Regulating Midwifery in Early 20th-Century Belfast

By Caitlin Smith, Ulster University

During the early decades of the twentieth century, local and state governments became increasingly concerned with the regulation of midwifery both in Ireland and Britain. This grew from a fear that uncontrolled midwifery practices increased infant mortality rates. Handywomen – women who offered their services during childbirth despite having no formal qualifications – were used throughout Ireland during this period, and were often blamed for rising mortality rates. The regulation of midwifery in Belfast began with the introduction of the Corporation Act, 1911, and was furthered by the implementation of the Midwives (Ireland) Act, 1918. Previous to this, there was no legislation in place in the city to control this occupation. The aim of the Acts was to increase the standards of midwifery across the city and stamp out handywomen. Yet whether they achieved their aim of removing handywomen from the realm of birthing assistants is questionable.

Regulation in England and Wales

Establishing the Central Midwives Board in Britain in 1882 was the first step toward regulating the practice of midwifery. This Board introduced measures, such as the adoption of expensive equipment and uniforms, to reduce the possibility of a  handywomen being able to upskill.[1] Moreover, the Central Midwives Board was the driving force behind the introduction of the Midwives Act 1902 in England and Wales, an Act that encouraged the Belfast Corporation to introduce their own legislation. The 1902 Act required newly registered midwives in England and Wales to complete three months training (which increased to six months in 1916), attempted to stop any unregistered woman from attending birth, and also made local governments responsible for the inspection of midwives.[2] As well as this, established midwives without qualifications, but known to be of good character, were allowed to continue practicing if they registered themselves with the Central Midwives Board by 1910.[3]

An Early Twentieth-Century Midwife. Image Courtesy of National Museums of Northern Ireland.

Corporation Act, 1911

The Midwives Act 1902 was not initially extended to Ireland. Due to this, the Belfast Corporation introduced their own legislation – the Corporation Act, 1911 – to regulate midwives in the city. The Acts were similar in many ways, their main aim being to stamp out the practice of handywomen. The 1911 Act stipulated that no woman ‘unless she be certified…shall, within the City, attend women in childbirth… [or] employ an uncertified person as her substitute.’[4] Also, similar to the 1902 Act, any woman who proved that she had at least three years’ experience as a midwife, and was of good character, could continue to practice under the Belfast Corporation Act.[5] Belfast also created its own midwives roll in order to control and regulate the practice of midwives.

Midwives (Ireland) Act, 1918

The Midwives (Ireland) Act, 1918, was an extension of the Midwives Act of 1902, and was made compulsory throughout the whole of Ireland. This generally followed the same lines as the Corporation Act, 1911, which was repealed on 1 January 1919, in favour of the new act. The Midwives Act helped to regulate the training and standards of midwifery, and provided free emergency medical aid to mothers who did not qualify for free treatment under the charities system.[6] This development brought the question of infant and maternal welfare to the governments’ attention.

The two main differences between both Acts were the training of midwives and allowing Irish midwives to practice in British territories. Britain was late compared to the rest of Europe in introducing compulsory maternity training for both doctors and midwives. Doctors did not have a compulsory maternity element in their training until 1886, and midwives until the 1902 Act.[7] This was changed in Ireland with the introduction of the 1918 Act. It introduced a ‘Code of Regulations, which [provided] for the training and examination of candidates,’ and was the first formal training for midwives implemented in Ireland.[8] In addition, Irish midwives, whose diplomas in midwifery were unrecognised in England, could now practice in England, or ‘any part of His Majesty’s Dominions’.[9] The Act was the first step toward the recognition of midwives as important medical practitioners.

These Acts, however, had more of an impact on how midwives were perceived rather than the type of women engaging in this work.[10]  Alice Reid highlights that the Midwives Act was seen as a chance to create a ‘new breed of professional, middle-class midwife’ and a respectable profession.[11] Yet, Caitriona Clear shows in her analysis of nurses in Ireland that women who entered the nursing profession ‘did not usually come from exalted backgrounds.’[12] Therefore, although the Acts pacified both doctors and government officials who argued that these services needed to be carried out by more respectable women, in reality, nursing and midwifery continued to be carried out by women from lower classes.

The Price of Help

Despite governmental attempts to regulate midwifery, handywomen continued to be a regular feature in Irish births well into the 1940s.[13] Not all handywomen were unprofessional or put their patients at risk. They simply ‘occupied a weak position in the hierarchy of untrained medical practitioners’ which in turn left them and their reputations ‘more vulnerable to external forces.’[14] By 1915, two years after the Belfast Corporation Act came into force, twenty known handywomen were still practicing in Belfast City.[15] This reduced only slightly to sixteen known handywomen by 1918.[16] This suggests that handywomen were undeterred from offering their services, and also, that working-class women continued to rely on them, most probably due to the cost of a handywoman compared to a registered midwife or doctor. Some working-class mothers may not have had the ability to pay for qualified medical practitioners to attend them in childbirth, and therefore risked their infants’ and their own safety during and following labour due to economic necessity.[17] Without governmental forms of maternal care, the poor were forced to turn to untrained midwives or neighbours.[18]

An obese midwife on her way to a labour in the early hours of the morning. Coloured etching by T. Rowlandson, 1811. Wellcome Collection. Although from an earlier period, this shows negative perceptions of midwives in the past.

Articles in Belfast Weekly News and Northern Whig reveal that on average, a handywomen would cost roughly 10s to employ.[19] As well as assisting during childbirth, handywomen often visited for a week or so afterwards and helped the mother with housework.[20] On the other hand, the lowest price for a qualified midwife at this time was roughly 15s, and these women would not help out around the house after birth.[21]

Midwifery was an occupation that brought in little money, even when the person was fully qualified and on the midwives register. These low wages often discouraged qualified women from practicing midwifery. Alice Reid, in her research on Derbyshire, contends that the reality for a number of women was that midwifery generated little more than a part-time income, which was similar for Belfast midwives.[22] In 1912, the Northern Whig recorded that in Belfast ‘the salary for qualified midwives ran at present from £15-30 a year, and…would not attract educated young women…to the profession.’[23] This had risen slightly by 1917. The average wage for midwives in Ireland was £5-7 a month, equating roughly to the same wage of ‘an average girl munitions worker,’ who earned £1 to 25 shillings a week.[24] As well as being paid low wages, midwives were also expected to use their earnings to supply themselves with apparatus and equipment needed to carry out their job.[25] Belfast salaries for midwives were not unique for the time; for example, in early twentieth-century Sheffield, the average salary for midwife working in a hospital was £20 a year, while the average salary for a skilled male labourer was £100.[26] Although 227 women were registered on the Belfast Midwives Roll in 1915, and rose to 243 registered by 1918 in the city, newspapers recorded that due to midwives being ‘the hardest worked and most underpaid…there was a serious shortage of midwives’ practicing in the city.[27] As a result, there were possibly more cases for handywomen to take.

Handywomen in the Court

Those who did not follow the regulations under the Midwives Acts could, and were, taken to court and fined. The Medical Officer of Health Report for 1913 outlined the clause of the Corporation Act, 1911, regarding those women who continued to offer their services despite being an unregistered midwife. It stated that ‘any woman so acting without being certified…shall be liable, on summary conviction, to a fine not exceeding five pounds.’[28] Belfast newspapers recorded two instances of women being summoned to court due to this practice, both in 1913. M. Pearson was fined twenty shillings plus costs for ‘acting as a midwife without being certified,’ this being her second summons.[29] M. McCorry was also summoned, but with a much more serious case. The male infant in her care was born ‘a dark colour’ yet McCorry failed to call for assistance on the case. The infant’s cause of death was ‘heart failure, consequent on respiration not being established owing to the incompetency of the nurse in attendance of the mother.’[30] Although McCorry was not convicted of manslaughter, a rider was added that stated she would never be able to obtain a certificate from the Belfast Corporation to become a recognised trained or bona fide midwife in the city.

Midwives in 20th-Century Belfast
Midwives in 20th-Century Belfast. Courtesy of website of Centre for the History of Medicine in Ireland.

What these cases show is that in spite of the 1911 Corporation Act, women continued to offer their services as unqualified midwives, undeterred by fines. Further, the absence of clauses that would help working-class women afford qualified medical assistance during childbirth (apart from in cases of medical emergency), underpins the ignorance of the local and state government as to why working-class women continued to use handywomen into the 1940s. The low number of cases against handywomen in Belfast, coupled with the number of known handywomen in the city, suggests that perhaps these women were largely able to operate under the radar of the law. It could be that the cases they attended did not draw attention to them and resulted in few complications. However, it could also be suggested that although there were a number of known handywomen in the city, it did not mean all were working or had adequate numbers of customers to keep them sustained and that is why few were seen in court.

[1] Ciara Breathnach, ‘Handywomen and Birthing in Rural Ireland, 1851-1955’, Gender and History, 28 (2016), p. 40.

[2] Alice Reid, ‘Birth Attendants and Midwifery Practice in Twentieth-Century Derbyshire’, Social History of Medicine, 25 (2011), p. 381; Lucinda McCray-Beier, ‘Expertise and Control: Childbearing in Three Twentieth Century Working-Class Lancashire Communities’, Bulletin of the History of Medicine, 78 (2004), p. 399; Tania McIntosh, ‘Profession, Skill, or Domestic Duty? Midwifery in Sheffield, 1881-1936’, Social History of Medicine, 11 (1998), p. 418.

[3] Reid, ‘Birth Attendants’, p. 381.

[4] Medical Officer of Health, Belfast County Borough, 1913 Report, p. 36, p. 37.

[5] Medical Officer of Health, Belfast County Borough, 1913 Report, p. 37.

[6] Lindsey Earner-Byrne, Mother and Child: Maternity and child welfare in Dublin, 1922-1960 (Manchester: Manchester University Press, 2013), p. 11; Fionnuala Walsh, Irish Women and the Great War (Cambridge: Cambridge University Press, 2020), p. 86.

[7] Irvine Loudon, ‘The Transformation of Maternal Mortality’, British Medical Journal, 305 (1992), pp. 1157-1160; McIntosh, ‘Profession’, p. 416.

[8] ‘Belfast Maternity Committee’, Northern Whig (8 November 1918), p. 4.

[9] ‘Belfast Maternity Committee’.

[10] Reid, ‘Birth Attendants’, p. 382; McIntosh, ‘Profession’, p. 420.

[11] Reid, ‘Birth Attendants’, p. 382.

[12] Caitriona Clear, Social Change and Everyday Life in Ireland, 1850-1922 (Manchester: Manchester University Press, 2007), p. 33.

[13] Fionnuala Walsh, ”Every Human Life is of National Importance’: The Impact of the First World War on Attitudes to Maternal and Infant Health’, in David Durnin and Ian Miller (eds), Medicine, Health, and the Irish Experience of Conflict, 1914-1945 (Manchester: Manchester University Press, 2016), p. 23.

[14] Breathnach, ‘Handywomen’, p. 38.

[15] Medical Officer of Health, Belfast County Borough, 1915 Report, p. 46.

[16] Medical Officer of Health, Belfast County Borough, 1918 Report, p. 48.

[17] Reid, ‘Birth Attendants’, p. 383; McCray-Beier, ‘Expertise and Control’, p. 402.

[18] Irvine Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality, 1800-1950 (Oxford: Clarendon Press, 1992), p. 47.

[19] ‘Belfast Infant Death- An Uncertified Midwife- Dr Graham’s Severe Strictures’, Belfast Weekly News (10 July 1913), p. 4; ‘Belfast Woman’s Death-Coroner’s Inquest- Midwife’s Examination’, Northern Whig (26 August 1913), p. 8.

[20] Loudon, Death in Childbirth, p. 180.

[21] Loudon, Death in Childbirth, p. 180, p. 209.

[22] Reid, ‘Birth Attendants’, p. 382.

[23] ‘Infantile Death Rate: Board of Guardians and Midwives- Lady Aberdeen’s Scheme’, Northern Whig (25 May 1912), p. 8.

[24] ‘From the Woman’s Point of View’, Belfast News Letter (20 June 1917), p. 6.

[25] Loudon, Death in Childbirth, pp. 212-13.

[26] McIntosh, ‘Profession’, p. 407.

[27] Medical Officer of Health, Belfast County Borough, 1915 Report, p. 37; Medical Officer of Health, Belfast County Borough, 1918 Report, p. 48; ‘From the Woman’s Point of View’, Belfast News Letter (20 June 1917), p. 6.

[28] Medical Officer of Health, Belfast County Borough, 1913 Report, p. 36.

[29] ‘Notification of Births’, Belfast News Letter (3 October 1913), p. 10.

[30] ‘Belfast Infant Death: An Uncertified Midwife. Dr Graham’s Severe Strictures’, Belfast Weekly News (10 July 1913), p. 4.