Nathalie Sage Pranchere (Paris-Sorbonne University)
Midwives’ and Medical Students’ Clinical Obstetric Training in Nineteenth-Century France
Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014
This paper intends to shed some light on the forms of midwives’ and medical students’ clinical obstetric training in nineteenth-century France, along with the evolution of clinical resources and the specific expectations of both professions. It will also highlight the strong imbalance between doctors and midwives, in favour of the latter, caused by the difference of availability and quality in training, and the slow constitution of a quality clinical training for physicians.
Therefore, this paper seeks to challenge the usual interpretation of the masculine preeminence in the medical field gained through the control of clinical training. In the last quarter of the eighteenth century, as the European states decided to train midwives on a large scale, the practical dimension of training became a problem. Three dimensional anatomical representations (ceramics or waxes), prepared and articulated bones or mannequins provided in this period and throughout the nineteenth century an alternative and / or a complement to clinical training. The Office des Accouchées of the Paris Hôtel-Dieu became the model for every European midwives’ school based in lying-in hospitals (such as Strasbourg, Turin or the Accouchierhaus of Göttingen).
As this institution became the School of the Hospice de la Maternité of Paris in 1802, it strengthened the choice of clinical primacy and inspired the chapter dealing with midwifery matters of the law of 10 march 1803 reforming medical education. Training midwives had to take place from then on in lying-in hospitals. The time dedicated to clinical training in the global course of midwives’ education became one of the most important evaluation criteria and this evolution reveals both the progressive definition of educational methods based on gesture’s repetition and quantified observation, and the increasing demands of qualification. Meanwhile, during the main part of the nineteenth century, medical students had access only to theoretical lessons in obstetrics and weren’t allowed for clinical training in lying-in hospitals. Those were exclusively reserved to midwives-to-be. The exclusion was based on moral criteria but resulted more of the political preference given to the training of midwives, more likely to fulfill the political expectations of a wide supervision of birth.
A first evolution occurred in 1834 with the opening in Paris of the Hôpital des cliniques. This hospital was part of the medical faculty and became quickly fully dedicated to clinical obstetric training. Nevertheless, it wasn’t until the 1860s that the physician’s clinical obstetric training really improved on a national scale. In the meantime, medical students had to rely on midwives’ goodwill who allowed them to observe the deliveries they performed in return for payment. This paper will use the archives of several midwifery schools, those of the Hôpital des cliniques and Baudelocque hospital, as well as those of the chair of obstetric clinic of the Faculty of medicine of Paris.