, since expense was probably not an issue for most of the women studied.

All these preparations, particularly when a trip to London was planned, were often expensive. For example, Lady Londonderry and her husband rented the Duke of St. Albans’ house on St. James’s Square at £500 a month in 1822. The travel, the rearrangement of rooms and furniture and the hiring and housing of birth attendants made preparation for birth an elaborate undertaking.

Errors in calculation of the due-date were common, and then as now, babies often upset plans. In 1827, the Duchess of Sutherland went into labor at Roehampton, on London’s South Bank, but nevertheless felt it important enough to be delivered in Town that she traveled to London, giving birth half an hour after her arrival. Several women in Lewis’s study gave birth as much as four months late, indicating that they must have conceived when they were already thought to be pregnant (evidence that couples continued to engage in sexual activity during pregnancy). Having made elaborate, expensive preparations, all they could do was wait.

Labor and Delivery

The centuries-old ritual of childbirth dictated that the lying-in chambers be kept dark and warm. Windows were closed, curtains drawn, keyholes and chimney holes stopped up and candles lit. The laboring woman was attended by a midwife and a group of women called the “gossips”. Together, they would drink caudle, a heated, spiced ale or wine-based drink. This ritual could be soothing to the laboring woman, and it has been suggested that the low-stimulus environment, which was maintained for weeks afterward during the mother’s recovery, may have helped to ward off eclampsia (high blood pressure).

During the Regency, these traditions were still observed by the lower classes, but aristocratic women and many of their counterparts in the gentry and middle classes were beginning to dispense with at least some of them, for reasons of health and fashion.

Concerned about puerperal fever but not yet certain of how it was transmitted, physicians and accoucheurs were already condemning the traditional childbirth ritual during the eighteenth century. In 1783, Dr. Charles White recommended that the “lying-in chamber be in every respect as sweet, and clean, and as free from any disagreeable smell as any other part of the house… The room is to be brushed every day, and the carpets taken out to be cleaned and aired… The patient is to be often supplied with clean linen, and clean well-aired sheets are to be laid upon the bed… The windows are to be opened… no board or other contrivance to block up the chimney, the curtains not to be closely drawn…”

By the Regency, these customs were in transition in aristocratic households. Darkening of rooms persisted in some cases, but in many matters the higher classes were quicker to effect changes recommended by men of learning.

In place of the “gossips”, the Regency lady would be attended by her accoucheur, the monthly nurse and female family members and friends. Husbands usually attended as well, and often did their best to provide loving support, as did Prince Leopold during Princess Charlotte’s fatal confinement in 1817. Other male relatives might be present in the outer chamber, though this was still considered a trifle unusual.

During the first stage of labor, the expectant mother’s attendants provided company and encouragement. The lady was advised not to take to bed too soon, but to continue normal activities as she desired. According to the influential Dr. Thomas Denman (Introduction to the Practice of Midwifery), “It will always be found more comfortable and useful to leave the patient to her own choice in these matters and her inclination will be her best guide… The patient will often find relief, either by walking or standing, pursuing some amusement, or choosing that position which she herself prefers, because she will instinctively seek that which is proper.”

During labor, ladies were advised to maintain a light diet, such as bread and barley-water and, sensibly, warned against rich foods or stimulating beverages. They were forbidden to drink caudle, although their family and friends might indulge.

Midwives favored a number of different birth-postures, which varied regionally. These postures included kneeling, standing up and sitting in another woman’s lap. Birth chairs or stools which supported the woman’s legs and hips but had a semicircular opening in the bottom were sometimes used. Originally low to allow the laboring woman to brace herself against the ground, by the Regency birth chairs were about 17 inches high, to make access easier for the attendant, and had handholds and footrests to compensate for the increased height. (More information on midwives and birthing chairs can be found in Birth Chairs, Midwives and Medicine by Amanda Carson Banks.)

However, aristocratic women were delivered in the specially constructed birthing bed. The recommended posture, now called the Sims position, was to lie on the left side, with her back toward the edge of the bed, knees bent and drawn up toward the abdomen. Denman considered this position “by far the most convenient as well as decent,” possibly because it precluded eye contact between the gentlemanly accoucheur and his patient.

Clothing during labor and delivery was planned for comfort and cleanliness. Dr. Charles Mansfield Clarke recommended, “The dress of the woman should be a shift tucked up under the arms with a short petticoat placed about the hips which is to be removed after labour and the dry shift drawn down.”

During the second stage of labor, the accoucheur continued to provide moral support until the delivery of the child. He would make sure the child was breathing and cut the “navel-string” once pulsation had ceased. He would wait for the third stage, delivery of the placenta, to occur naturally, unlike his counterparts in the mid-eighteenth century who manually removed the placenta.

By the Regency, male practitioners had been attending births for long enough to realize what midwives had always recognized: that most births would proceed to a happy conclusion with only modest assistance. Reacting to the invasive practices of the mid-eighteenth century and reluctant to unnecessarily touch their aristocratic patients, they tended to allow nature to take its course.

As Denman wrote in 1815, “It may be doubted whether any part of medicine has been more improved within the last sixty or seventy years than the practice of midwifery, by returning, as it were from too much artifice to the simplicity of nature and by relying on the general efficacy of the powers of the constitution in overcoming the difficulties which occur in childbirth.”

However, interventions during childbirth were available and were used on occasion.

Medical Interventions During Childbirth

For centuries, labor pain had been regarded as women’s punishment for Eve’s transgressions. By the Regency period, this thinking was beginning to go out of vogue, but pain was still considered a normal and natural part of labor.

Women of the lower classes might use caudle to assuage labor pangs, but aristocratic ladies were less likely to do so. In the eighteenth century Dr. Buchan had advised against the drinking of caudle, recommending bloodletting instead. Denman, however, believed that neither caudle nor bloodletting were appropriate during labor. Instead, he believed that the best thing the accoucheur could do was to soothe the patient and keep her cheerful, in the belief that “No woman has ever had a pain which was in vain. Every pain must have its use.” Anesthesia would not be used during labor until 1847, when ether was administered to a laboring woman by Scottish physician James Simpson.

Several techniques were known that could speed labor. The use of ergot of rye, a fungus which infected rye and other grains, had long been known by midwives. However it was not documented in academic medicine until 1808 and only reached more widespread use during Victorian times. Midwives sometimes sped labor by stretching the woman’s labiae, a technique that was also used by Dr. William Smellie, a Scotsman under whom Denman studied in his youth. However, Regency accoucheurs were not likely to have used either of these methods. Long labors were not considered dangerous in themselves in the absence of other troubling symptoms.

Conditions that did cause concern were awkward presentations of the baby: breech, cross (sideways) or face up. Disproportion between the baby’s head and the woman’s pelvis (which could be the result of rickets in malnourished women) could also cause obstruction by the head. Some midwives and male practitioners practiced various forms of version (turning) to bring the baby into a deliverable position. Cephalic version would turn the baby into the normal head-down position. A pedalic version (to the feet) might be performed in the case of a cross-birth or a birth obstructed by the head. Version tended to be more successful when performed early in the labor, and both types of version carried risks for baby and mother.

Instruments could also be used in the case of births where the head was obstructed.

At the beginning of the eighteenth century, a surgeon would normally have been called only to deliver a woman after days of labor, generally when the child was believed dead. In a technique called craniotomy a hook called a crotchet would be used to extract the child and save the woman’s life. Likewise, Cesarean sections were considered too dangerous to attempt and were performed only after the woman had died, to save the child’s life.

The belief that “when a man comes, one or both must necessarily die” began to erode during the mid-eighteenth century. At this time the forceps, a family secret of the Chamberlens, became publicly known, along with several other instruments: the vectis, rather like a shoehorn, and the fillet, a band of leather or other pliable material that would be wrapped around the baby’s head and used for traction. These instruments were controversial. The Chamberlens were alternately denounced as charlatans or blamed for not making public a potentially life-saving method. Their opponents recommended other techniques for dealing with obstructed labors, including repositioning of the woman and manipulation of the coccyx to open up the birth canal.

In the end, both forceps and alternative methods began to supersede the dreaded craniotomy. Laboring mothers and their families became increasingly willing to summon a male practitioner. Since midwives (with a few exceptions) were not trained in these techniques, this led to an increasing masculine presence in the birthing-chamber.

By the late eighteenth century, Smellie had refined and improved the use of the forceps, popularizing its use to the degree that a counter-reaction set in. Dr. William Hunter believed it to be overused. In 1778 he wrote: “I admit that it may sometimes be of service, and may save either the mother or the child. I have sometimes used it with advantage; and, I believe, never materially hurt a mother or child with it, because I always used it with fear and circumspection. Yet, I am clearly of the opinion, from all the information which I have been able to procure, that the Forceps (midwifery instruments in general, I fear) upon the whole, has done more harm than good.”

Denman’s attitude was an extension of Hunter’s. In what became known as Denman’s Law, he recommended that forceps not be resorted to until contractions had entirely ceased for six hours and the fetus was low in the pelvis. Regency accoucheurs maintained this conservative practice until the tragic death of Princess Charlotte in childbed.

(Note: Further information on the early history of obstetrics can be found in A Short History of Midwifery by Irving S. Cutter and Henry R. Viets and The Making of Man-Midwifery by Adrian Wilson.)

Princess Charlotte’s Ordeal

Princess Charlotte went into labor on the evening of Monday, November 3, 1817. Her contractions were inefficient and she dilated slowly. Her attendants, Sir Richard Croft (who had been trained by Denman and was also his son-in-law), Dr. Sims and Dr. Baillie, followed the accepted practice of the time and allowed the labor to proceed naturally. After about fifty hours of labor, Princess Charlotte gave birth to a stillborn son. Her attendants, still following standard procedure, waited for the placenta to be expelled, but Croft was eventually obliged to remove it and noted an hourglass contraction of the uterus. For the following two hours the princess seemed “as well as Ladies usually are, after equally protracted labors” but a few hours later, she complained of feeling sick. Given a camphor mixture, she vomited, then drank some tea and rested a short time. Not long after which she became restless and suffered “spasmodic affections of the Chest.” She was given cordials, antispasmodics and opiates but died not long after.

The public was outraged. Princess Charlotte and Prince Leopold were popular and the death opened up the succession to the Prince Regent’s dissolute uncles. Croft and his colleagues were accused of a cover-up. Not knowing what had gone wrong themselves, they were unable to provide an explanation that could satisfy a grieving country.

Medical historians have suggested various possible causes of Princess Charlotte’s death, including pulmonary thrombosis, postpartum hemorrhage (although others believe the blood loss was not sufficient), and an attack of porphyria, the disease that plagued her grandfather, George III. Other possible factors include kidney disease, the postmaturity of the baby and preeclampsia. Experts who have analyzed the information do not believe that the use of forceps would have saved the Princess or her child, substantiating the statement made by her attendants that “instruments were in readiness in case they might have been required, but the Employment of them never became a question, because the labour, though proceeding slowly, advanced naturally.”

Nevertheless, critics blamed Croft for not resorting to the forceps. Over the next few months, his character and competence came under attack. When another patient died in similar circumstances, Croft committed suicide.

The medical establishment was wracked with controversy. The Princess’s death gave fuel to influential physicians and surgeons who opposed the new scientific man-midwifery. Accoucheurs, sympathetic to Croft’s plight but determined to preserve their profession, were forced to reevaluate their attitude toward interventions during childbirth. The tragedy gave added impetus to the movement to find ways of making labor less dangerous and painful but also helped create the atmosphere that made “chloroform and forceps” deliveries common in the Victorian period.

Recovery

The lying-in period, or “confinement” as it was termed by the more refined, took place over at least a month and up to six weeks after the labor and delivery.

Traditionally, women remained in the lying-in chambers which continued to be kept darkened and warm after the labor and delivery. As early as 1762 Dr. Buchan complained that women suffered the “greatest hazard from too much heat” and during the Regency men of medicine continued to advocate a clean and airy atmosphere. Their recommendations met with a mixed response.

In 1772, Lady Mary Coke, visiting the Duchess of Buccleuch, wrote that the duchess was “perfectly well in her great room with all the windows open, and no one thing that conveys the idea of a lying-in lady, but a great Boy.” On the other hand, the custom of darkened rooms continued in many families. In 1804, Lady Bessborough described her daughter-in-law Lady Duncannon’s room as a “damper” and that “added to the darkness of the room, I could slumber away the day very quietly.”

As mentioned before, learned men of the day hoped that an airy atmosphere would help ward off puerperal fever. In times past, when midwives presided at all births, the incidence of puerperal fever was low, probably because midwives tended to be noninvasive in their methods and carried low caseloads. During the eighteenth and nineteenth centuries it became much more of a problem, particularly in lying-in hospitals where attendants cared for large numbers of women. Observant individuals were beginning to realize that a healthy birth attendant could spread the disease from patient to patient, although this would not be accepted as medical fact until Victorian times. Accoucheurs during the Regency knew that cleanliness was important, but mere washing was not always enough. Although innovators were beginning to experiment with heat and chlorine for sterilization, neither had yet passed into common use.

When puerperal fever did occur, patients were treated as other fevers, with a lowering system, bloodletting, purges, Peruvian bark and opiates such as laudanum, with mixed success. Opiates might also be given to alleviate postpartum pain.

Visitors to the lying-in chambers continued the custom of drinking caudle into Victorian times, but mothers themselves were advised to continue a low diet of broth and gruel, gradually introducing stronger foods. Some women did as they wished, however. Lord Morley, writing about his wife’s condition an hour after delivery, said she was “quite stout and well, & going to eat some chicken.”

During the confinement, ladies were expected to gradually increase their activity. According to Lewis, “the stages consisted of increasingly long forays from bed to sofa; thence to the outer or dressing room of the lying-in chambers; downstairs, possibly to dine with the family; and finally to take her first leave of the premises.”

During the initial stages, the lady might wear a dressing-gown over her nightrail or shift. According to Linda Baumgarten, in What Clothes Reveal, “Once they emerged from the chamber following their lying in period, most women wore their usual clothing while nursing. As long as necklines on stays and gowns remained low-cut, women could nurse by unpinning or pulling aside their dress or bed gown. For convenience, some women chose stays that laced in front, rather than in the back.”

There was by no means an established rule as to whether an aristocratic lady would hire a wet-nurse or not. Lewis writes that the “very short birth intervals that characterized our group indicate that the majority of women probably did not nurse their own children.” However, medical experts of the time urged mothers to feed their own babies, and some mothers did so out of as sense of duty, affection, or both.

Most women in Lewis’s study who breastfed seemed to take pleasure in it, notably the Duchess of Devonshire. She nursed her daughter Georgiana for over a year in defiance of family pressure to wean her because of their “impatience for me having a son and their fancying I shan’t so soon if I suckle.” Though not a reliable form of birth control, it was known that breastfeeding could delay fertility. As a result, some mothers were pressured by their husband or families not to breastfeed. Conversely, women might nurse hoping to extend the interval between pregnancies. Lady Verulam used a wet-nurse for her first four children, but Lewis writes that she “nursed her younger children for exceptionally long periods of time in the hope, probably, of avoiding impregnation.”

In the old tradition, men other than the husband would not be admitted to the lying-in chamber during the first two weeks of birth. During the third, close male relatives could visit, and during the fourth, any males. During the Regency this timeline was still being observed but attitudes were changing. Lady Morpeth gave birth the day before her sister’s wedding to Lord Granville Leveson-Gower. Two days later she complained “I have pined a little at not seeing Ld Granville last night — I think on such an occasion the usual etiquette might have been laid aside, & for my Brother too.” By the next generation, men and women began to visit on the same basis.

The confinement period was a time of emotional adjustment. Postpartum depression was not yet a medically recognized condition, but people were nevertheless aware that confinement could be an anxious or depressing time for women. Many of their sources of anxiety may seem familiar to us.

Although aristocratic ladies had servants to perform humdrum tasks, as mothers they were expected to take an active role in caring for and educating their children. Most took this role very seriously. First-time mothers could feel overwhelmed with their new responsibilities, while mothers of very large families might worry about how to care for yet another child.

Some husbands were helpful and attentive; others, less so. The day after Lady Verulam gave birth to their ninth child, Lord Verulam went shooting with his friends, dined downstairs and spent the evening out, then was annoyed with his wife for feeling irritable on his return.

Mothers also had to cope with their own feelings and those of others when the child produced was not of the desired gender. The birth of a boy could be disappointing if there was already a surplus of sons and the mother wished for a female companion; the birth of a girl was disappointing if the all-important first son had not yet been produced.

But then as now, a child could also be a great source of joy to its mother and family. Lady Morley was delighted at the birth of her first daughter, calling her a “most darling and extraordinary child.”

When a lady gave birth to an heir, it was an occasion for rejoicing. Husbands sometimes rewarded their wives for this “service”. The Duke of Devonshire deposited £13,000 into the debt-ridden Duchess’s bank account in 1790 when she gave birth to a son. In 1821, Lord Londonderry gave his wife a set of pearls worth £10,000 upon the birth of his first son.

Churching

Upon completion of the recovery phase, women were expected to go to church and partake in the ceremony known as the “Thanksgiving of Women after Childbirth”. It has been suggested that it was a ritual of cleansing, but the name and words of the rite indicate the purpose was indeed thanksgiving. The woman was greeted with the words: “For as much as it hath pleased Almighty God of his goodness to give you safe deliverance, and hath preserved you in the great danger of childbirth; you shall therefore give hearty thanks to God.” Her response was: “I am well pleased that the Lord hath heard the voice of my prayer. The snares of death compassed me round; and the pains of hell got hold upon me.”

Respectable women of all classes partook in this ceremony. Lady Verulam recorded in her diary for 1810 that “I was churched on this day by Mr. Robert Hodgson, and returned thanks to Almighty God for the recovery of my dear children and my own.” However, the aristocracy was beginning to be a bit lax about churching. For health and privacy reasons, some ladies were churched at home. Lady Caroline Lamb’s grandmother encouraged her to be churched “before she stirs out of the house.”

Wherever it was done, churching signaled the end of the confinement. It preceded christening, which was usually the lady’s first public appearance after giving birth.

Christening

Christening often took place shortly after churching. In aristocratic families, christenings were carefully planned and elaborate events.

The choice of godparents was an important demonstration of the family’s status and connections. In 1807, the Prince of Wales stood as sponsor at the joint christening of Lady Cowper’s first child and its cousin Augustus, child of William and Lady Caroline Lamb, held at St. George’s in Hanover Square.

A large dinner was typically held after the religious ceremony. These could be lavish affairs where important guests would be invited. To celebrate the christening of their eldest daughter in 1822, the Londonderrys were host to thirty-four guests including “Esterhazys, Becketts, Lievens, Munster, Duke of Wellington, Camdens”. According to Lewis, “Festivities seem to have been no less grand for younger children than for older, and for daughters no less than sons. All were welcomed into the society of the British aristocracy.”

Families often spared no expense in fitting out themselves and their babies. Hundreds of pounds might be spent on linens, robes, layettes, etc… Display was an essential part of the christening. Mrs. Bradford, the wife of the chaplain to the British embassy in Vienna, noted during an 1821 christening that Lady Londonderry “had a profusion of diamonds in her hair” and that her husband, the ambassador, was “in full hussar uniform, yellow boots and all, not to mention a gold chain clasped by a ruby and an emerald set with diamonds, and a diamond serpent which he always wears… The proxies renounced in the babe’s name all the pomp and vanities of this wicked world, while the unconscious little innocent was dressed and surrounded with every vanity and pomp which money could purchase.”

Aristocratic families during the Regency period were in a position to obtain the finest trappings and engage the most learned accoucheurs. However, wealth and social status did not relieve ladies from the pain and peril of childbearing. Nevertheless, to many, motherhood was a source of great joy. As Lady Frances Cole wrote after giving birth to her sixth child, “I certainly do not feel anxious for any great addition to my family, but I cannot agree in considering as an evil that from which I derive my greatest interest and comfort in life.”

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