Abstract
Throughout the 19th century, midwives were depicted as incompetent slatterns in both popular imagery and medical literature. We examine how, between 1500 and 1800, midwifery was regulated by a combination of formal licensing by the Church and informal oversight within the community. We argue that episcopal licensing demanded that midwives demonstrate knowledge and competence in midwifery, not only that they were spiritually fit to baptise dying infants. Although episcopal licensing lacked statutory authority, the symbiosis of formal and informal systems of regulation ensured good midwifery practice and midwives were regarded as experts in all matters relating to childbirth. The Midwives Act 1902 introduced statutory regulation of midwives, restoring their ‘professional status’ if in a subordinate role. We show that the history of the regulation of midwives across four centuries casts light on the interplay between formal and informal regulation and matters of gender and professional status.
Highlights
This article addresses the regulation of female midwives in England from the 16th century to the passing of the Midwives Act 1902
We argue that the Church oversaw a system of external regulation of midwives that, while not perfect, validated midwifery as a skilled and expert undertaking and conferred status upon all midwives, not just licensees
While most historical studies of healthcare regulation cite the Medical Act 1858 as the first instance of a regulatory strategy in England, Moran acknowledges the importance of the Apothecaries Act of 1815 in creating a template for medical regulation that ‘all subsequent professionalising projects in healthcare have had to respond to’
Summary
Studies of regulation law rely heavily upon medicine as a primary model for thinking about the relationship between state intervention and the development of the professions in the 19th century.[2]. The background to the 1902 legislation indicates that the Act owed more to the entrenchment of medical hierarchies and gendered perceptions of ‘women’s work’ than patient safety.[12] A study of midwifery regulation between 1500 and 1902 reflects many modern concerns about the licensing and regulation of healthcare professions including the efficacy of licensing and regulatory structures; patient autonomy and access to expert knowledge; professional relations and culture; interactions with the state; and methods of enforcement.[13] Neglect of the earlier history of the regulation of midwives has deprived us of a model of partnership between external and self-regulation. Becoming a midwife with or without a licence entailed training, self-identification and crucially, approval by the community.[33] The efficacy of community regulation of midwifery practices is evident in its longevity, continuing long into the 19th century, outliving episcopal licensing. Midwives who did not meet the expectations of their clients or her attendants were unlikely to be engaged again in communities where reputation was a key component of good business practice.[34]
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