Reflection on practices in obstetrics and midwifery via a historical prism

Submitting Institution

University of Oxford

Unit of Assessment

Modern Languages and Linguistics

Summary Impact Type


Research Subject Area(s)

Language, Communication and Culture: Cultural Studies, Literary Studies
History and Archaeology: Historical Studies

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Summary of the impact

Birthing tales by lay people and medical practitioners abound in all cultures. On her research website for both non-specialist and academic readers, Valerie Worth-Stylianou provides important early modern French sources in a portal accessible to a broad and interdisciplinary audience. This central information source on the history of midwifery is supplemented by her English translation (2013) of key medical texts. In 2012 she co-organised an international conference in Oxford for historians, social scientists and contemporary health practitioners to investigate, through the prism of history, societies' changing attitudes to the physical and cultural phenomenon of birth; this enabled practising midwife delegates to reflect on their current work methods and feed historical insights back into their midwifery practices.

Underpinning research

Before returning to Oxford in 2009, Professor Valerie Worth-Stylianou had established an international reputation for her research on the role of translation in the transmission of knowledge in early modern Europe, including in the particular domain of women's medicine. Her 2007 critical bibliography (Droz) of some 20 key obstetrical or gynaecological texts received excellent reviews, and was recently described as `invaluable' (Kirk Read, Birthing Bodies in early modern France (Ashgate, 2012), p.7). Since October 2009, she has collaborated fruitfully with the large group of early modern French specialists in Oxford (notably Professor Ian Maclean and Dr Wes Williams), and has drawn on Oxford's rich early modern library holdings principally to undertake research on birthing tales in France.

During 2009-10, Worth-Stylianou undertook research, in preparation for the compilation of a bilingual research website on birthing tales in early modern French medical texts [1]. The research established the sharp growth in frequency of individual case histories of births in medical works in French in the16th and earlier 17th centuries, departing from the tendency in earlier medical works to treat generic diseases or conditions rather than particular manifestations of them, and confirming the rise of the case history in this period. It also demonstrates that some elite surgeons and one court midwife collected and published case histories, and that two subjects dominate birthing tales: the interest in monstrous births (c.1560-1590) and the fascination with detailed anatomical descriptions, exemplifying non-specialist readers' engagement with medical discoveries in the nascent field of embryology. The Birthing Tales website establishes ways in which tales of birth in medical texts in French c.1500-1630 represent birth as at once a universal and a unique experience. Key research questions answered on the site include: how far the professional allegiances of authors influence the accounts of birth; how the putative readership influences the style and nature of the writing; and what evidence birthing tales provide of key social and medical debates, and of evolutions in medical practice and social attitudes.

Case histories and interactions between health professionals, family and friends are also central to Pregnancy and Birth in Early Modern France [2], Worth-Stylianou's study and English translation of the works of four physicians and a surgeon. The work appears in the series `Other Voices in Early Modern Europe', Toronto University Press, noted for offering cultural enrichment by making texts available to an English-speaking readership through scholarly translations and editions. The volume pinpoints the speed and frequency of changes in medical and surgical practice, and revises previous assumptions, notably proving that skilled male surgeons attended some normal deliveries of elite women in Paris as early as 1600-1610. Worth-Stylianou's translations give insights into rivalries between different professional groupings (physicians and surgeons, surgeons and midwives, midwives and unskilled attendants), but also furnish less well-known instances of co-operative networks. The book and the website testify to the important shared or liminal space between medical and literary writings; in this respect, the research provides an important corollary and testing-point for some recent studies which examined ways early modern French fiction drew on medical writings to depict birth.

Worth-Stylianou's research uses comparative historical analysis to engender interdisciplinary reflection by both academics and healthcare practitioners on contemporary practice and attitudes. Her article (`The definition of obscene material', 2010 [3]) on some of the earliest charges of obscenity leveled against printed materials in France, draws parallels with the psycholinguistic framework Pinker proposes for contemporary understanding of the affective charge of obscenity. Her study (`La théâtrilisation', 2010 [4]) of the midwife's and the royal doctor's reports of the birth of the future Louis XIII, identifies an early struggle for power in the birthing-chamber. Her book (Pregnancy and Birth, 2013 [2]), demonstrates the extent to which `caring' early modern physicians and surgeons placed the individual woman's well-being at the centre of their recommendations, anticipating some modern trends such as Michel Odent's `gentle birth', and promoting a holistic, individualised assessment of the mother's needs.

References to the research

Selected publications

[1] Bilingual research website: (completed 2010). Research supported by British Academy Small Research Grant: `Birthing tales in French medical texts 1500-1630', £6977.

[2] Pregnancy and Birth in Early Modern France: Caring Physicians and Surgeons (1581-1625). Other Voices in Early Modern Europe Series, Toronto University Press, 2013 (442 pages). Available on request. Research for this volume supported by a grant awarded by the National Endowment for the Humanities, US: 2012-13, $19,000 Canadian dollars.

Recommendation of Pregnancy and Birth in Early Modern France by external reader (Prof Gianna Pomata, Johns Hopkins University) for Toronto University Press, 2012: `I strongly recommend that this book be published in the "Other Voices" Series. It makes accessible to a wide reading public some very interesting early modern medical texts dealing with women's health. These texts ... present important evidence that, contrary to stereotypes, women were the recipients of medical texts written specifically for them. [They] allow the reader to access an important group of primary sources on issues related to women's health, including childbirth and caesarean section, sterility, miscarriage, breastfeeding, etc. The selection of texts is well organized and coherent, the translation is accurate and fluent; the book will be easily used by scholars and students, including undergraduates. This anthology will be very useful in a variety of graduate and undergraduate course, on European medical history, women's history, gender history, etc. It is entirely appropriate for the "Other Voices" Series because it provides evidence of a new concern and attention for women's health needs, which, most interestingly, went often hand-in-hand with the rejection of misogynist stereotypes and the challenging of conventional views of female subordination and inferiority.'

[3] `The definition of obscene material 1570-1615: three medical treatises held to account', Early Modern France (2010), pp. 148-167. (A peer-reviewed journal). In REF2.

[4] `La théâtralisation de la naissance du dauphin (1601) chez Louise Bourgeois, sage-femme de Marie de Médicis', in Le "Théâtral" de la France d'Ancien Régime, ed. S. Chaouche, (Paris, Honoré Champion, 2010), pp. 137-154. Available on request. Honoré Champion is a leading French academic publisher; articles within the volume were assessed by the volume editor and publisher.

Details of the impact

Since October 2009 Worth-Stylianou has drawn on amongst others, Oxford's rich early modern library holdings, to translate into English early modern medical texts which were previously not available to Anglophones or non-specialist readers. The birth tales website makes her translations freely available to internet users and receives 40-50 hits per week on average [i]. The website offers non-specialists as well as Renaissance scholars a glimpse of the sheer variety and verve with which birthing tales are related in works which purport, at least, to be serious medical treatises. All the English translations are her own. In a few cases, an English translation was published in the 16th or 17th centuries, but she opted to give a modern translation in order to make these 'birthing tales' accessible to a wider audience. Between 2010 and 2012, the website has stimulated discussions and requests for further information from a range of non-academic users, primarily healthcare practitioners, but also historians of art, and authors of fiction. References to the Birthing Tales website as a major resource are found in other online resources e.g Siefar and De Partu [ii].

A Wellcome Trust-funded conference in Oxford in 2012 on `Retelling Familiar Tales of Birth' [iii], co-organised by Worth-Stylianou, Professor Helen King (Open University and Principal Investigator for the grant) and Dr Janette Allotey (Manchester University), brought together over 50 researchers and practitioners from humanities and social sciences disciplines (from Australia, Canada, India, Italy, the UK and the US), including 20 healthcare practitioners (notably midwives from the UK and Germany) to consider a range of contemporary practices and policies via a historical prism. The conference provided a unique opportunity for a multidisciplinary, international group of academic researchers and healthcare practitioners to consider why retelling familiar tales is so important to the anticipation, event, and memory of birth. The conference examined the use of birthing tales in media such as drama and online forums; how fiction has historically addressed new issues, including donor-conceived children's need for tales of their birth; the spaces afforded in different societies (1950s England, present-day India) to the male birthing partner and the dhoulla; and how healthcare affects the bonding between mother and child (in relation to contemporary community midwifery in Germany, and to historic attitudes to the surgical termination of ectopic pregnancies).

Midwives are reflective practitioners in the technical sense of reflection as one of the main learning methods endorsed by professional, statutory and regulatory bodies (the National Medical Council and the Royal College of Midwives) to promote the development of knowledgeable and competent practitioners; hence the midwives' attendance at the conference was a formative part of their professional development. They particularly valued the opportunity to reflect on their current practice within a comparative historic context: e.g. why, in popular imagination (from Antiquity to the age of the internet), births at eight months paradoxically generate more fear than those at seven months; how the language used by different parties (mothers, midwives, surgeons, physicians) to describe the female reproductive system can be symptomatic of conflicting attitudes. The historical prism afforded by Worth-Stylianou's research, and that of the various speakers, allowed the midwives and primary carers to reflect on their experiences from a fresh and stimulating angle, so that contemporary debates (e.g. the role of the dhoulla as distinct from the midwife, the use of retelling tales / drama as a therapy for postnatal stress) could be recontextualised. Those midwives in leadership roles (e.g. university lecturers in midwifery, senior community midwives) recognised that the experiences of history — both in terms of continuity and of change — would provide very useful support and material for reflection for the teaching of current practice to their midwifery students. The dissemination of discussions around international historical and contemporary ethical issues was another significant achievement, which participants took back to places as diverse as the Department of Ethics in Mangalore, the community midwives of the Ruhr area in Germany, or those researching on the identity of donor-conceived children in the Department of Political and Social Sciences, Fiesole.

An attendee who was formerly the General Secretary of the Royal College of Midwives [1] commented: `The conference was a great success in terms of bringing together practitioners and academics from all over the world who might otherwise not have found a forum to exchange ideas. This can only serve to advance thinking and argument especially for those academics whose background is grounded in practice.' A Midwifery Lecturer at Manchester University [2] thought that `The event facilitated networking opportunities between academics and practitioners, and has assisted with the dissemination of the presenters' research to wider audiences.' These comments demonstrate the impact of combining academics and practitioners in the conference and the collective learning experience achieved. The Director, Centre for Ethics, Yenepoya University, Mangalore, India [3] said afterwards: `One of the best summer schools I have attended. It was truly Interdisciplinary in nature with experts from different backgrounds bringing rich experiences that helped us crystallise our perceptions. The presentations were of high quality and made an impact on the audience. Coming from a developing country like India, due to a Wellcome travel grant [...] I was able to attend and be a part of the rich exchange of Ideas. I think this momentum should not be lost, but rather be the epicentre from where more such workshops should emerge'.

Following the Oxford conference, Worth-Stylianou was invited to deliver the keynote lecture in Manchester in May 2013 at the annual meeting of De Partu (the UK association for the study of the history of midwifery). This lecture was attended by twenty-five midwives, and a recording of it has been placed on the De Partu website (August 2013) [iv] for the benefit of international members of the group. As a historian of medicine, Worth-Stylianou encouraged the midwives to reflect actively on their current practice, notably on positions adopted to facilitate obstructed deliveries, and on the changing definitions (e.g. by the National Institute for Care and Health Excellence (NICE)) of `risk' in childbirth. Taking the impact of her research forward, she was invited to speak on `The collective memory and the appropriation of birthing tales from earlier centuries' at the cross-cultural and interdisciplinary Network Conference on Motherhood in post-1968 European Women's Writing at IGRS London in October 2013, which was attended by practitioners (therapists, social and health workers), and a range of activists, community groups, policy-makers, charities, and reading groups, as well as academics.

Sources to corroborate the impact

Testimonial evidence:

[1] Email statement from former General Secretary of the Royal College of Midwives

[2] Email statement from Midwifery Lecturer Manchester University

[3] Email statement from Director, Centre for Ethics, Yenepoya University, Mangalore, India

Other sources of evidence:

[i] Hits on Birthing Tales website: no formal hit counter is in place, but the page via which links to the database are currently routed is receiving 40-50 hits a week.

[ii] Links to Birthing Tales website from and

[iii] Conference information birth-oxford-3rd-4th-july-2012/

[iv] De Partu Annual Lecture,31 May 2013 2013/