Midwife. Few words in the history of western medicine can evoke sudden and unequivocal academic tribal sentiment as that single term. To one school of thinking, the rise of the professional doctor and surgeon class to supplant local midwifery was a necessary precondition for the development of modern medicine and the curtailing of the infant mortality rate. For others, the doctors’ assumption of the midwives’ role was a usurpation by a jealous and organised body who sought to use their standing and administrative power to muscle out a dedicated and deeply experienced group of competitors from their highly skilled livelihoods, a gendered strike against the growing organisation of women professionals.
Those two conceptions of the midwife, as the experienced front-line hero of childbirth and as the doddering unschooled rural ignoramus, grew in intensity over the eighteenth century, and in one country centred on one particular figure, a tireless woman who trekked across the country armed with a king’s commission to teach the art of childbirth wherever she went. She was Angélique Marguerite Le Boursier du Coudray (c.1712–1794), inventor, businesswoman, lecturer and an unrivalled expert in the subtle art of delivering babies, and the subtler art of teaching that skill to thousands of largely illiterate countrywomen in a way they could understand and bring back to their native villages.
Many surgeons deeply respected her craft, and came to her classes to learn, but as the years wore on and her mission extended across the towns and villages of France, training a new generation of women to confidently handle difficult childbirths without the need to consult the local male doctors, a stiff resistance to du Coudray – and by extension to all practising midwives – set in that sought to slander her in print and deprive her of the opportunity to do the work she had been royally appointed to do.
Against a less resolute woman, these tactics might have worked, but du Coudray was a force, who knew her worth to the nation and would not sit idly by while usurpers and slanderers attempted to diminish the value of her mission. Where she got this indomitable will, we shall probably never know, as the details of her first three decades of life are all but entirely lost. She first appears in the historical record in 1740, when she registered as a licensed midwife in Paris after a traditional three-year apprenticeship with Anne Bairsin. This was a costly licence to obtain, and prospective applicants had not only to pay a fee but pass an exam before a panel of medical notables, present testimony by a member of the clergy as to their religious character, and withstand the questioning of all their known friends to determine their moral rectitude.
The level of personal and professional probing was deemed necessary because of the midwife’s legal and moral authority in early eighteenth-century Europe. Her expertise was often sought in legal cases, and her word was taken as truth in judgments about pregnancy, virginity and paternity. She was trusted by the local community as a protector of women having children out of wedlock, by the Church with the responsibility of presenting children at christenings, and by the state in determining biological facts pertaining to women that had legal significance. This status was looked upon with jealousy by not a few male medical practitioners, who felt that women’s virtual monopoly on child birthing was something suspicious grounded in a superstitious femininity that must be supplanted by modern theory and technologies. Out with the practised hands of the midwife, in with the technical precision of the obstetrical forceps, invented in the sixteenth century, but seeing its first wide use now in the early eighteenth. For some time, the surgeons of Paris simply refused to hold the exams that would allow the creation of new midwives, claiming that there were too many already, leaving the midwife community, with du Coudray as one of its leading voices, to find alternate venues for medical instruction, skilfully playing the rival jealousies of the doctors and surgeons off one another in an attempt to gain knowledge and certification.
Growing in authority as one of the leading midwives of Paris, du Coudray eventually rose to the station of head midwife at the Hotel Dieu, where women could go to deliver their babies regardless of ability to pay. Here, approximately 1,500 children were delivered in a year, and du Coudray’s experience in handling every conceivable malpresentation and natal complication would prove crucial in the formation of her legendary classes of the 1760s through to the 1780s. She was doing well, but there must have been a hunger for something more, for when in 1751 an Auvergne noble advertised a desire to have a midwife come to his estates to teach the peasants there about the art of child delivery, du Coudray leapt at the opportunity, leaving behind her apprentice and practice to try something new and promising.
Over the next few years, du Coudray developed a teaching programme unique in the history of Europe: a hands-on course that stressed practice over theory and for which she developed a machine, a fabric mock-up of a mother’s womb and the baby within, which allowed the peasant girls studying with her to practise each of the malpresentations that du Coudray had encountered over her years at the Hotel Dieu. Later, she added fluid-filled sponges throughout the machine that accurately mimicked different warning signs and regular discharges that a midwife must recognise and interpret, but to begin with the simple but accurate fabric mannequin allowed women to practise complex delivery techniques that they might otherwise have to wait years in the field to experience and come to grips with.
In an era where traditional village matrons held rapid delivery as the greatest goal, and encouraged the mother to hop up and down if the process seemed to be taking too long (with predictable results), du Coudray focused on how the midwife could, by feel alone, recognise different unique birth conditions, and develop best strategies for dealing with each so that she was rarely taken by surprise and never inclined to dangerously rush a delivery. Her students were enthusiastic, and glowing reports of her ability to take a few dozen village peasants and change them into confident and skilled analysts and delivery practitioners spread through France, helped along in 1759 by her publishing the Abrégé de l’art des Accouchements, an illustrated manual on childbirth that would go through several, ever more elaborately diagrammed, editions in the years to come.
The Abrégé treated the presentation of childbirth in a radically new way. Instead of illustrations that lingered dramatically on the naked body of the mother, du Coudray adopted colour-coded X-ray like images of the womb and child within, complete with illustrated hands to represent what the midwife ought to be doing in each case. This was a book written for her students, women who might be illiterate but still could use the illustrations as reminders of what to do in particular cases, while those who could read were treated to a medical text which forsook questionable theory and impenetrable jargon for practical advice in understandable terms.
Du Coudray’s work came at an important time in French history, when demographic experts were warning of a coming population implosion fuelled by the scourge of rural infant mortality rates. The state, which ordinarily kept itself at a far remove from such issues, was suddenly intensely interested in the quality of child delivery in France. Too many babies were dying at birth, and too many of those that survived were disfigured or disabled by reckless delivery methods, and it was starting to tell on the bottom line of national productivity. Just as ministers were convincing themselves that something had to be done, du Coudray’s book and courses were earning her national fame as the nation’s expert on midwife instruction. A radical idea took shape in Paris, approved enthusiastically by the king – why not give this woman a royal commission to travel throughout France, teaching women village by village, and thereby exponentially multiplying her priceless knowledge on a national scale?
There was no precedent for such a commission, but seemingly desperate times called for new ideas, and du Coudray was duly given a royal brevet, a commission with the full weight of the Crown behind it, to go wherever she thought she could do the best work, and to collaborate with local governments to find potential midwife candidates and train them using her established methods. For the next two decades, from 1761 to 1783, du Coudray would do just that. District overseers lavishly competed with each for the honour of a visit from the famous teacher and midwife, enthused by tales of wild success in locale after locale, of classrooms filled with 100 women turned in the course of three intense months into sophisticated experts in the art of complicated child delivery. Du Coudray drove herself hard, travelling the length and breadth of the country, sorting finances, organising teaching and living spaces, constructing and selling new teaching machines to be used by trained demonstrators once she left a locale, and building up a network of enthusiasts who would be her first line of defence against the increasingly shrill criticism being heaped upon her by a male medical establishment who saw nothing but threat in the growing legion of competent women practitioners.
She was not welcome everywhere. A few surgeons had taken all-out war against midwives as their life’s cause, and where they reigned supreme, du Coudray was not allowed to even offer her class. The surgeons saw the often-brutal condition of rural childbirth, and decided the solution lay not in an organised and knowledgeable education of a new generation of midwives, but in the total elimination of women from the profession of child delivery. Women, so these surgeons wrote, lacked the mental capacity to understand the theory of medicine, and in focusing so closely upon one aspect of the body, were liable to critically miss important secondary circumstances that impacted upon childbirth. It was the eighteenth century, medicine was professionalising itself, and there was no room in it anymore for these women claiming some traditional competence.
The attacks on du Coudray became more virulent as her successes grew more conspicuous. The medical establishment used its power to keep her name out of official medical journals, and to promote rival childbirth manuals written by sanctioned male authors, even sending them to the towns where she was teaching to try and trick her students into buying them. They built and advertised birth demonstration machines to compete with her own and lobbied the government to end her mission, compelling her on numerous occasions to return to the capital, armed with reams of testimonials of the importance and success of her work, to forcefully re-establish and extend her authority.
By virtue of an indomitable will, in spite of the coordinated attacks of an entire profession, du Coudray held on to her role (and even began collecting a regular salary instead of a conditional stipend) and continued travelling and teaching into her early seventies before handing over her title and authority to the adoptive niece who had been her steady helper since the virtual beginning, Madame Coutanceau. Coutanceau, for her part, would go on to become the first woman to run a medical clinic in France, and continued du Coudray’s mission of midwife instruction into the early nineteenth century. As for du Coudray herself, increasing weight and age forced her at last to retire from her relentless schedule in the early 1780s, and as France plunged into the French Revolution, her future was anything but secure. On one hand she was lauded as a patriot who brought knowledge to the dark superstitious corners of the nation, on the other she was under suspicion as a long-time employee of the now disgraced royal family.
Her pension, and her niece’s fees for teaching midwifery, stopped being paid by the state – in spite of an official inquiry which showed the overwhelming impact of her work in the provinces. Testimonials and statistics poured in detailing the impact of her mission, the students trained who went on to train further generations in a radiating pulse that touched all corners of the land. But whatever information one government collected was lost to the next as Assembly succeeded Assembly and the Terror sank its claws into the national consciousness. Du Coudray and Coutanceau somehow kept themselves from starving, and even managed to keep Coutanceau’s clinic open and running, but agents of the Terror increasingly had them under surveillance.
It was under these circumstances, reduced to near penury and living in fear, that Madame du Coudray breathed her last, probably as a result of the shock and stress of an interrogation at the hands of Jacobin agents attempting to establishing her ‘patriotic’ credentials. Her last moments are as much a mystery as her first decades, her legacy all but buried in the mad rush of a medical community attempting to fully professionalise itself. She was virtually lost in the medical record until historians recently, out of a renewed interest in the story of the interface between midwives and surgeons, painstakingly began piecing together the tale of European midwifery in the early Modern age. Her impact, they discovered, was vast, not only in the innovation of using demonstrative models to teach delivery methods, or in publishing a child delivery textbook that employed cutting edge publishing and illustrative techniques to show the most important aspects of the birthing process, but in the radiating waves of influence resulting from her insistence on teaching young and promising but uneducated rural women in ways that they could understand and pass along. The knowledge of one woman became the expertise of thousands, and the population of France thrived in the century to come under that expertise.
FURTHER READING:
One scholar went above and beyond the call of historical duty to painstakingly assemble all of the existent letters by and to du Coudray in an attempt to recreate and document the complicated travels of Louis XV’s revolutionary teacher. She is Nina Rattner Gelbart and I saw her work first in a compilation of essays about the history of midwifery (The Art of Midwifery: Early Modern Midwives in Europe (1993)), and in one of the footnotes she mentioned she was preparing a full-scale book on the topic of Madame du Coudray, to be titled Delivering the Goods: The Midwife Mission of Mme du Coudray in eighteenth-century France, at which point I instantly sought out the prospective book only to find that its title ended up being The King’s Midwife: A History and Mystery of Madame du Coudray (1998), which disappointed me because I do love a good silly pun in the title of an academically rigorous work; however, the book itself is wonderful. Deeply researched with regard to both du Coudray’s peregrinations and the history of the conflict between medical professionals and rural women practitioners, it lifts the veil on a bygone time to tell a story almost too heroic to be true.
And if you want to read more stories of women in Medicine, you can pick up a copy of my A History of Women in Medicine and Medical Research from Amazon or Pen and Sword UK or US.
