On Time, Pain and the Labor Process: Considering the History of Midwifery

Birth fractured my sense of time, of how time unfolded. I had previously taken for granted that time passed swiftly from one moment to the next. I organized my understanding of my own life according to the idea that time moved forward. I drew timelines on the whiteboards of my classrooms for my students, to help them understand cause and effect, event and transformation, the slow movement of one period of history into a subsequent one. I did not question the forward, onward, progression of time, not in arranging the sequences of my own life or in arranging the sequences of the past. And this easy understanding of temporality, in turn, took form in my writing. Thought followed thought; argument proceeded logically. I did not question the shape of the plot.

This all ended when I gave birth. Sequence unraveled, and with it the onward rush, progression, the sense of one event coming after another; my understanding of cause and effect, of the chronological chopping-up of time both personal and historical, before and after, premodern and modern, all blurred, folded, unraveled out of reach. Birth taught me, forced me, to imagine and experience temporality differently. Partly it was the time of labor, which was a kind of temporality I had never before experienced. To bear something unbearable for so long; for the pain not to recede, not to get better, but to arrive cyclically: this changed my understanding of how time itself could flow. Afterwards, I experienced memory in waves, and time itself moved in waves. I went into labor at eleven in the morning on a Tuesday, and my son was born around one in the afternoon the following day. For weeks after his birth, I relived that cycle of time. Each Tuesday into each Wednesday. And then each month; and then, finally and with an unforgettable intensity, on his first birthday. And then, after that first year, time rearranged itself again; and I was released from the tug of its tides.

During that first year I could not write history. I panicked. I was afraid of the silence. I felt sure that I would not write again. How could I write, when the very medium of my work, time, had fractured, and had reassembled itself again in this strange new form? I did not recognize it; I had not yet understood what had happened to me. I had not yet understood that I would have to work with a dif­ferent medium: not the chronology I had been taught, of change over time, of onward motion; but a temporality of repetition, of obsession, of an almost ritual attention.

Repetition is so easily confused with stasis, with inertia. But after my son was born, I learned that obsession is another way of paying attention.

In early modernity, women were the keepers of this obsessive temporality of attention, of the current of time that flows beneath event, beneath change. Women meditated on Christ’s Passion, following its stages in prayers that drew power from their own physical suffering. They reenacted it every year. They entered into mystical marriages with Christ, took him as their lover, spent night after night with him; they wove in and out of prayer, in and out of mystic and ecstatic states, when time was suspended and sensation broke over them in intense waves. Even ordinary women who never laid claim to mystical experience uttered prayers again and again, throughout the day, for their entire adult lives. When Jane Gilbert died in 1639 her funeral sermon memorialized her: “Witnesse Her every Dayes taske, which was to say by Heart, and in her Heart, the eight chapter to the Romans.”

I had been afraid of a time that does not move relentlessly forward. Repetition is so easily confused with stasis, with inertia. But after my son was born, I learned that obsession is another way of paying attention. To relive the hours of labor, or of Christ’s Passion, or mystical union, or just prayer, is to pay attention to pain; to try to understand pain, to attempt to make meaning from it. I see now that there was little difference between attentiveness and presence. This form of attention required my silence, but the silence wasn’t forever. After the final repetition, a year after my son’s birth, I stopped reliving those hours and haven’t relived them since. I found that I wanted to write but never in the same way again. I wanted to find a way to write that flowed from the body and that moved to dif­ferent patterns of time.

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Before forceps were publicized in the early eighteenth century, a midwife presented with an irredeemably obstructed birth would insert a hook into the fetus’s skull to pull it out, or dismember it and remove its body in pieces. The fetus would, obviously, die, but the laboring woman might survive. The oaths that women swore in labor were concerned with this problem of parting one body from another. They begged God to “make a way out”; “it seemeth that thou for my sins hast shut up the doors of my womb,” one prayerbook reads, “and caused the babe to stand still like to be stifled.” The terror was that “the child and I will never part.” Only around 2 percent of births in seventeenth-century England were stillborn due to obstruction. But it was the fear that mattered, not the odds.

When my son had to be delivered by forceps, I saw the curved purple bruises on his cheeks as an accusation. The parting hadn’t worked out, and I was sure it was my fault. I tried to relieve my guilt by reminding myself to be grateful for modern medicine, at least he wasn’t removed with a crochet hook, but forceps aren’t modern. Nor do they feel modern. They feel like exactly what they are: an invention of eighteenth-century male practitioners’ metallic devotion to reason and elegance in all things. I had spent years in the archives trying to gain some intellectual intimacy with the past, and there I was: being penetrated by the Enlightenment. “What do you do?” a midwife asked as she helped me to the bathroom. We were in the postnatal ward for people who had difficult or complex births. “I’m a historian of…all this,” I answered, and gestured vaguely around at the ward. It sounded improbable, faintly ridiculous, that any of this should even have a history, never mind that someone like me, bleeding and dazed, should be a custodian of that history. This ward for broken women was so entirely of the present; time seemed to cease at its threshold. Curtains were drawn between us, but that did not stop me from overhearing their phone conversations with their partners and friends, as they tried to explain what had happened to them, that is: the inexplicable. His head is as big as a tangerine, one woman said over and over again. In a voice filled with wonder. I told the midwife that everything hurt, and she gave me two paracetamol in a tiny white paper cup.

Elizabeth, Countess of Bridgewater, wrote her own book of poems in the mid-seventeenth century. One, for a labor that stopped and started, read: “O Lord hear, O Lord forgive, and suffer me not to accompany my sins in the deep, but part us, and make me become a new creature.” I liked this prayer because I could recognize in it some truth: The fear of childbirth is not only a fear of dying, but a fear of what, who, you will be, if you actually live through it. To part one body from another and so to become new: at once the desire and the fear of a laboring woman, between the waves of pain. Do not allow me to follow the past into the deep. Do not allow the sins of the past to overwhelm, to drown the present. Make me new.

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Here is one way to tell the history of midwifery: Between the sixteenth and the eighteenth century, the practice of midwifery transformed. At the beginning of the period, midwives were women; by the end, male midwives were relatively common, especially in cities like Paris and London. Historians have seen this transformation in the gendered practice of midwifery as the crux of a set of related changes: the introduction of anatomical drawing into midwifery manuals; the increased acceptance and practice of intervention, both manual and instrumental, in delivery; the professionalization of midwifery from a relatively informal apprenticeship system to a discipline taught in medical schools, lecture tours, textbooks.

Here is another way: Once, when a woman went into labor, her husband would go out knocking. He would gather the women: the midwife, and her assistants; his wife’s friends, neighbors, her sisters and cousins and aunts. In East Anglia, the summoning had a special word: nidgeting. Ralph Josselin remembered in his diary that when his wife went into labor in 1645, “oppressed with fears that she should not do well on this child,” he rose at midnight; tracked down his horse, out of the pasture; there wasn’t much rain; got the midwife; “called in the women by daylight, almost all came.” The midwife came, cloaked in red. She would carry on her back a simple stool: with three or four legs; with an opening cut from the seat; with handholds, held in the white knuckles of dozens of women before. Throughout premodern Europe, this is how she was known, the figure in the cloak with a stool on her back, walking to houses at all hours, day and night. She would come with a jar of oil of almond, or oil of white lilies, to anoint her hands. The touching was critical. Louise Bourgeois, the famed French midwife, wrote in 1626: “The midwife may touch gently, to see if the womb is tightly shut, like a hen’s rear into which one could not introduce as much as a grain of wheat.”

The women would gather in the bedroom, now made over into a birthing chamber and free of men. Keyholes were blocked up. Heavy curtains lined the bed, the windows. Candles burned and burned. The women prepared special drinks, wine heavily spiced and sugared. The midwife would feed the mother, keep her warm, help her find a good position: on the stool, or kneeling, or standing up, or leaning in the lap of an assistant. The midwife would “help her to use her labor pains to bring everything to a happy conclusion.” Elizabeth Josselin gave birth to a daughter named Jane at eleven or twelve o’clock the next morning, and, Ralph writes, “we had made a good pasty for this hour.”

By the eighteenth century, this centuries-old practice had changed. Particularly in the cities, one was as likely to see a male midwife carrying a bag of “clashing” metal instruments as a female midwife with a chair on her back, walking the streets at midnight. Even the stool on her back changed: became taller, straighter, more like a chair, so that birth attendants might have a better view but a woman labored less comfortably; she couldn’t brace as easily. There were still the women attendants, there were still candles and curtains, but the drama of the birthing chamber was now focused on the male midwife: the prospect of him coming, in the case of a difficult birth; his presence, with his “irons.” Middle- and upper-class women began to pre-book male midwives.

The interpretation of these transformations in midwifery and its imagery have been fiercely contested. The earliest historians of midwifery argued that this was a progressive story of the triumph of expertise and science and reason over the superstitions and backward practices of untrained female midwives. In the 1960s and 70s, feminist historians viewed these transformations instead as the loss of female authority at the hands of unsafe, overly interventionist male practitioners; female midwives were not permitted to use instruments. More recently, historians have suggested that men did encroach on midwifery practices, but much earlier than the early modern period; and that female midwives still undertook the vast majority of maternity care well into the Enlightenment.

The fear of childbirth is not only a fear of dying, but a fear of what, who, you will be, if you actually live through it.

Two spheres of midwifery practice emerged across the late seventeenth and eighteenth centuries: regular and emergency midwifery. Regular midwives were primarily women, trained as apprentices but not institutionally educated. They attended normal labors, were embedded in their communities, and provided both pre- and post-natal care. Emergency midwives were normally men who trained in medical schools, learned theoretical midwifery and anatomy from books, and were called in by regular midwives to attend complicated labors that required intervention. The gendered division of midwifery practice was not hard and fast, some men were regular midwives, some women attended emergency deliveries, and women authored important midwifery manuals, too, but across the eighteenth century, the gap between regular and emergency midwifery widened. This is the longer history of a division between “medicalized” and “natural” childbirth that has deepened in the present; it is a gap that I traversed on a hospital trolley. At the hospital where I gave birth to my son, the distance between regular and emergency midwifery is as wide as a hallway. When things go wrong, they roll you across the hall from the electric-candlelit midwifery suites into the bright whiteness of the obstetrician-led ward.

Transformations in midwifery practice coalesced around the problem of whether it was possible to practice upon the interior of the laboring body. By visualizing that dark interior, images of fetuses in the womb, getting ready to be born, assumed a critical place in these debates. The figures of fetal presentations from the sixteenth century are odd, charming things. They show male, curly-haired toddler-fetuses doing joyful acrobatics in the womb: floating, leaping, flying around in there; smiling, fat, joyful two-year-olds that appear ready to dive effortlessly through the birth canal into the outside world. These healthy children were an argument for a midwife’s skills. They allayed the fear that the child might come out speared on a hook, or come out a girl.

In the sixteenth and early seventeenth centuries, literacy rates were high among midwives. They owned manuals that contained birth figures and formed part of their professionalization. Elizabeth Hunt inscribed her midwifery manual: “Elizabeth Hunt her Booke not his.” Another wrote in her copy of The English Midwife Enlarged: “Mary Hillyer her book / god give her grace ther / unto look but not to look but / to understand larn [learning] is beter / then house or land.” Mary asked that God would grant her understanding and learning from studying her midwifery book, and that he would show her that such learning was more valuable than worldly riches. The woodcut birth figures contained in these books were not images drawn from observation, pregnant cadavers for anatomical drawing were hard to come by, but were instead abstracted diagrams of the chaotic diversity of laboring bodies. They invited midwives to imagine the interior, and so to imagine practicing upon it.

Midwives were used to taking care of mothers, offering medicines, catching babies, cutting cords, washing and swaddling. Now, armed with images of what was happening inside, they could attempt to turn breech babies; could alter how nature or God had arranged them. One German midwife was caustic about her colleagues who refused to intervene: “There are some midwives who do not think about what they are doing,” she wrote, “and know no more and wish to know no more than how to receive a child when it falls into their hands and how to cut the navel string. They do not concern themselves with anything more, even violently dispute the possibility that a midwife can do anything more, because it is hidden from them.” Here and there, midwives were beginning to imagine what had been hidden, and to deliver babies alive who would have otherwise had to come out in pieces.

In the early Enlightenment, new sets of birth images came into fashion. Authors of midwifery manuals and their illustrators didn’t simply copy the same old fifteenth-century German woodcuts, but produced new images using new observational techniques: Philippe Peu used “some small puppets” that he kept at his house to demonstrate fetal positioning to his draughtsman. Copperplate engraving permitted more detail. Birth figures came to reflect real cases that midwife-authors had attended, not theoretical possibilities. Justine Siegemund, a German midwife who learned her practice by studying books, was often asked to consult on complex labors. In her own midwifery manual, she detailed a severely impacted arm presentation and commissioned illustrations that represented exactly how she had managed, by removing its arm, to deliver the child.

In these later seventeenth-century birth figures, which depict the interventions of hands and arms and rods and string, wombs are no longer playrooms for acrobatic toddlers. Instead the reader of midwifery manuals is confronted with the close, contracting force of the body in labor; and they show, too, the incredible skill required to work with birth tools in the small and dynamic space of the womb. There were new details, like placentas, and membranes, and buttocks, that lent a new reality effect to the images. Fetuses got serious about the work of being born: their smiles were replaced with grave little faces, sometimes turned away from the viewer or hidden behind tight fists. Birth figures showed what might be accomplished by a skilled midwife, and the impossibility, for most, of ever accomplishing it.

Male midwives attempted to resolve this tension with their perfectly androgynous hands. In Hendrik van Deventer’s New Improvements in the Art of Midwifery, his illustrator demonstrated how a male midwife might insert his hand in order to feel the shape or tilt of the womb; in Cosme Viardel’s Observations on the Practice of Natural, Unnatural, and Monstrous Deliveries, he showed the delicate, highly skilled contortions and tractions that might be performed with the hands to safely deliver a breech birth. According to van Deventer’s manual, the ideal male midwife had “slender Hands, long Fingers, and quick Feeling.” His arms were unnaturally bendy, his fingers freakishly jointed; the muscles of his forearm rippled with the strain of controlled effort. The midwife’s hand was a gender-bending invention of the Enlightenment, combining the intelligence and strength of a man’s touch with the sensitive delicacy of a woman’s. This androgynous hand made a visual argument that the fetus would be delivered alive, and the woman would feel little pain. In one engraving from van Deventer’s manual, his arm is shown inserted into an empty uterus almost up to the elbow, the engraver’s close, texturing lines transforming his hand into a radiating light within a cavernous female darkness.

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From Presence: A Hidden History of the Female Body by Erin Maglaque. Copyright © 2026. Available from Astra House.