The voluntary maternity hospital : a social history of provincial institutions with special reference to maternal mortality, 1860-1930
From an historical perspective, the maternity hospital has borne criticism in two major respects. Firstly it has been argued that the voluntary maternity hospital played a negligible, even harmful role in delivering women in childbirth and therefore cannot be regarded as having a positive influence on maternal mortality. Secondly, but not unrelated, is the widely held assumption that the maternity hospital was little more than an instrument of male medicalisation responsible for subordinating midwives and their patients to medical authority. Drawing evidence from hospital records (Board minutes, registers and annual reports) relating to Manchester, Liverpool, Sheffield, Birmingham and Newcastle, the thesis challenges both points of view. Using Manchester as a principal case study, it has been found that the city's two maternity hospitals, conducting both ward and home confinements, played a far more demographically significant role than previous estimates have allowed. By adopting those factors considered crucial determinants of low maternal mortality, 'free', 'accessible' care of 'a high standard', administered by a 'careful midwife' and a 'skilled doctor', the hospital's potential to influence local maternal mortality rates was formidable. The Manchester material is again used in the medicalisation debates, but much more relevant to this discussion are the findings at the Liverpool Maternity Hospital. Managed by the Ladies Committee, practices at the hospital refute the opinion that, women managing women's affairs, was to the greater good of their gender simply because they shared 'the same biological experience of femaleness ...'. Class interest also accounted for the women's involvement and the way they exercised their influence. The Liverpool material also provides, along with material from other provincial maternity hospitals, a detailed explanation of the medicalisation process so far as it effected maternity hospitals. It is only from the 1920s that the medicalisation of the institutions begin to have a detrimental effect on the confinement of women, but as the conclusions indicate, there was more to the maternity hospital by this date than forceps and sutures.