.You wo ked on you own, making you
own decisions and coping on you
own.: Midwi e y knowledge, p ac ice
and independence in he wo kplace in
B i ain,
1936
o he ea ly
1950's
MAXINE
RHODES
(*)
SUMMARY
l.-In oduc ion. 2.-The occupa ional s uc ii e. 3.-The na u e and p ac ice o
midwi e y knowledge. 4.-Conclusion.
ABSTRACT
Midwi e y knowledge is a complex en i y-comp ising o aining and expe ien ial
elemen s-no ixed bu mu able, bo h in o med and al e ed by p ac ice. This s udy uses
o al his o y accoun s o explo e how midwi es iewed hemsel es and how hey in e ac ed
wi h midwi e y knowledge in an a emp o gain a g ea e unde s anding o hei powe
and independence in he wo kplace and, as a esul , o hei p o essional s a us.
Midwi e y knowledge canno simply be de ined as he echnical skills augh in aining;
i was also shaped by he en i onmen in which p ac ice ook place and he midwi e's
ela ionships wi h women and wi h doc o s.
BIBLID [0211-9536(1999) 19; 191-2141
Fecha de acep ación: 30 de no iemb e de 1998
(*)
Senio Lec u e in Social His o y. Wes hill College o Highe Educa ion. Weoley
Pa k Road, Selly Oak. Bi mingham B29 6LL. Uni ed Kingdom. E-mail:
m. hodesQwes hill.ac.uk
DYNAMIS. Ac a Hisp.
Med.
Sci. His . Rlus.
1999,
19,
191-214.
192
MAXINE
RHODES
l.
INTROD UCTION
His o ians ha e ended o ocus on he p o essionalisa ion o midwi e y
h ough an examina ion o he s uggle o egis a ion and by explo ing
he in e - ela ionships be ween midwi es and o he medical heal h ca e
p o essionals
(1).
Few ha e been in o med by he wo k o sociologis s,
who ha e begun o explo e and ede ine heo e ical amewo ks h ough
which o s udy he p o essions
(2).
T adi ionally, emale/ emale-domina ed
g oupings ha e been dubbed semi-p o essions
(3),
a heo y which clea ly
e lec s no ions o gende and powe in socie y by insis ing ha ((because
women a e no men, hen "semi-p o essions" a e no p o essions~
(4).
His o ians he e o e ha e ended o accep such models unc i ically
ins ead o explo ing new heo e ical amewo ks. Simply pu , a p o ession
has been de ined as an occupa ion usually equi ing some ad anced
lea ning/specialis ainiing, whe e hose in ol ed ha e a la ge deg ee
o au onomy in he wo kplace and a e ega ded as
«awning»
knowledge
and/o skills, access o which is con olled by he g oup. As an en i ely
emale wo k o ce, midwi es we e gene ally denied ull p o essional s a-
us and we e also excluded because hey ha e did no ha e comple e
con ol o e hei own aining p og ammes o ules and egula ions.
Howe e , de ini ions o lie p o essions which ely on he no ion o
comple e au onomy ha e been challenged and ecen esea ch has
sugges ed ha «knowledge based g oups ha e ne e been cha ac e ised
by a o al au onomy~
(5).
(1) DONNISON, Jean.
Midwi es and Medical Men:
A
his o y o he s uggle o he con ol
o childbi h,
London, His o ical Publica ions L d., 1988.
(2) See o example: BURRAGE, Michael; TORSTENDAHL, Rol (eds.).
P o essions in
Theo y and His o y: Re hinking he s udy o he p o essions,
London, Sage Publica ions,
1990 and
The Fo ma ion o P~o essions: Knowledge, S a e and S a egy,
London, Sage
Publica ions, 1990.
(3)
ETZIONI, An onio.
The Semi-P o essions and Thei O ganisa ion: Teache s, Nu ses,
Social Wo ke s,
New Yo k, The F ee P ess, 1969.
(4)
WITZ,
Anne.
P o essions and Pa ia chy,
London, Rou ledge, 1992,
p.
60
(5)
TORSTENDAHL, Rol . In oduc ion: p omo ion and s a egies o knowledge-
based g oups.
In:
Michael Bu age and Rol To s endahl (eds.),
The Fo ma ion o
P o essions: Knowledge, Sa e and S a egy,
London, Sage Publica ions, 1990, p.
5.
DYNAMIS.
Ac a
Hisp.
Med. Sci. His . Rlus.
1999,
19,
191-214.
Midwi e y knowledge, p ac ice and independence in he wo kplace in B i ain
193
Gi en such p oblems o de ini ion, he key o unde s anding he
de elopmen o p o essional iden i y and s a us lies in he ela ionship
be ween specialis knowledge and he powe such knowledge acco ded
an occupa ional g oup. Howe e , he ela ionship be ween knowledge
and powe is no s aigh on a d as bodies o knowledge ecei e di e en
le els o es eem a di e en poin s in his o y. Fu he mo e, knowledge
and powe canno be ega ded as one-dimensional, simplis ic no ions
wi h a causal ela ionship. Whils Foucauldian analysis ela es powe
and knowledge i mly oge he
(6),
some esea che s ha e challenged
his appa en link and a gue ha al hough ~Knowledge can con e
powe
.
. .
i does no au oma ically do so»
('7).
This is pa icula ly appa en
in midwi e y, whose knowledge base in wen ie h cen u y Wes e n socie ies
has no been held in as high a ega d as he «supe io » knowledge o
he obs e ician. By iden i ying hie a chies o knowledge and powe ,
his o ians can begin o explain how di e en p o essional g oupings
we e awa ded di e en s a us and hus a oid he (gende ed) labels o
semi-/ ull p o ession.
An h opology can also in o m his o ical esea ch in o powe ela ions
and knowledge sys ems. Fo hose conce ned wi h he his o y o medi-
cine o gende , much can be gained om he wo k o B ige e Jo dan
who has discussed he no ion o au ho i a i e knowledge in ela ion o
childbi h. Jo dan a gues ha
« o any pa icula domain se e al knowledge sys ems exis , some o
which, by consensus, come o ca y mo e weigh han o he s, ei he
because hey explain he s a e o he wo ld be e o he pu poses a
hand o because hey a e associa ed wi h a s onge powe base and,
usually bo h.
(8).
Such an app oach has impo an implica ions o he s udy o midwi es
in his o y as i ou lines mo e clea ly he complex na u e o he ela ionship
(6)
McNAY, Lois.
Foucaul : A c i ica1 in oduc ion,
Camb idge, Poli y P ess, 1994, p. 64.
(7) CORFIELD, Penelope.
Powe and he P o ssions in B i ain
1700-1850,
London,
Rou ledge, 1995, p. 250.
(8)
JORDAN, B igi e. Au ho i a i e Knowledge and
I s
Cons uc ion.
In:
Robbie, E. Da is-
Floyd and Ca olyn,
F.
Sa gen (eds.),
Childbi h and Au ho i a i e Knowbdge: C oss-
cul u al pe spec z es,
Be keley, Uni e si y o Cali o nia P ess, 1997, pp. 55-79 (p. 56).
DYNAMIS. Ac a Hisp. Med.
Sci.
His . Illus.
1999,
19,
191-214.
MAXINE
RHODES
be ween powe and knowledge. The applica ion o such no ions o
his o ical enqui y, sugges s ha he knowledge/powe nexus may no
necessa ily be a p e equisi e o p o essional s a us, o a leas ha his
ela ionship can ha e a ange o esul s depending on whe he i is he
ela ionships wi hin an occupa ional g oup, hose wi h he clien ele o
hose wi h ou side agencies ( hemsel es in ol ed in a ange o powe
and knowledge s uc u es) which a e being examined.
Recen ly, medical his o ians ha e been conce ned wi h explo ing
he na u e and impac o medical knowledge h ough he examina ion
o p ac ice, policy and pa ien expe iences
(9).
Howe e , he knowledge
sys ems o mos ly/comple ely emale p o essional g oupings ( o example,
midwi es, nu ses and heal h isi o s) ha e ecei ed less a en ion in he
B i ish li e a u e-al hough esea che s (pa icula ly wi hin he his o y
o nu sing) ase beginning o explo e he issue o nu sing knowledge (10).
T adi ionally, he his o y o midwi e y has ended o ei he cha he
de elopmen o he p o ession as a discipline (ll), o explo e in e -
p o essional ela ions (12). Howe e , he popula i y o o al his o y as a
esea ch ool has lead o some esea che s (many o hem midwi es
hemsel es) o begin o Yden i y he changing na u e o p ac ice (13)
and o explo e he his o ical dimension o speci ic policy changes wi hin
hei p o ession (14). Despi e his ac i i y, li le a en ion has been paid
o he c ea ion o midwi e y knowledge i sel and i s ole in helping o
o m p o essional iden i y h ough aining (15), o o he indi idual's
(9) Fo ecen esea ch and he cu en s a e o medical his o y see: he jou nal
Social His o y o Medicine
and BYNUM, William F.; PORTER, Roy (eds.).
Companion
Encyclopaedia o he His o y o Medicine,
London, Rou ledge, 1997.
(10) See o example: RAFFERTY, Anne Ma ie; ROBINSON, Jane; ELKIN, Ru h (eds.).
Nu sing His o y and he Poli ics o Wel a e,
London, Rou ledge, 1997 and RAFFERTY,
Anne Ma ie.
The Poli ics o Nu sing Knowledge,
London, Rou ledge, 1997.
(1 1) See o example: TOWLER, Jean; BRAMALL, Jean.
Midwi es in His o y and Socie y,
London, C oom Helm, 1986, which p o ides an excellen in oduc ion o he
de elopmen o midwi e y.
(12) DONNISON, no e
1.
(13) LEAP, Nicky; HUNTER, Billie.
The Midwzje's Tale,
London, Sca le P ess, 1993.
(14) ALISON, Julia.
Deli e ed a iome,
London, Chapman and Hall, 1996.
(15) See: RHODES, Maxine. Bi hs, Bedpans and Bugs: The con ibu ion o p o essional
educa ion and aining o becoming a midwi e.
Zn: Heal h, Wel a e and O al
His o y,
London, Rou ledge, 1999 ( o hcoming).
DYNAMIS. Ac a Hisp. Med. Sci. His . .nlus.
1999,
19,
191-214.
Midwi e y knowledge, p ac ice and independence in he wo kplace in B i ain
195
in e ac ion wi h he p o essional knowledge and he consequences o
his o he ole ( o example, o he ca e she ga e mo he s) and he
s a us wi hin he ma e ni y se ices. Mo eo e , he e is much scope o
esea ch in o he ela ionships be ween midwi es and nedics wi hin
ins i u ions (such as hospi als and clinics), in he domicilia y se ing
and a bo h he local and na ional le e1 ( o example, wi hin o mal
commi ee s uc u es and wi hin he Cen a1 Midwi es Boa d)
(16).
Such issues can bes be explo ed by he applica ion o o al his o y
echniques as he cen al me hodological ool. Though no wi hou i s
p oblems, o al es imony allows a ulle accoun o he pas o be explo ed
and, by aluing he expe ience o he indi idual, allows an explo a ion o
human ela ionships
(1'7).
In his way, his o ians can engage mo e easily
wi h he applica ion o abs ac no ions o powe , knowledge and s a us.
Whils documen a y e idence p o ides impo an in o ma ion abou he
cons uc ion and dissemina ion o midwi e y knowledge his o ical s udies
a e, wi hou some explo a ion o i s p ac ica1 applica ion o impac ,
limi ed o an unde s anding o he ideal a he han he eali y. This wo k
is he e o e based upon de ailed in e iews wi h midwi es who ained and
began hei ca ee s in he pe iod be o e
1952
in B i ain. Al1 he in e iewees
ained in he No h o England and al1 wen on o p ac ise in he same
ci y (Kings on upon Hull in Yo kshi e). Thei es imony shows a simila i y
o expe ience which, 1 would a gue, e lec s he na u e o midwi e y
aining. Howe e , whils
1
acknowledge he limi a ions o such a local
s udy (and hope o comple e a mo e geog aphically di e se s udy in he
u u e), such an app oach does p o ide a de ailed unde s anding o he
dynamics o knowledge which la ge s udies may obscu e.
2.
THE OCCUPA TIONAL STRUCTURE
Be o e explo ing in dep h he na u e, s uc u e and impac
o
midwi e y knowledge, i is impo an o ha e some unde s anding o he
(16) The Cen al Midwi es Boa d was he midwi es' uling body. C ea ed by legisla ion
in 1902, i was domina ed by nedics and had an impo an ole in p oducing he
basis o midwi e y knowledge.
(17)
PERKS,
Robe ; THOMSON, Alis ai .
The
O al
His oly
Reade ,
London, Rou ledge,
1998.
DYNAMIS. Ac a
Hisp.
Med. Sci.
Hzs .
Rlus.
1999,
19,
191-214.

196
MAXINE
RHODES
his o ical de elopmen o midwi e y in B i ain in he i s hal o he
wen ie h cen u y and in pa icula o he way in which his all- emale
labou o ce was o gaaised du ing he pe iod in ques ion. Whils i is
di icul o sepa a e he midwi e y labou o ce om he se ice i
p o ided, he in en io i in his sec ion is o p o ide a sho occupa ional
his o y, ocusing on he changing na u e o he wo k and he posi ion
o he midwi e. This na a i e is in ended o help he eade loca e he
discussion o midwi e y knowledge wi hin i s his o ical con ex bu does
no claim o be exhaus i e. I s p ime unc ion is o show how legisla i e
change a ee ed midwi es and o highligh he impo ance o he 1936
Midwi es Ac .
The his o y o midwi e y egis a ion and he de elopmen o legisla ion
in B i ain has been well documen ed (18). Midwi es had ecei ed he
a en ion o legisla o s om 1902 when he i s Midwi es Ac was
passed and he Cen al Midwi es Boa d (C.M.B.) wi h i s p o essional
egis e we e c ea ed. F om his ime o wa d, midwi es we e moni o ed
a he local le e1 h ough a sys em o inspec ion by he Local Supe ising
Au ho i ies ( he L.S.A.s we e usually o ganised h ough he local Medical
O ice o Heal h's depa men ) and na ionally by he C.M.B. Bo h
bodies had wide powe s o discipline midwi es should hey ail o comply
wi h he ules o hei p o ession and in addi ion, he C.M.B. could
emo e a name om he egis e . This sys em o inspec ion was no only
conce ned wi h s anda ds o p ac ice bu also wi h pe sonal cha ac e
and beha iou , bo h o which we e conside ed when assessing compe ence.
The 1902 Ac helped o clea ly de ine he ole o he midwi e as he
p ac i ione wi h esponsibili y o no mal childbi h by equi ing he
o cal1 medical assis ance only i a pa ien de ia ed om he expec ed
pa e n o labou (as laid down in aining and in he ules) and his
de ini ion emained an impo an pa o he p o essional iden i y.
T adi ionally, midwi es we e independen p ac i ione s and whils
some wo ked ei he o local cha i ies, he Poo Law o he hospi als,
he majo i y wo ked o hemsel es in domicilia y p ac ice. Mos bi hs
ook place a home and we e midwi e-a ended, and whils he 1902 Ac
(18) See DONNISON, no e 1,
and
TOWLER;
BRAMALL,
no e 11.
DYNAMIS. Ac a Hisp.
Med.
Sci. His .
Zllus.
1999,
19,
191-214.
Midwi e y knowledge, p ac ice and independence in he wo kplace
in
B i ain
197
had al e ed hei ela ionship wi h ou side agencies such as local
go e nmen , he majo i y o midwi es appea o ha e essen ially con inued
o be sel -employed in o he in e -wa yea s. Howe e , inc easing numbe s
did wo k o he eme ging ma e ni y and in an wel a e se ice which
began o be mo e i mly di ec ed by na ional and local go e nmen in
he in e -wa yea s as g an s om public money became a ailable and
legisla ion encou aged local a en ion o he de elopmen o se ices.
As he mos usual bi h a endan , midwi es we e a c ucial componen
in he eme ging ma e ni y and child wel a e se ice and hei ole was
o be ex ended in he pe iod a e 1902, no only o co e he bi h
i sel bu o p o ide an e-na al, pos -na al and neo-na al ca e. In his way
midwi es had a ange o esponsibili ies, no only in p o iding o he
needs o mo he s and babies bu in keeping a wa ch ul eye o any
complica ions and epo ing hese o a doc o . On he one hand, hei
in luen ial ole was ecognised, bu on he o he , hei wo k was inc easingly
ega ded as being in need o egula ion and supe ision and hei
con ibu ion o ma e nal and in an heal h was o en seen as ha m ul
a he han help ul, especially in he yea s be o e 1936 (19).
The 1902 Ac did no eplace he un ained handywoman wi h a
ained p o essional o e nigh . Al hough he Ac had c ea ed he machine y
o egula e, ce i ica e and inspec midwi es, i did no ini ially p e en
al1 un ained midwi es om p ac ising bu ins ead c ea ed a h ee ie
sys em o hospi al- ained, bona- ide (un ained midwi es who had p ac ised
be o e he Ac and who we e conside ed o good cha ac e and allowed
o con inue hei wo k) and unce i ied midwi es ( he adi ional olk
midwi e o handywoman). Al hough he unce i ied midwi e was no
pe mi ed by law o p omo e he sel as a ained midwi e, she did no
disappea -e en hough li le in o ma ion emains abou he wo k, she
does appea o ha e su i ed in some locali ies (20). Whils midwi e y
(19) His o ically, midwi es ound i di icul o shake o he image o he un ained
handywoman and he s anda d o midwi e y in B i ain was o en seen as a cause
o ma e nal dea hs. I was only as he ma e nal mo ali y a e began a sus ained
decline om he mid 1930's ha his began o change.
(20) Local s udies a e use ul he e.
In
Kings on upon Hull, he e
is
e idence o show
ha handywomen we e being wa ned o desis p ac ising and some we e p osecu ed
DYNAMIS. Ac a
Hisp.
Med. Sci.
His .
lllus.
1999,
19,
191-214.
198
MAXINE
RHODES
was changing, he un ained bona- ide midwi e s ill con inued o be an
impo an pa o he labou o ce o some ime.
The 1902 Ac emained (wi h some amendmen s) he basis o he
o ganisa ion o midwi e y un il1936 when ano he Midwi es Ac comple ely
al e ed he whole s uc u e o he midwi e y labou o ce by making al1
midwi es sala ied public employees. Howe e , his legisla ion was he
culmina ion o ends ha had begun much ea lie (21) and we e
al eady a ec ing independen p ac ice. The in oduc ion o municipal
midwi e y schemes o example (whe e local go e nmen employed
midwi es and a anged he collec ion o subsidised ees om mo he s)
,
esul ed in some con lic be ween he L.S.A.s and independen midwi es.
A he same ime, he C.M.B was u he e ining he ole and esponsibili ies
o he midwi e- o example, by equi ing he o ca y ou an e-na al
inspec ions om 1926 and by ex ending he pos -na al esponsibili ies
om 10 o14 days om 193'7.
Howe e , he mos signi ican piece o legisla ion o midwi es had
come in 1936 when he Midwi es Ac comple ely es uc u ed midwi e y.
A guably mo e impo an o midwi es, in p o essional e ms, han he
in oduc ion o he Na io ial Heal h Se ice in 1948 (22), his legisla ion
was o o m he basis o he s uc u e o midwi e y h oughou he
pe iod unde conside a ion. The Ac comple ely al e ed he o ganisa ion
o he midwi e y se ice in England and Wales by legisla ing o « he
o ganisa ion h oughou lie coun y o a domicilia y se ice o sala ied
midwi es unde he con ol o he local supe ising au ho i ies» (23). I
ollowing he legisla ion o 1910 (which p e en ed hem ac ing as midwi es
~habi ually and o gain,>).
Annual Repo o he Medical OJ ice o Heal h,
London,
HMSO, 1911, p. 43. Howe e , whils o icial sou ces would sugges ha he
handywoman had disappea ed, o al his o y accoun s p o ide e idence o he
con inued exis ence. In Hull, o example a leas one such woman was wo king
in o he 1940's. RHODES, Maxine. Unpublished in e iew wi h Hull Midwi e.
(21) Fo a de ailed accoun o he p essu e o e o m see: WILLIAMS, A. Susan.
Women and Childbi h in he Twen ie h Cen u?,
S oud, Su on Publishing, 1997.
(22) Howe e , he e is oom o no e esea ch in o he impac o he NHS, midwi es'
eac ion o i and place wi l iin i .
(23) MINISTRY OF HEALTH.
Ci cula
1569:
Midwi es Ac
1936,
London, H.M.S.O.,
1936.
DYNAMIS. Ac a Hisp. Med.
Sci.
His . Rlus.
1999,
19,
191-214.
Midwi e y knowledge, p ac ice and independence in he wo kplace in B i ain
1.99
The Nu ses' Home, Albion S ee , Hull. Pupil midwi es li ed
he e whils comple ing hei dis ic aining.
was gene ally hoped ha , as a esul no only would ma e nal mo ali y
be educed bu midwi es would also bene i as he «whole s a us o he
midwi e y p o ession will be aised by p o iding adequa e sala ies and
secu e p ospec s o hose midwi es who en e he se ice»
(24).
(24)
MINISTRY
OF
HEALTH, no e
23.
DYNAMZS. Ac a
Hisp.
Med.
Sci.
His .
Illus.
1999,
19,
191-214.
206
MAXINE
RHODES
and he mo he died. Following he dea h, she had o go in o he
Supe iso 's o ice and explain he case o a emale doc o :
MI was e y so y abou M s
X.
1 couldn' wo k. The nex day
1
couldn'
go o wo k.
1
had o go o he o ice and explain he case. She said,
'You didn' iddle wi h he undus".
(Manually in e@e e wi h he womb)
She ga e me qui e a wigging
( elling o B
and 1 said: "1 don' hink
1
wa an his ea men ".
1
didn' eel
a
al1 guil y
...
jus in ensely so y.
To see ha woman gasping, you know i 's in e na1 haemo haging.
(37).
Midwi es had less powe han doc o s bu i was only when disas e
s uck ha hey would be ques ioned; in eali y, hey had o deal wi h
e en s as hey occu ed. When in e iewed, midwi es ecalled dealing
wi h haemo hages and incomple e deli e y o he placen a and alked
o independen ly adminis e ing d ugs
(38).
One midwi e, emembe ing
he limi ed ea men s a ailable o hem, ecalled:
((We didn' ha e
an
injec ion o s opping he bleeding. You ga e
hem so many d ops
o
e gome ine. I ook wen y minu es o ac . We
managed o ge Pi ui in. We used o gi e hem ho agina1 douches
o s op hem bleedingn
(39).
In eali y he e o e, midwi es egula ly s epped in o he p ese e o
doc o s and such expe lences had impo an consequences o he
midwi es' p o essional pe sona. The ac ha hey could and did a end
such bi hs u he ein o ced midwi es' belie in hei compe ence and
s a us as p o essionals, equal bu di e en o doc o s.
Al hough al1 he in e iewees discussed a ending abno mal
p esen a ions, he doc o always a ended hose bi hs ha equi ed
ins umen al in e en ion (such as a o ceps deli e y) and he e is no
e idence o sugges ha he midwi e would pe o m any o he ole han
ha o ma e ni y nu se a such e en s. Such e idence, aken in conjunc ion
wi h he es imony on abno mal p esen a ions, no only sugges s ha
(37)
M s Sy, Tape
8.
(38)
LJsually an ac i i y associa ed wi h he ole o he doc o (o a leas supe ised
by him), midwi es we e allowed o adminis e some medica ion.
(39)
Miss
S,
Tape
1
and
2.
DYNAMIS. Ac a
Hisp.
Med.
Sci.
His .
lllus.
1999,
19,
191-214.

Midwi e y knowledge, p ac ice and independence in he wo kplace in B i ain
207
no mal and abno mal bi h was less well de ined han oday bu ha in
p ac ice he e was some blu ing o di isions be ween he wo k o
doc o s and midwi es. The dis inc ions made be ween he ole o he
doc o and he midwi e we e clea in he ex books and in he
C.M.B.
ules bu in eali y, i was he use o ce ain bi h echnologies ha
sepa a ed expe ise. Doc o s we e b ough in o o ceps deli e ies and
su u ing, p ac ices which i was belie ed, needed medical aining, whils
midwi es' wo k hough echnical was ega ded as less specialised.
P ac ica1 expe ience was clea ly impo an o p o essional de elopmen ,
bu he co ela ion was nei he simple no di ec . T aining in communi y
midwi e y and ea ly p ac ice ended o help o m a i udes o he wo k
and in e iewees spoke o being al e ed by hei expe iences. One, o
example, spoke abou how he ea ly expe iences o hospi al wo k ensu ed
he ca ee mo ed on o he Dis ic (communi y midwi e y). In his case,
he midwi e when newly quali ied had had wo auma ic expe iences
close oge he , bo h in ol ing ma e nal dea hs:
«We knew she wasn' going o eco e . She was unconscious and Sis e
had gone o dinne and 1 was le wi h his ishe man
( he husband o
he unconscious woman)
...
and he said: "Bu she's going o be al igh
isn' she?"And you' e le he e, e y young and wha do you
...
?
I 's
he only dea h I'd had any hing o do
wi h
and
1
hough : "Oh, 1 don'
wan o wo k he e anymo e"~
(40).
Such expe iences howe e p o ided hese midwi es wi h addi ional
knowledge and in o med hei sense o wha women equi ed in childbi h
and o hei own esponsibili ies wi hin his. Ano he , o example,
main ained ha hospi als we e he bes places o al1 bi hs al hough i
la e anspi ed ha he ai h in domicilia y deli e y had been sha e ed
by he expe iences. Asked o a end a woman who had deli e ed he sel ,
she had a i ed a he scene and was e en ually le in o he house by a
young child: eand when we go in, she'd had a baby
...
The baby was
he e. I was a esh s illbi h wi h he placen a si ing on i s head, on
i s ace, and i was a co one 's case*
(41).
This midwi e exp essed a
(40) M s
B,
Tape
7.
(41) Miss
P,
Tape
5.
DYNAMIS. Ac a
Hisp.
Med.
Sci.
His .
Illus.
1999,
19,
191-214.
MAXINE
RHODES
belie ha women we e bes p o ec ed by he hospi al sys em, especially
i hey could no a ange adequa e ca e o hemsel es. In o he cases,
he unpleasan expe iences p o oked sympa hy. One midwi e ecalled
cases o pue pe al insani y which ~ igh ened he dayligh s ou o mes
(42)
bu encou aged a com,passiona e app oach and a desi e o engage o he
heal h p o essionals in i s cu e. Expe ien ial knowledge did no always
a ise om pleasan expe iences and many o he midwi es in his sample
appea ed deeply a ec ed pe sonally and p o essionally by p ac ice and
hese helped o m he own a i ude and he app oaches o p egnan
and childbea ing women.
Midwi es appea o ha e engaged wi h midwi e y knowledge in
di e en ways, depending on whe he hey wo ked in he mo he s' own
homes o in he ma e ni y hospi al. In hospi al he e was a mo e igid
hie a chy and, by design, a mo e o mal sys em o moni o ing bo h s a
and pa ien s. Few examples o independen wo king o ule b eaking
we e ecalled by hose based in ma e ni y hospi als, al hough one midwi e
did commen on he abili y o asse he sel . Recalling he wo k wi h
junio doc o s in he hospi al, she had a sys em o p o ec ing midwi e y
cases: a1 would jus say o he doc o : "No, she's no you s, mine. No,
no mal. Oh, I'd like you o see he
(and
so
on)"
and hey no mo e da e
ouch my pa ien s!» (43). Howe e , since his example came om la e
in he ca ee his sugges s ha such con idence did no accompany
ini ial quali ica ion.
I was in domicilia y p ac ice ha midwi es ound mo e oppo uni ies
o independen wo king and i was he e, in he communi y, ha hey
belie ed hey had s anding: «I el
1
was somebody* (44). Midwi es
alked abou hei p ac ice and linked hei independence a wo k wi h
hei abili y o ha e (almos ) comple e con ol o e he bi h: «I did
mos o my own deli e ies wi hou a doc o p esen a al1 because 1 used
o manage i
...
When 1 was aining 1 was glad o ha e someone a he
side o me» (45). Midwi es alked o he need o pa ience, o he
(42)
M s
B,
Tape
7.
(43)
Miss
S,
Tape
1
and
2
(44)
M s
Sy,
ape
8.
(45)
Miss
S,
Tape
1
and
2.
DYNAMIS. Ac a Hisp.
Med.
Sci. His . llus.
1999,
19,
191-214.
l
Midwi e y knowledge, p ac ice and independence in he wo kplace in B i ain
209
necessi y o aking ime wi h bi hs and le ing na u e ake i s cou se.
One epea edly s essed his: «You jus used o wai he ime» and
la e «Le na u e ake i s cou se. I 's a no mal hing is childbi h and
always will be and, 1 mean, you can' ush i ~ (46)-such p ac ice was
ein o ced by he midwi e y ules which encou aged midwi es o wai
( o example, o wo hou s o he second s age o p og ess in women
ha ing i s babies). Domicilia y wo k he e o e allowed plen y o
oppo uni ies o e ine wha had been augh . Ini ially ne ous o he
inc eased esponsibili y
(4
was le he e on my own, jus new on he
Dis ic ~)
(47), midwi es soon ound hei p o essional pe sona. Many
ecalled ying o o de he domes ic en i onmen in line wi h aining,
demanding bed linen be changed (o en when he e was no a clean
al e na i e) bu in p ac ice ha ing o make do wi h wha was a ailable.
One emembe ed ying o keep new bo n wins wa m wi h limi ed
acili ies: «Al1 1 could do was ill up an o dina y glass bo le wi h as ho
a wa e as 1 could manage
...
and pu i nea hem in he clo hes
baske .
(48).
Ano he , emembe ing some o he condi ions, alked
abou he p oblems o p epa ing o deli e y and disposing o he
a e bi h: (& e you'd had he deli e y you'd
. ..
o dispose o he
a e bi h a home so i used o be pu on he i e. I was only a li le
i e. I was a p oblem bu i was he ules and we mus bu n i be o e
we le he house~
(49).
The midwi es in his sample wo ked wi h some
o he poo es women in he ci y and midwi es we e p oud o hei
abili y o cope unde di icul ci cums ances-NI ha e d unk ea wi h
he di ies a
(50).
They spoke o gi ing p ac ica1 help: &he had no
blanke s o he co . Only a dozen nappies. Well 1 hadn' been on he
Dis ic long
...
1 ook he a lo ely hick g ey blanke
...
hal a dozen
nappies
...
oh, she was deligh ed wi h hem*
(51).
This abili y o wo k
wi h women and adap o he su oundings o e ed midwi es g ea e
au onomy han hospi al wo king.
(46) M s
F,
Tape
3.
(47)
M s
S,
Tape
4.
(48) M s
Sy,
Tape
8.
(49) M s
S,
Tape
4.
(50) M s
Sw,
Tape
9.
(51) M s
Sy,
Tape
8.
DYNAMZS.
Ac a
Hisp.
Med.
Sci.
His . Zllus.
1999,
19,
,191-214.
210
MAXINE
RHODES
Whils aining e nained he basis o p ac ice, i was no ixed and
ules we e no always adhe ed o. In his way, midwi es ac ed au onomously,
and some o he midwi es alked o bending o b eaking o he ules
qui e eely. One o example, alked o pu ing in s i ches, which was
a comple e iola ion o he C.M.B. ules as su u ing was conside ed he
p ese e o doc o s. Howe e his midwi e knew exac ly wha she was
doing and commen ed: KTO pu in a couple o s i ches, he e was
no hing in ha ~ (52). Mo eo e he es imony is pa icula ly in e es ing
as i no only illus a es he belie in he sel as a compe en p o essional
bu also highligh s he de e ence o he doc o s: «Pu one o wo
s i ches in o sa e a doc o a wo o'clock in he mo ning-maybe up al1
nigh be o e- om ge i ig up~ (53). O he
ins an es
o delibe a e lou ing
o he ules could also be ound amongs hose who wo ked in domicilia y
p ac ice. One midwi e in pa icula alked ankly abou he hough s
on some o he midwi e y ules and admi ed o delibe a ely e using o
a end he disin ec ing s a ion in cases o pue pe al e e and o wea
glo es when asked o do so (54). Whils much o his independence in
p ac ice can be explained by he con inued dominance o midwi es a
he side o childbea ing women (mos bi hs a his ime, whe he
hospi al o domicilia y, we e wi hou complica ion), he s uc u al
o ganisa ion o he wo king en i onmen was also impo an . The
p edominance o domicilia y wo k, he endency o wo k alone a he
han in eams and he lack o di ec supe ision helped midwi es main ain
a deg ee o au onomy.
Thei independence and s a us we e u he ein o ced h ough
hei dealings wi h he women hey a ended. Midwi es el pa o a
communi y and some ecalled ha women would o en ha e he same
midwi e o successi e bi hs. O he s el hey we e espec ed:
*In hose days he niidwi e was "The Midwi e" and he e was always
someone ha li e ally an a e you
...
We had a highe s a us in he
communi y. Once you a e he same as hem ( he pa ien s), hey' e no
going o ake you ad ice qui e he samem
(55).
(52)
Miss
S,
Tape 1 and
2.
(53)
Miss
S,
Tape 1 and
2.
(54)
M s
Sy,
Tape
8.
(55)
M s
B,
Tape
7.
DYNAMIS.
Ac a
Hisp. Med. Sci. His . nlus.
1999,
19,
191-214.
Midwi e y knowledge, p ac ice and independence in he wo kplace in B i ain
21
1
This powe ela ionship was appa en wi h al1 he midwi es. Only
one commen ed on his: «Some pa ien s used o be sca ed o he
midwi es. Some midwi es we e, 1 don' know, so s ic , so se gean
majo ypen (56). A he same ime, howe e , he es imony illus a es
he a he pa onising way she ea ed women whom she e e ed o as
being N e y, e y goodn (57). I was also in hei ela ionships wi h he
women hey a ended ha he midwi es we e able o asse hei powe
and independence in he wo kplace. One pa icula episode illus a es
he ypical app oach o women in childbi h: «We had one lady who
had o ha e a s i ch in and we asked he husband o come in because
she was being a bi naugh y and he old he o
(laughs)
and she was as
good as gold!~ (58). O he s ecalled how women appa en ly did no
unde s and he necessi y o cleanliness: «They ne e had good mo he s
hemsel es you see. So o cou se, hey didn' know how o copen (59).
Ano he ecalled he gene al app oach as a ela ionship bu i was clea
his was no an equal one: «You' e go o ha e plen y o pa ience.
You' e go o know you pa ien s and you pa ien s ha e go o know
you and ely on you and
...
do
as
you ask hem» (60). Clea ly, i was
he e o e in dealing wi h mo he s ha midwi es could ein o ce hei
s a us. Midwi es we e o en ega ded wi h awe, some imes ea ed and
al hough midwi es epo ed good ela ionships wi h mo he s, he e
we e sha p powe di isions be ween hem.
Midwi es we e p oud o hei ole as he p ac i ione wi h esponsibili y
o no mal childbi h; om his hey gained hei sel -image. They we e
de ensi e o hei posi ion as independen p ac i ione s and esen ul
o wha hey saw as unnecessa y in e e ence by doc o s. They p o ec ed
hei place a he side o women and o en gained g ea sa is ac ion
om he misdiagnosis o doc o s. One emembe ed a woman she suspec ed
was ha ing wins and how he doc o ailed o no ice his un il he bi h:
«Ca ne he day, she wen in o labou and one li le baby ca ne.
1
said
"The o he one won' be qui e so big hen Doc o , will i ?" He was
(56) M s
F,
Tape
3.
(57) M s
F,
Tape
3.
(58) Miss
P,
Tape
5.
(59) M s
Sy,
Tape
8.
(60) M s
F,
Tape
3.
DYNAMIS. Ac a Hisp.
Med.
Sci. His . Illus.
1999,
19,
191-214.

212
MAXINE RHODES
eally li id wi h me
...
1 ne e liked ha doc o . She had wins
...
He
wen bee oo ed and
I
ne e eg e ed i
(laughs).
Well, 1 mean,
1
had sugges ed o him he e migh be mo e han one»
(61).
Al hough his would sugges an agonism be ween he midwi e and
he local
G.P.,
midwi e's in e ac ions wi h doc o s we e mo e complex
han his and much o he p o essional s a us was in ac shaped by he
dealings wi h doc oi s. Some had good ela ionships wi h doc o s and
belie ed ha his was i al o sound p ac ice:
«As
long as you go a
good doc o a he back o you, you' e al igh »
(62).
Bu ela ionships
a ied and midwi es had be e ela ionships wi h some doc o s han
o he s:
<<I
used o ha e Doc o
M
a lo because he was e y good. We had
ano he doc o , Doc o
C
...
bu he was a e o . He would come ou
and say: "I 'll be bo n. Nex ime
1
come i 'll be in i s co ". Well I'm
a aid in ano he hou , ano he hou and a hal ,
1
had o cal1 him
again and we in a iably go a s illbi h
...
He was s ubbo nn
(63).
Clea ly he in e ac ion wi h doc o s was no always easy bu i did
encou age sel - eliance and some asse i eness. This could be e y use ul
o doc o s as o wo k wi li a compe en midwi e would mean ewe calls
o assis ance, pa icula ly a nigh : «Wi h doc o s o my own gene a ion,
i we had o send o hem in an eme gency, i was said well hey ook
hei ime because hey knew he midwi e would ha e deal
wi h
i by he
ime hey go he e»
(64);
«I you wo ked in an a ea o a long ime
...
you could phone he n up i you we e ha ing a p oblem and hey'd
a ange admission o hospi al wi hou coming ou , on you say so.
(65).
Di icul ies a ose when doc o s o e uled midwi es o would no
a end when called ou : «He said: "I 's my hal day. I'm no coming ou
o anybody"~
(66).
This e idence sugges s ha he ela ionship was no
(61) M s
Sy,
Tape
8.
(62) M s
F,
Tape 3.
(63) M s
F,
Tape 3.
(64) M s
S,
Tape
4.
(65) M s
B,
Tape
7.
(66) M s
Sw,
Tape 9.
DYNAMZS.
Ac a
Hisp.
Med.
Sci.
His . Illus.
1999,
19,
191-214.
Midwi e y knowledge, p ac ice and independence in he wo kplace in B i ain
213
s aigh on a d; doc o s we e no simply obse ing midwi es o supe ising
hem. The ac ha midwi es we e du y bound o cal1 o medical
assis ance in some ci cums ances did no mean ha she could be ega ded
au oma ically as he doc o 's in e io . The ela ionship be ween he wo
p o essionals was clea ly mo e complex han ha , wi h some le e1 o
in e dependence. Whils some epo excellen wo king ela ionships
wi h local G.P.s, i appea s ha hese ela ionships we e ex emely
agile and i migh only ake one inciden o a midwi e o lose ai h
in he abili y o al1 local doc o s. Such expe iences o p ac ice ein o ced
in he midwi e's mind he need o he o asse he sel , bo h o p o ec
he p o essional space and, as she saw i , o p o ec women in childbi h.
4.
CONCLUSION
Whils he midwi e y ules ended o ein o ce he s a us o midwi e y
as in e io o ha o doc o s, midwi es we e a he same ime, encou aged
o wo k independen ly, us hei own judgemen and de elop a sense
o p o essional p ide. In eali y, he di ision o p o essional space be ween
he doc o and he midwi e e lec ed wha midwi es had been old
abou he limi a ions o hei ole, bu a he same ime, midwi e y
knowledge wi h i s expe ien ial elemen encou aged a sense o p o essional
independence, an awa eness o hei sphe e o in luence and consequen ly
a deg ee o powe in he wo kplace. Midwi e y knowledge canno simply
be de ined by he in o ma ion gi en in aining. Whe he i be echnical,
mo al o p o essional, midwi es seem o ha e e ined wha hey had
been augh and he eby e ained some powe in p ac ice. I is his
expe ien ial elemen o midwi e y knowledge ha u he complica es
issues o powe and s a us in he wo kplace.
On he one hand, midwi es had a clea ision o he medical
s uc u e o he ma e ni y se ice and hei place wi hin i bu a he
same ime, hey did no always accep he con ines o his s uc u e.
They ie cely gua ded hei posi ion wi hin he se ice and e idence
sugges s ha bo h domicilia y and hospi al midwi es e ained a deg ee
o con ol o e hei posi ion in he wo kplace and ha hey o en
ede ined he o mal knowledge augh in aining o
i
p ac ica1
expe ience. In his way, hey we e able o e ain some powe a wo k
DYNAMIS.
Ac a
Hisp.
Med.
Sci.
His .
Illus.
1999,
19,
191-214.
214
MAXINE
RHODES
whils o mal mani es a ions o midwi e y knowledge (p o essional
egula ions, o example) ein o ced hei in e io s a us.
Midwi e y knowledlge has o be seen as a complex en i y-comp ising
o aining and expe ien ial elemen s-no ixed bu mu able, bo h
in o med and al e ed by p ac ice. By explo ing how midwi es iewed
hemsel es and how hey in e ac ed wi h midwi e y knowledge, a g ea e
unde s anding can be ob ained o hei powe and independence in he
wo kplace and, as a esul , o hei p o essional s a us. Midwi e y knowledge
canno simply be de ined as he echnical skills which pupils we e
augh in aining; i was also shaped by a numbe o o he ac o s. The
en i onmen in which p ac ice ook place and he midwi e's ela ionships
wi h bo h he women (and he amilies) she se ed and wi h he doc o s,
al1 con ibu ed o he s anding as a p o essional. P ac ica1 engagemen
wi h midwi e y knowledge encou aged p o essional independence (a
heme in oduced in a small way du ing aining) especially in he
domes ic se ing bu e en in he es ic ed and mo e igidly hie a chical
en i onmen o he hospi al, midwi es ound ways o asse hemsel es
and main ain hei p o essional independence. I is only by explo ing
hese con adic ions a he local and indi idual le e1 ha we can see
how c ucial midwi e y knowledge was o de eloping a sense o he
p o essional sel , whils p o iding simul aneously s uc u es which made
any imp o emen in s a us wi hin he medical p o ession i ually impossible.
Whils midwi e y knowledge was c ucial in de eloping a p o essional
iden i y h ough i s expe ien ial elemen , a he same ime i e lec ed
and suppo ed exis ing powe s uc u es wi hin medicine; in his way,
midwi e y knowledge exp essed i s con adic o y na u e. As a esul ,
midwi e y knowledge enabled in a-p o essional de elopmen by
encou aging au onomy in he wo kplace, whils a he same ime i also
helped o main ain impo an in e -p o essional dis inc ions (in pa i-
cula he di e ence be ween he wo k o he doc o and ha o he
midwi e) which con ibu ed o main aining he low s a us o midwi es.
By examining mo e closely he indi idual's expe ience o hei occupa ional
knowledge, his o ians can be e explo e he complex dimensions o
p o essionalisa ion, especially in hose p o essions which a e gende ed.
DYNAMIS. Ac a
Hisp.
Med. Sci.
His .
Illus.
1999,
19,
191-214.