Mrs Blood, Dr Crook, Mrs Killer and Mrs Tipler – which would you choose to be your birth attendant?

These people all practised in Derbyshire early in the twentieth century. Dr Crook was a male GP, Frances Killer was a qualified, trained midwife, and Elizabeth Tipler was a ‘bona fide’ midwife – she had no training but was registered, and had some experience. Mrs Blood was one of a diminishing band of uncertified, untrained ‘handywomen’ who delivered babies and helped afterwards. Which had the best outcomes, for the mothers and babies they cared for? The answer is surprising and may also help explain why birth outcomes did not improve much at first after midwifery became a regulated profession in 1902.

Mrs Killer and Dr Crook: Birth Attendants and Birth Outcomes in Early Twentieth-century Derbyshire looks at birth outcomes using data from Derbyshire between 1917 and 1922, and works out that the qualified midwives – Mrs Killer and her colleagues – had the best outcomes, followed by bona fide midwives, with doctors last – with higher rates of stillbirths, and neonatal and maternal deaths. The difference cannot be explained by the probable tendency to call doctors to more difficult deliveries.

After 1902, when the Midwives Act came into force, more midwives were trained and nearly all had some supervision – but the main outcomes did not appear to improve for perhaps 30 years. This intriguing article suggests that there could, in fact, have been improvements in midwifery care by trained and bona fide midwives, but that doctors were called into an increasing number of deliveries, raising the risk of infection and intervention.

Mrs Killer and her trained colleagues undertook more deliveries, and Mrs Tipler and hers increasingly followed the rules and guidelines, although their numbers declined. Crucially, these women were not allowed to use instruments and were compelled to call a doctor for anything abnormal, increasing the chance of ‘unnecessary and dangerous interventions’. The authors speculate that Mrs Killer’s patients might have fared better had she been allowed to use forceps, as her Swedish counterparts were.