‘On Gracious God Relying…’

All the way back in 1690 there was a book published in Germany that would bear historical significance for midwifery all across Europe and beyond. The German title of the book in its entirety contains twenty one words and the subtitle contains a further fourteen, so I will omit it for now and offer you the snappy title of the English translation instead.

‘The Court Midwife’

The book is significant in that it is the first book detailing the female anatomy written by a woman in Germany. It deals exclusively in abnormal phenomena that can occur in pregnancy, birth and in a woman's life in general. It is, by all accounts a medical text and those were not normally written by women.

You may know that my first language is German and I do own a German version of this book in its original wording. But judging by what you now know about the title of the book, it may not come as a surprise to you that I find it far easier to read the English translation by Professor Lynne Tatlock, a scholar of the Humanities in the Department of Germanic Languages at Washington University in St. Louis. This beautiful translation must have been incredibly tedious to do given the old fashioned, wordy version of German that was spoken in the 1690s .

‘The Court Midwife’ by Justine Siegemund is one of my favourite midwifery texts. It offers a kind of insight into womanhood back in those days that we don’t find very often. Its publication is testament to how highly regarded Justine was in her time, and it offers not only her extensive knowledge of how to resolve complications of childbirth but also an insight and documentation of her life.

She shares with us the peculiar way in which she came to midwifery in her early twenties. Justine had been married that year and by consensus of the midwives she was with child and the midwives calculated when to expect the baby.

Justine writes ‘When the forty weeks calculated for me were up, I was to give birth, or make ready to do so. The midwife was of the opinion that the child was in the right posture. Because I did not know any better than what I was told, I was in labour for three days without being delivered….’

This is such an interesting story given that

a) German doctor Franz Naegele is largely credited (or discredited these days) for coming up with how to calculate the length of a pregnancy and his text wasn’t published until 1830; yet Justine's midwives effectively gave her a 'due date' more than a hundred years previously

b) after three days of seeking the opinions of four midwives in total, they all agreed that Justine and her baby would just have to die if she couldn’t manage to give birth

c) a sailor’s wife who was also a midwife was brought to Justine’s house and diagnosed a prolapsed uterus with no baby in it - she was finally able to help

My guess is that some kind of fibroid or underlying infection caused a swelling in Justine's abdomen and that Justine pushed out her own uterus under the guidance of the midwives. It would be quite a coincidence for the womb of a twenty year old woman to prolapse spontaneously around the time of her ‘due date’ and a bunch of midwives just happen to be present.

It's also interesting to me that Justine didn't know what was happening in her own body.

This is a phenomenon that is fairly common even today.

Most women (and men) outsource the authority over their bodies to others. We list our symptoms to doctors and other 'experts' in this and that and they match them with a diagnosis and the diagnosis with a pharmaceutical (or two).

I wonder exactly when women became strangers to what goes on under their skin and I also wonder how much the church has to do with this.

Were there still women in 1690 who were celebrating their bodies and knew themselves or had they all been burnt at the stake by then? 

Like many midwives to this day, Justine was inspired to learn about the wondrous world of women’s reproductive health after her own experience of ‘childbirth’ and given the highly unusual nature of her ‘labour’ she was particularly drawn to ‘abnormal’ labours.

Justine was at an advantage in that her parents had made sure that she could read and write when formal education for girls was not deemed important. Many midwives at the time didn’t know how to read and their knowledge was handed down woman to woman. I have no way of knowing how common it was for midwives to be as far off the mark as they were in Justine’s case but it puts the call for regulation and a formal education for midwives in perspective, doesn’t it?

According to her own account, Justine was first called to a birth when a midwife who knew of her studies called her to an obstructed labour when she was twenty three. The baby’s arm had slipped into the birth canal and Justine resolved the situation manually and was able to help the baby be born. The baby was ‘weak but alive’.

Word of this learned woman who knew how to help in difficult labours spread and Justine helped anyone she could. She makes a point of saying that she didn't charge for her services because she was already taken care of by her husband. And so ensued a career that stretched over four decades and spanned across an area that covers parts of what we now know as the countries of Poland, Germany and The Netherlands.

By the time Justine published her book she had already been a midwife for over 30 years. She had gained a reputation so great that Frederick William, Elector of Brandenburg and Duke of Prussia appointed her as his court midwife and Justine Siegemund became the midwife present at the births of several royal offspring not just in his court but in other royal households, too.

Those connections allowed her to publish a medical text at the time and Justine’s book contains her letters to several noble men and women of the time.

The privilege to write any kind of instructional manual in the field of medicine or otherwise had thus far been the prerogative of men and apart from a handbook published by French midwife Louise Bourgeois in 1609 and translated into German in 1619 there were no publications on gynaecology and birth authored by women.

Justine’s practice as a midwife differed greatly from that of other midwives of her time and even midwives of today. Her practice extended into gynaecology as well as birth and obstetrics. She describes removing a cervical tumour when nobody else knew how to help Louise, Duchess of Legnica. The male physicians in attendance didn’t know how to help and consulted Justine who figured out what might be the problem and removed the tumour granting the Duchess a further nine years of life.

Eventually Justine was accused of unsafe practice by a physician. 

Interestingly the medical faculty sided with her. They thought it apparent that her extensive knowledge base exceeded that of the relatively inexperienced accusing doctor. 

Maybe you are wondering why I am telling you about all of this.

Well, firstly, if you are interested in childbirth, The Court Midwife is a must-read.

Not only will you read some gobsmacking accounts of how Justine dealt with scenarios that would almost certainly lead to the death of a mother and baby in the days before routine access to caesarean sections, but you can also see how smart she was at pre-empting potential criticisms as a woman writer in such matters reserved for men. 

Justine presents her expertise in conversation with Christina, a novice midwife who asks Justine questions about certain scenarios.

She is very careful to answer with great humility and despite the fact that her astuteness undoubtedly saved the lives of women in situations that included cases of significant placenta praevia, she always graciously accepts that she doesn't get to decide who lives or who dies.

There's a higher power at play, always, and in Justine's explorations of various case studies women and babies only ever survive 'so God willing' regardless of how Justine contributed to shifting the odds.

Justine knew that her hands were guided not only by her knowledge but also by God.

She pursued her calling in devotion to the women she served, in devotion to the craft itself and in devotion to God. 

‘On gracious God relying. My skillful hand applying. Devoted deeds allying.'

This is Justine's motto, the inscription of which was printed into the introduction to her book and I was reminded of it after two conversations last week with other birth workers.

You can listen to one of those conversations in last week's podcast with Kemi Johnson where we delve into our own experiences of being able to lean into this more now that we are no longer working in institutionalised birth.

When you are able to switch off the noise around birth that is brought by the various interventions in the institutions that midwives now serve, it is inevitable to come back to the spiritual aspects of what is playing out when a new human lands in our midst.

In the last year I have witnessed some families who have chosen not to seek ANY input from outside authority in their pregnancies. Some of them decided not to have ultrasound scans either.

What I learned there is what it means to TRUST and PRAY.

Prayer is opening yourself to receiving wisdom and divine guidance when you need it. To me prayer is the reverse of meditation. It's directed outwards. Instead of focusing further in, you direct your attention towards an outward deity in order to find the answers that already lie within us all.

As someone who never engaged in prayer much in adult life, it took my yoga practice for me to understand prayer and to led go of the childish notion that prayer was just asking God to grant my every wish.

Prayer and trust, as I see it now, go hand in hand. Trust isn't the naive notion that 'everything will be fine', trust is allowing yourself to act in whatever way you are called to do as a mother and as anybody in the birthing space.

Obviously, in the context of helping with complicated birth, acquiring a theoretical understanding of its unfolding is going to be part of the equation. For Justine this meant studying whatever medical literature she could get her hand on but for others this might mean intuitive responses to whatever presents itself in front of them.

'My skillful hand applying'. 

Not so long ago I found myself in the company of a young woman who had studied birthwork at Da a Luz. 

The young woman told me of the birth that only just occurred recently in the very house we were in.

She had asked one of the other women if she would catch the baby (only after the mum and dad both declined to cup the little crowning head), she responded to her hesitation with the words

'Your hands will guide you'. 

and they did. And so it came to be that this mamas best friend caught the baby a few years after the birthing mama had caught hers. 

I was privileged to enter the space when the new parents were still glowing with the arrival of their little girl. I got to tuck them into bed, feed them and tidy up so that everyone could go to sleep after the eventful few hours that had preceded.

As someone who has never been big into religion, my first reading of Justine's book was very different to how I see it now. 

Initially I saw Justine's frequent reference to the will of God as strategy. 

For one, although the peak of the witch trials in Germany occurred between the 1580s and 1630s, some regions continued to pursue 'dangerous' women until the early 18th century. It appears that there was still good reason for Justine to be cautious if she wanted to avoid any possibility of being accused of witchcraft. At the very least she needed to appear humble to find acceptance for her publication among the clergy and medical men.

Though I have always had some sort of grounding in spirituality, I understood the institutionalised Christian ‘God’ as the bearded guy in the sky that had to be imagined by a mind far more naive and less sophisticated than Justine’s. 

Now, having stepped into the unknown alongside a handful of families, I can see where technology has replaced faith in modern societies. Modern families who choose to step away from technology entirely still can go and seek medical help if needed (and they all intend to), whereas in Justine's day all she had was faith in her ability and faith in God. 

I can see that my understanding of her text was heavily influenced by my social and historical beackdrop but also by how I had been initiated into midwifery.

At some point I fully believed that a ‘good’ midwife or doctor with excellent skills would rarely ‘loose’ a baby and if they did, then truly nothing else could have been done.

It took years to understand that it doesn't quite work that way and that there is far more at play.

Sometimes babies don't come through for no apparent reason and sometimes babies, helped by skillful hands defy all odds and live. 

It took me years to understand that trying to control every outcome comes at a price and having witnessed these families in the last twelve months I have caught glimpses of what that price might be. 

In amongst the scanners, blue curtains, scrubs, strip-lights, stethoscopes and the machines that go 'beep' it was hard to catch glimpses of the sacredness of birth. 

We have lost our humility. If a baby dies, someone is usually to blame. Another guideline gets introduced and we move further towards technology.

Those families who wish to embrace the sacredness of birth, who wish to embrace the experience of birth fully and as an initiation into parenthood can find it hard to find support.  

On reading parts of Justine’s book again this time I can relate so much more to her humility and her frequent reference to God's will..

I have come to believe that there is a Universal Order and there are things about birth and life and death that we cannot know. 

I am asking myself what we can we learn from Justine?

In many ways Justine's ways were cutting edge technology of her time but Justine was only called to apply her tools when they were truly needed. 

She frequently emphasises to Christina, the novice midwife, the importance of not intervening unless it is absolutely necessary. 

Nature is best left to itself she says. 

Could we take a similar approach with our modern pregnancy and birth tech?

What if we were to stop venerating medicine and held each birth sacred instead?

Imagine!