Midwives

8th Mar 20217th Mar 2021

Choosing to Challenge

The theme of International Women’s Day 2021 is #ChooseToChallenge so today we are highlighting the stories of women we have researched and written about during the course of our Born in Birmingham project over the last couple of years. Some of them were well-known in their field or still remembered here in Birmingham; others have been long forgotten or only remembered by their families. But all of them in their own way chose to challenge the role of women and what may have been expected from them, and in so doing helped pave the way for those who followed in their footsteps.

We’ve featured several women from the medical professions which is not surprising given part of our research has been into maternity services in Birmingham during the 1914-1924 period. These included the stories of two contrasting midwives : Hannah Armishaw, an old school midwife with little or no formal training who was allowed to join the new Central Register of Midwives in 1904 on the basis of, what we would now call, her accredited prior learning having been in practice for a number of years; and Lizzie Keeping, one of the new breed of qualified midwives who had qualifications in nursing and midwifery and moved to Birmingham to further a career. She lived in Balsall Heath for many years with Claire Bement, an Inspector of midwives. Just good friends and colleagues? Or were they choosing to challenge in other ways too?

Dame Hilda Lloyd is remembered for her pioneering work in the field of obstetrics, including establishing Birmingham’s first emergency obstetrical service: the flying squad. Much of her career has been well-documented as she climbed the medical ladder; becoming a lecturer in 1934, professor in 1944 (the first female to achieve a professorship at UoB), and chair of Obstetrics and Gynaecology in 1946. She received national recognition in 1949 when she was elected as the first female President of a Royal Medical College at the Royal College of Obstetricians and Gynaecologists (RCOG) serving a three year term. In 1951 she was knighted Dame of the British Empire ‘for her services to her Speciality, College and her University’. Our blog covers some of her lesser known activities in promoting family planning services against much opposition so definitely choosing to challenge!

Several of our volunteer researchers concentrated on infant welfare including the establishment and expansion of Infant Welfare Centres and the role of health visitors.

Profile of an Infant Welfare Lady Superintendent looked at the life and career of Miriam Shewell, a Quaker from Yorkshire who after training as a nurse and midwife was appointed Lady Superintendent of Sparkhill and Greet Maternity and Infant Welfare Centre in 1919. She involved local women in decision making at the Centre, recognising their localised knowledge and experiences. She was well respected in her field and wrote a series of standardised health talks used in welfare centres nationwide.

The Carnegie Infant Welfare Centre was opened in 1923 and considered a centre of excellence. Its first matron was Elizabeth Exell who during WW1 had been a nursing sister with the Women’s Hospital Corps, established by former militant suffragists Flora Murray and Louisa Garrett Anderson. The WHC established two women-run military hospitals in France: the first in Claridge’s Hotel in Paris with the support of the French Red Cross and the second in Wimereux near Boulogne which was sanctioned by the British War Office. Elizabeth continued work with the WHC back in London at the Endell Street Hospital from 1917 before moving to Birmingham to take up work at Pype Hayes Convalescent Hospital and thence to the Carnegie.

The newly established role of infant health visitor was crucial to the tackling high rates of infant mortality in the City alongside that of the IWCs. Their Superintendent Blanche Gardiner in 1914 oversaw the work of responsible for 19 Health Visitors, 5 Infant Health Visitors, 10 TB Visitors, 1 Inspector of Midwives and 2 Inspectors under the Factory and Workshop Act. By 1924 her role focused entirely on maternity and child welfare and she had responsibility for 61 Health Visitors and Infant Health Visitors who dealt only with infants or still births occurring outside the Infant Welfare Centre boundaries.

This highlights just a few of the women in Birmingham who deserve commemoration as “Choosing to Challenge” on International Women’s Day. Each in their own way helped provide crucial maternity and infant welfare services to hundreds of women and were pioneers in their fields, constantly challenging the status quo and seeking improvements in the way services were developed and delivered. #ChoosetoChallenge

Liz Palmer

Project Co-ordinator

15th Apr 2020

Profile of an Infant Welfare Lady Superintendent

MS 4101 Greet & Sparkhill IWC Annual Report 1917 Cover — Sparkhill and Greet Maternity and Infant Welfare Centre Annual Report 1918 [MS4101]

Our researchers have been investigating many individuals who played their part in maternity services. Born in Birmingham project volunteer Laurie, sheds light on the fascinating story of Miriam Shewell.

Miriam Shewell, born 11 September 1875¹, she was the eldest of 10 children of Caroline and Joseph Shewell, an iron bridge manufacturer who, at 34, employed 40 men and 6 boys. The family lived in Hurworth, Durham, with a general servant and nursemaid².

Miriam and her three younger sisters were sent to Ackworth School in Yorkshire³, which was a Quaker boarding school.

In May 1903, Miriam obtained a midwifery qualification from the London Obstetrical Society and in the following year she was enrolled at no.615 on the Midwives Roll ⁴.

In 1911, a visitor in Cheshire on census night, Miriam’s occupation was described a ‘Monthly Nurse’ ⁵.


Interior of a maternity ward (1913) Wellcome Collection {25/01 552273i}

From Bristol Settlement, Miriam was appointed as the third Lady Superintendent of Sparkhill and Greet Maternity and Infant Welfare Centre, and took up her duties in February 1919 ⁶. The Centre had opened in April 1916 and the first Superintendent left after 18 months to get married, while the second stayed barely 12 months. Miriam seems to have provided a much-needed period of stability in the management of the Centre and her work is mentioned several times in local newspapers.

In 1920, Greet Centre Committee took the unusual step of asking a small group of mothers they knew well, to join the Workers’ Committee and to help in the work of the centre. Miriam Shewell said “They know all about their own districts in a way we could never know it, and understand the superstitions and difficulties and tiresomenesses in their own streets. We find them full of common sense and splendid suggestions.” ⁷

During Baby Week 1923, Miriam produced a propaganda play ‘Danger Ahead’ in which she played a grandma offering advice to a young couple on the dubious basis of “’aving ‘ad 9 and buried 8!” ⁸

The same article reports that Miss Shewell had been asked to write a series of standardised health talks to be used in welfare centres nationwide. In the following year’s Baby Week programme, the paper reported that the ‘ever-enterprising’ Greet Centre proposed baby-bathing demonstrations in small relays by a nurse, and Miriam invited mothers to volunteer their babies, promising that no baby would be bathed more than once! ⁹

Miriam Shewell lived in College Road, Moseley when she first arrived in Birmingham and later moved to Tetley Road. By 1925, her youngest sister had joined her (10) and in 1939 they lived in Hall Green where Miriam is described as Retired Infant Welfare Superintendent.

She lived there until her death aged 74, on 6 August 1950. (11)

Laurie Spencer

1 1939 England and Wales Register Ancestry
2 England Census 1881 Ancestry
3 England Census 1891 Ancestry
4 Midwives Roll 1931 Ancestry
5 England Census 1911 Ancestry
6 Sparkhill and Greet Maternity and Infant Welfare Centre Annual Report 1918 Birmingham Archives MS4101
7 Birmingham Daily Gazette 5 March 1920 British Newspaper Archive
8 Birmingham Daily Gazette 4 July 1923 British Newspaper Archive
9 Birmingham Daily Gazette 1 July 1924 British Newspaper Archive
10 Electoral Register 1925 Ancestry
11 England and Wales National Probate Calendar Ancestry

13th Apr 202013th Apr 2020

Two contrasting midwives

Following on from last week’s blog by Maggie about the changing role of midwives during the 1914-24 period here she looks at the lives of two midwives of the period.

Kelly’s directories found in the Library of Birmingham covering the period we are examining gives listings of all the Midwives who were permitted to practice in Birmingham year by year and can be used with the information on the Central Midwives Register and other genealogical records to trace the lives and career of some of these women who often remained in practice in Birmingham for many years.

Firstly a quick look at one of the old school – Hannah ARMISHAW.

The Central Midwives Register provides name and address of the women but also details when the midwife was enrolled on the register – and also the qualification they held. And other genealogical sources such as the 1911 Census can give us information about age and family circumstances.

The CMB Register for 1915 shows Hannah living at 77 Victoria Road Harborne and gives us the additional information that she was first registered in 24 November 1904 and her qualification was that she had been in practice prior to July 1901. The symbol before her name means that she had indicated to the Board that she intended to practice during 1915. Further searches in the annual Registers show that she was listed from 1905 until 1926.

From the 1911 census we can find Hannah Armishaw living with her husband William Illsley Armishaw, an Army Pensioner. Hannah was 61 years old – and according to the CMB Registers was to practise for a further 15 years until the age of 76! The census enumerator has added in red ink the word ‘Certificated’ next to her self-recorded occupation of midwife. The census also reveals that she was no stranger to childbirth herself having given birth to fourteen children of whom 12 were still living. Three of her daughters were still living at home – all working in the chocolate business (no doubt at nearby Cadbury factory at Bournville).

We have been lucky to discover that a descendant of Hannah ARMISHAW has posted this wonderful family image of the ARMISHAW family online – and very pleased to have been granted permission to use it. It is one of the only images we have found locally of a midwife in uniform.

In contrast, Lizzie Keeping was one of the new breed of qualified midwives.

Unlike Hannah Lizzie was not a local girl and appears to have moved in pursuit of her career. She was born in Reading in 1866 and the 1901 census shows her working as a staff nurse at Brentford Union Workhouse Infirmary Isleworth Middlesex. She was on the UK and Ireland Nursing Register from 1902 registration number 295.

Lizzie obtained her midwife qualification from the London Obstetrical Society in July 1903 and enrolled on the Midwives Roll on 24/11/1904 registration number 9472 whilst working at Lambeth Workhouse Infirmary.

Sometime prior to 1910 she moved to Birmingham – to Mary Street, Balsall Heath and practised from that address for a quarter of a century.

The 1911 census shows her living at 262 Mary Street Balsall Heath Birmingham with her occupation listed as trained nurse and midwife. Also in the house were her sister in law and children and also listed as Joint head of the household a Clare Bement, described as Trained Nurse & Midwife acting as Inspector of Midwives at City Health Department. Both of these women lived together on Mary Street until Clare’s death in 1938 and appear to have been working as midwives till this date. Both would have been in their late 60s.

Following Clare’s death Lizzie Keeping left Balsall Heath and retired to Devon – to Whitpot Mill, Kingskerswell, where she died aged 76 on 27/01/1942 leaving effects worth £1825.

Maggie Brownlie

6th Apr 2020

Midwives in Birmingham 1914-24

A key topic in our project has of course been Midwives. Here project volunteer Maggie outlines the impact of the Midwives Acts on the increasing professionalisation of midwifery in Birmingham.

100 Years ago the majority of Births in Birmingham took place in the home with the assistance of a local Midwife. The Midwives who were working at that time had little training unless they had been formally working as nurses and many were untrained, known as a local handywomen “the woman you called for “ when your baby was coming. She would often be involved in helping the sick and the dying and sometimes would offer home help service washing and assisting with childcare

The period we are looking at,1914-1924, was a period of much change in Midwifery and maternity . There was much worry over paying for health care . Childbirth was not seen as a medical process and in working class areas doctors were rarely called except in severe emergencies as people could not afford to pay the fees.

“the work of a busy midwife is very hard, holidays and off duty times are difﬁcult to secure the responsibility is exceptionally grave, the remuneration comparatively small. Midwifery, more than any other branch of nursing, unquestionably taxes to the utmost professional skill and judgment, physical capacity and endurance, patience and sympathy.” From { Dr Janet Campbell Senior Medical ofﬁcer at The Ministry of Health through throughout the 1920’s in a report on the Physical welfare of mothers and Children in England and Wales 1923}

Midwives Bag - Image Science Museum — Midwifery bag complete with contents, bag by Arnold and Sons, London, 1925-1955. Science Museum

The ﬁrst Midwives act of 1902 was an Act to secure the better training of Midwives and to regulate their practice and introduced the Central Midwives board {CMB} The board formulated restrictive practice requirements , a supervisory requirement and a disciplinary system which were apparently designed to make it impossible for working class midwives to continue practising . Midwives who had a recognised qualiﬁcation in Midwifery either from The London Obstetrical Society or from certain lying in hospitals could apply to enrol on the register of qualiﬁed midwives . There were several training centres for midwives in Birmingham:

Birmingham Aston Union Workhouse Gravelly Hill
Birmingham Union Inﬁrmary at Selly Oak;
Birmingham Maternity Hospital Loveday Street
Birmingham Workhouse inﬁrmary Dudley Road

The 1902 Midwives Act which came into operation on 1st April 1903 required newly registered Midwives to undertake 3 months training which was increased to 6 months in 1916 and subsequently to 12 months by 1926.

Women who had been in practice for at least 12 months and who could show they were of good character { usually by a reference from a clergyman} could also apply . They were known as bona ﬁdes . Any other women who wished to take up the practice of Midwifery had to pass an examination in competence to obtain a certiﬁcate . In order to be admitted on the Midwife Roll candidates had to satisfy the Central Midwives Board the they had reached

A sufﬁcient standard of general Education
A birth certiﬁcate showing the candidate is not under 21
Certiﬁcate to the effect that the candidate had undergone training
A certiﬁcate of good moral character
Must pass an examination

From 1905 only women certiﬁed under the Act would be entitled to use the title of “Midwife” and to recover any fee for attendance as a midwife .

Certified Midwife Badge c.1918 — Early Badge for Certified Midwife

Training

The cost of the training which usually took place away from home. The use of medical latin in the examination would have been prohibitive to many working class women . A pupil midwife would attend and watch the progress of no less than 20 labours including making abdominal and vaginal examinations and delivering the baby. She would be required to nurse 20 lying in women during the 10 days following labour. (lying in is an old child birth term involving a woman resting in bed for a period after giving birth) She would have to attend a course of instruction which should be no less than 3 months with an oral practical and written examination .

The course included :

elementary anatomy of the female pelvis pregnancy and its complications including abortion

the symptoms mechanism course and management of natural labour

the signs of of abnormal labour

haemorrhage treatment

use of a clinical thermometer and catheter antiseptics- the way to prepare and use them

management of the puerperal patient ( the period of around 6 weeks after childbirth when the mother’s reproductive organs return to their non pregnant condition.
management (including feeding) of infants and the signs of important diseases which may develop with the ﬁrst 10 days after birth.
Obstetric emergencies and how to deal with them until a doctor arrives ( to include the knowledge of drugs needed in such cases
House sanitation & disinfection of the person their clothing and appliances

Midwives were subject to regulation concerning equipment and clothing and it was noted back in 1905 in the Journal of Midwives that the cost then of required equipment and a lined midwifery bag would be one guinea – prohibitive to many handywomen who were so often paid in kind .

Rules affecting Midwives

The rules laid down in the Midwives act were enforced by strict supervision undertaken by often local dignitaries many of whom were not trained in midwifery or nursing and the midwives had their homes investigated which was intrusive. After 1910 no person could “habitually and for gain “ attend a woman in childbirth except under the direction of a doctor. Any woman acting without being certiﬁed was liable on summary conviction to a ﬁne not exceeding £10. County boroughs were to be the local supervising authority over midwives within the area. they were to provide general supervision, investigate charges of malpractice negligence or misconduct and report to the CMB . They were also responsible for suspending any midwife from practice in accordance with the rules under the act During the month of January each year the supervising authority would supply the CMB with the names and addresses of all midwives who, during the preceding year, had notiﬁed their intention to practice in the area .The requirement was that every woman certiﬁed under the act would give notice in writing of her intention to practice . If any woman omits to give the said notice shall by summary conviction be ﬁned up to £5. The penalty for obtaining a certiﬁcate by false representation was a misdemeanour and the woman would be liable to imprisonment with or without hard labour for a term not exceeding 12 months.

Increasing professionalisation of midwives

The Medical Officer of Health Reports for Birmingham provide many statistics relating to the employment of midwives in Birmingham and can be used to show the impact of the Midwives Act over our period of study.

In 1914 253 midwives were registered to practise. 174 were admitted by reason of their having been bona ﬁde prior to the passing of the Midwives Act (1902) and the remaining 79 held recognised certiﬁcates of training in Midwifery. They attended 15,664 births during the year which was almost 70% of the total number of recorded births in Birmingham. .

16 attended over 200 births but most attended around 50 births each.

The reports also give details of suspensions and actions taken against midwives who did not comply with desired practice. In this year alone 62 midwives were suspended for poor practise. 53 for cases involving puerperal fever and 5 for cases of Pemphigus Neonatorum (see glossary)

Ten years later the proportion of certiﬁed to uncertiﬁed midwives had greatly increased. In 1924 here were 231 midwives of whom 170 were certiﬁed and 61 were bona ﬁde. Between them they attended 11459 births – 62 % of the total.

The reports also reveal the pay which depended on the status of the midwife:

Bona ﬁde midwives earned about £16 per year while trained midwives could command higher fees and earned £42 per year. In our next blog we will look at two different Birmngham midwives.

Maggie Brownlie

30th Jan 202023rd Mar 2020

“Born in Birmingham 1914-24” Talk at the Gunmakers Arms on Tuesday 4th February 2020

What was life like if you were born in Birmingham 1914 -24? Join our NHLF research volunteers for an informal talk which will shed light on this topic.

7.00pm on Tuesday 4^th February 2020, at the Gunmakers Arms, 93 Bath Street, Birmingham, B4 6HG.

Booking is essential via Eventbrite: https://www.eventbrite.co.uk/e/born-in-birmingham-1914-to-1924-maternity-midwives-and-infant-welfare-tickets-84803338067

18th Sep 201918th Sep 2019

Tracing Brummie Midwives

100 years ago the majority of births took place at home – with the assistance of a local midwife. Concern over the competency of many untrained midwives the 1902 Midwives Act aimed to regulate the profession by requiring certification of midwives and fines for anyone practising without certification. In addition the Act established the Central Midwives Board to regulate the training courses and to maintain the register of certified midwives.

Useful sources for tracing midwives and their careers are the Central Midwives Register (available to view on Ancestry) combined with local trade directories. The 1913 Kelly’s Directory of Birmingham lists nearly 200 registered midwives and gives their home addresses. It should be remembered that most midwives were effectively self-employed at this time and only relatively few worked in the local Maternity Hospitals. Hence the need to be listed in such directories. The Central Midwives Register provides name and address of the women but also details when the midwife was enrolled on the register – and also the qualification they held. And other genealogical sources such as the 1911 Census can give us information about age and family circumstances.

Thus from the 1913 Directory we can see that a Mrs Hannah Armishaw was a registered midwife living at 77 Victoria Road, Harborne.

m0525-01062 reduced — Extract from 1913 Kelly’s Directory of Birmingham showing list of Registered Midwives

The Central Midwives Board Register for 1915 confirms this address and gives us the additional information that she was first registered in 24 November 1904 and her qualification was that she had been in practice prior to July 1901. The blurb at the start of the Register suggests that at this date about half of registered midwives had undergone training and passed the Examination of the Central Midwives Board and the other half, as with Hannah Armishaw, were registered on the basis of their prior experience. The symbol before her name means that she had indicated to the Board that she intended to practice during 1915. Further searches in the annual Registers show that she was listed from 1905 until 1926.

Armishaw CMB Register 1915 — 1915 Central Midwives Board Register

Turning to the 1911 census we can find Hannah Armishaw at the same address living with her husband William Illsley Armishaw, an Army Pensioner. Hannah was 61 years old – and according to the CMB Registers was to practise for a further 15 years until the age of 76! The census enumerator has added in red ink the word ‘Certificated’ next to her self-recorded occupation of midwife. The census also reveals that she was no stranger to childbirth herself having given birth to fourteen children of whom 12 were still living. Three of her daughters were still living at home – all working in the chocolate business (no doubt at nearby Cadbury factory at Bournville)

Extract from 1911 Census showing Hannah Armishaw, midwife

We are hopeful that during the project at least one volunteer will be interested in examining the records such as these in more detail to give us a better understanding of who these early registered midwives were, how long they stayed in the profession and the proportions of them that had passed the relatively new qualifications. Newspaper searches may discover stories related to some of the midwives especially if any were struck off for practising whilst unregistered or were involved in cases of malpractice.

Come along to our project launch on Saturday 21st September at the Library of Birmingham to find out more about the archival records we will be using during the project – and how you can get involved.

Liz Palmer, Project Co-ordinator