A Call to Arms: Heroic Midwifery during WWII by Rebecca Alexander

When war came, midwives delivered babies on shelters
Credit Jennifer Ryan

While researching health care in the 1940s for a novel, I found many astonishing stories about the changing role of midwives during WWII. Before 1936, most midwives learned about delivering babies by shadowing an experienced colleague and learning in the classroom in teaching hospitals. Training taught midwives to deliver babies with the least possible trauma to the mothers and babies, and to reduce the risk of infection. The Midwives’ Act (1936) recognised the need for full time, salaried professional midwives with advanced training. By 1939, most towns and cities provided council organised services for pregnant women, charging the mothers for the delivery and ante- and post-natal care. Coming from Portsmouth, I was surprised to see two midwives who were rewarded with honours for bravery, in horrendous circumstances.

Untrained ‘handy women’, already disqualified from calling themselves midwives, were forced to retire or worked as ‘maternity nurses’. These helped mothers who could afford them with child care, laundry and housekeeping. Poorer families in rural areas still relied on these untrained handy women to deliver babies, with varied experience or training. 

Survival of mothers varied hugely, from 1.51 deaths per thousand in Portsmouth, with a rate of 6.0 in some areas of the north of England, similar to the rate of maternal death in 1850. (At the time, there was no data collected for comparison of babies’ deaths). By 1939, midwives received £240-280 per year, with an allowance of £20 for a car and £4 for a bicycle. Before the NHS, families paid a standard fee to the council, usually around ten shillings and sixpence. Midwives provided all their own equipment, medicines, antiseptics and uniforms. About a third of midwives were self -employed private midwives, charging the mothers directly. Trained midwives emphasised antiseptic techniques, the use of gloves and the prevention of damage or infection to the mothers, but handy women were still called upon to save money. 

At the opening of the Second World war, the attitude changed. Unlike nurses, midwives were not considered to be doing war work and thus did not receive war pay. Many midwives applied to fill nursing posts, leading to reductions in the number of midwives across the country. Many areas lost 25-40% of the midwifery workforce, with more lost as the war went on. Many older midwives were swamped with work, so retired or became ill. Others were unavailable for full time work, being older or having children. 

In some areas, like Birmingham, services were overwhelmed by demand, midwives delivering far more babies than expected by the Midwives Act which suggested a maximum of 100 births per year and a compulsory retirement age of 60 but many delivering twice that many, and up to the age of seventy. The role of midwife was already under strain by 1939, and recruitment of pupil midwives was struggling. One training school had thirty-five places for trainee midwives but could only recruit two pupils. 

A call was put out for retired midwives but many had not attended the most modern courses or studied up to date techniques. Accelerated training was offered for pupil midwives and independent midwives were asked to volunteer for areas with high numbers of evacuated pregnant mothers. Evacuation caused havoc for the mothers, children and the services scrambled to look after them. 

On Dartmoor in Devon, the team of nine qualified midwives was slashed to two by the migration of practitioners to nursing. Younger doctors were also recruited for the war effort, leaving more older general practitioners to provide obstetric support to the midwives. Doctors were both more expensive for the families (averaging a guinea for their visit, which would be paid instead of the midwife’s fee of about ten shilling and sixpence) and sometimes less experienced in the biomechanics of childbirth. When doctors attended, there were more likely to be interventions like the use of forceps and more need for repairs. Midwives did not, at the time, carry morphine or do suturing. A smaller number of doctors, some trained decades before and not specialists in obstetrics, were left to support a reduced number of midwives. 

Despite the difficulties, a number of bravery honours were awarded to midwives operating in wartime Britain. They delivered babies in bomb shelters, damaged houses, in areas hit by fire and even in the street as pregnant women tried to get to safety during air raids. Maternity wards were damaged by bombs, both in the UK and in Germany. One especially notable case was that of Sister Violet Frampton of Bristol Maternity Hospital, who was awarded the George medal after treating casualties trapped in a house in Bristol during repeated bombing of the area. She was awarded her medal by the king. She was one of several midwives who received honours in recognition of their bravery.

British Journal of Nursing, February 1942

Supplement to the London Gazette 7th March 1941 p.1347

Even long retired midwives found themselves caring for women in labour in wartime conditions. 

Supplement to the London Gazette 7th March 1941 p.1346

Mrs Leaver also won the British Empire medal despite having retired as a midwife over twenty years before. Despite high explosive bombs and incendiaries falling all around, she moved the labouring mother to the basement and delivered the baby safely with the help of a doctor.

Despite the government's best intentions, most evacuated women returned to their homes in cities and towns, where their support networks and employment was. Pregnant women chose their birth attendants themselves, for financial reasons but also wanting people they knew to attend them from their own communities, meaning handy women continued to deliver babies until the founding of the NHS. Midwives left the profession to find work with regular hours and better pay. Only the Beveridge Report (1942) could start to suggest a cradle to the grave healthcare system, where midwives were valued as independent health practitioners with a wealth of knowledge and skill. 

Bibliography: 

Dawson S.T. (2024) Mothers, Midwives and Reproductive Labor in Interwar and Wartime Britain, Lexington Books 

McIntosh, T. (2012) A Social History of Maternity and Childbirth, Routledge

Starns, P. (2018) Blitz Hospital, The History Press