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Childbirth and the Victorian Workhouse

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Reader in English Literature shares some insight from her newly released book, Confinement: The Hidden History of Maternal Bodies in Nineteenth-Century Britain...

"The patient  stretched out her hand towards the child. The surgeon deposited it in her arms. She imprinted her cold white lips passionately on its forehead; passed her hands over her face; gazed wildly round; shuddered; fell back – and died."

So ends the life of the eponymous hero’s mother in the opening of Charles Dickens’s Oliver Twist (1838). Her infant son initially appears likely to follow in her footsteps:

"For some time he lay gasping on a little flock mattress, rather unequally poised between this world and the next: the balance being decidedly in favour of the latter. Now, if, during this brief period, Oliver had been surrounded by careful grandmothers, anxious aunts, experienced nurses, and doctors of profound wisdom, he would most inevitably and indubitably have been killed in no time. There being nobody by, however, but a pauper old woman, who was rendered rather misty by an unwonted allowance of beer; and a parish surgeon who did such matters by contract; Oliver and Nature fought out the point between them."

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Though fictional, the circumstances of Oliver’s birth reflect those of many thousands of babies born in the workhouses of Victorian Britain. Between 1861 and 1865 in London alone, almost twelve thousand women gave birth in workhouses. Giving birth in the workhouse was risky, with an average maternal mortality rate of 0.8 per cent. Overall, maternal mortality rates remained relatively steady throughout the Victorian period, with approximately one in two hundred births (0.5 per cent) resulting in the death of the mother, but this varied according to circumstances and locale. As these figures suggest, the maternal mortality risk in workhouses was somewhat higher than average, and in some of these institutions, it was higher still: in Islington workhouse in 1865, for instance, it was over five per cent.

As Dickens’s description suggests, Oliver’s survival was against the odds. Infant mortality was high throughout the Victorian period – averaging around twenty per cent, but as high as fifty per cent in some areas. Amongst infants born in the workhouse whose mothers died in childbirth, it was even higher. If mother and baby did survive, they might be relocated to the workhouse nursery, and, as with the lying-in wards, these places were often far from sanitary, and unlikely to contribute to the recovery of mothers or the healthy development of infants. The Medical Officer at the Strand Workhouse in London included a description of the nursery there when testifying to a House of Commons select committee looking at conditions in the workhouse in 1861:

"[The nursery] was a wretchedly damp and miserable room, nearly always overcrowded with young mothers and their infant children. That death relieved these young women of their illegitimate offspring was only what was to be expected, and that frequently the mothers followed in the same direction was only too true. I used to dread to go into this ward, it was so depressing. Scores and scores of distinctly preventable deaths of both mothers and children took place during my continuance in office through their being located in this horrible den."

The care which Oliver and his mother received also parallels the reality for many birthing women who ended up in one of Britain’s many workhouses. Such places, as the above description suggests, were often unsanitary, and medical assistance could not be guaranteed, though of course medical aid was no guarantee of a successful outcome anyway – especially in lying-in wards such as those found in the workhouses, where infections could be easily spread between patients. Whilst all workhouses were required to employ a medical officer, he was not necessarily summonsed to births, and in some instances, women were attended in childbirth only by fellow paupers. Whilst Dickens is guilty of perpetuating the stereotype of the drunken, incompetent midwife in his fiction (Martin Chuzzlewit’s Mrs Gamp being the most notable example), it was nonetheless the case that many of the women who gave birth in the Victorian workhouse received inadequate – and sometimes no – medical attention.

Like many of those born in the workhouse, Oliver Twist is illegitimate. The various lying-in hospitals in Victorian Britain, which provided support for poorer women in childbirth, typically offered aid only to married women, so poor unmarried mothers often had no choice but to attend the workhouse. By and large, these were far from welcoming institutions: concerns were raised about women taking advantage of the care provided and entering the workhouse too early. This resulted in some women being turned away. In one tragic case in 1857, an eighteen-year old woman was turned away from Bradford Workhouse after the matron decided the birth was not imminent. Shortly afterwards, she collapsed in the street, where she gave birth to a stillborn child without any medical assistance. In addition, some workhouses participated in the widespread moral condemnation of unmarried mothers, by forcing them to wear particular colours or items of clothing as a marker of their ‘disgrace’.

Despite the harsh conditions and attitudes associated with giving birth in the workhouse, it did at least – assuming the mother survived – allow for rest after childbirth: women were generally permitted to stay in the lying-in ward for one month following delivery. Whilst there is no doubt that the workhouse was not a particularly desirable option, all things considered, the alternative for poorer women was often to return to hard labour – domestic or paid – soon after giving birth. Prior to the establishment of the National Health Service, the workhouse represented one of the only means of state support for poorer citizens. Today, women who once would have had little choice but to give birth in the workhouse, risking their own and their babies’ lives, have undisputed rights to hospital and medical care. The last workhouses in Britain closed their doors in 1948 – the same year the NHS was formed.

Jessica Cox’s book Confinement: The Hidden History of Maternal Bodies in Nineteenth-Century Britain is published by The History Press and is available now. This blog is republished with permission from History... The Interesting Bits! read the original here