Lying-in and laying-out: fetal health and the contribution of midwifery.
This article considers the quality of midwifery skills and practice principally in eighteenth-, nineteenth-, and early twentieth-century England. It discusses the merits of assessing effectiveness via differentials and changes in late-fetal rather than maternal mortality. Evidence from the lying-in hospitals, both in-patients and out-patients, in terms of stillbirths and the deaths of mothers and children is set against what is known from demographic studies of the background levels of early-age and maternal mortality. The conclusions emphasize the value of taking a "fetal health" perspective, rather than viewing midwifery simply in terms of maternal well-being. They also note the apparent superiority of London's position compared with the provinces and the steady improvement during the eighteenth century, and lack of progress during the nineteenth; and they reconfirm the particular dangers to mothers delivered as hospital in-patients. Finally, the considerable methodological problems faced by such studies are emphasized.
Woods
Robert
R
university of Liverpool, Department of Geography, Roxby building, Liverpool L693BX, United Kingdom. riwoods@liv.ac.uk
D005260:Female; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D006760:Hospitalization; D006771:Hospitals, Maternity / Q000266:history; D006801:Humans; D007086:Illegitimacy / Q000266:history; D007231:Infant, Newborn; D008880:Midwifery / Q000266:history* / Q000592:standards; D009026:Mortality / Q000266:history*; D009774:Obstetrics / Q000266:history* / Q000592:standards; D011247:Pregnancy; D012307:Risk Factors; D050497:Stillbirth; D006113:United Kingdom / Q000453:epidemiology