From the first page, it’s clear that Dr. Jessica Cox’s Confinement: The Hidden History of Maternal Bodies in Nineteenth-Century Britain is very personal. Professor Cox, a Reader in English Literature at Brunel University in London, explains that this project came out of her own pregnancy and childbirth experiences. She doesn’t just note this in the introduction, however. One of the things that makes Confinement stand out is the way Cox continues to bring in her own experiences throughout the book, interjecting with brief notes to provide significant contrast to the history in question.At first, I found the interjections unexpected and a bit jarring. The more I thought about it, though, I came to see these as one of the book’s strengths. Conception, pregnancy, pregnancy and child loss, childbirth, and postpartum life are intimate, personal topics. Cox’s rhetorical approach makes Confinement not just a history of the personal, but a personal history in a way that is very fitting.
Cox brings a wide lens to the subject matter. In addition to pregnancy and its aftermath, Confinement also examines child loss, unwanted pregnancy, postnatal bodies and postpartum depression, and feeding infants. Cox’s interest in nineteenth-century cultural history of the nineteenth century means the book also delves into women’s responses to these issues, as well as cultural responses. In short, any topic related to women’s bodies and childbearing is fair game here.
Today, it is assumed that highly industrialized countries have access to the tools that make it possible to support and intervene effectively in pregnant people’s medical care when necessary. Cox explains that her experience becoming a mother prompted her to think about the contrasts between childbirth today and childbirth in the past, “a time when medical assistance was limited, and in some circumstances dangerous.” As Cox notes, the nineteenth century in Britain was also the period that saw a shift from woman-centered maternal care (through midwives) to maternal care provided by formally trained medical professionals – usually male physicians.
Cox creatively incorporates a variety of sources in Confinement. As she points out, the nineteenth century was a time when pregnancy and childbirth were not openly shown in cultural artifacts like artwork and literature. This does not mean, of course, that these issues were not discussed. As Cox notes, “The oral tradition of sharing birth stories which likely existed between some women has, inevitably, not been preserved.” It’s a question, then, of which visual and written sources are available, and whose voices come through. Court cases, archival materials from hospitals, and different types of medical literature are important resources here. She also notes that there were many advice books available, such as physician Pye Henry Chavasse’s Advice to a Wife on the Management of Her Own Health and on the Treatment of some of the Complaints Incidental to Pregnancy, Labour, and Suckling, dating from the 1840s. According to Cox, Advice to a Wife was readily available to women from its date of publication through the end of the century. It “sold in vast quantities, running to dozens of editions.” Cox cites Chavasse dozens of times throughout Confinement, illustrating the good doctor’s medical opinions on a variety of topics, from the causes of infertility to what type of person should attend a woman in labor.
Cox also uses written sources from women themselves, including well-known women, such as Queen Victoria. Women in the higher socioeconomic classes are somewhat easier to find in the historical record, but even so, Cox reads carefully, translating the coded language often used to describe pregnancy, its ills, and childbirth in those days. She acknowledges that there are more sources available from women with means, and tries to avoid privileging those experiences more than others. Sources from working-class women appear in other ways, usually filtered through institutions and government records, but Cox makes use of two types of resources that are particularly worth noting here: autobiographies that working-class women wrote in the twentieth century, talking about their lives in the nineteenth century, and letters collected in 1914. That year, the Women’s Co-operative Guild asked working women to send them information about motherhood and childbirth. Accordingly, “over 400 women responded, and many of the letters detail their maternal experiences in the late nineteenth century, and talk candidly about pregnancy, miscarriage, abortion, childbirth, and infant loss.”
Cox emphasizes that these responses are significant for understanding women’s maternal experiences because they come from women who typically have left a much smaller historical record. “The particular value of these letters lies in their capturing of the voices of women who often struggled financially and were frequently forced to work throughout and shortly after their (often many) pregnancies.” Moreover, these records provide documentation from mothers about the frequency of miscarriages and stillbirth, as well as infant mortality. The Guild’s 1914 campaign preserved the voices of hundreds of working-class women and provided information on how working-class mothers experienced maternal care (or not).
Cox also notes other challenges to the study she’s undertaken here. While her goal is to look at all women’s lives and experiences, she points out that the evidence she has found quite often reflects rich, white women’s experiences. Moreover, Britain’s census did not ask questions about ethnicity until the late twentieth century. In Cox’s sources, there is no way of knowing a writer or subject’s ethnicity unless it was particularly addressed. Thus, Cox explains, “the lives of people of color living in Britain at the time, their histories of pregnancy, childbirth, and motherhood remain largely elusive, and consequently, with some exceptions, the stories discussed here are either focused on white women, or those of unknown ethnicity.”
Confinement is a fascinating and strong work. I read it with a particular interest in midwifery, likely because of my love of Call the Midwife and Laurel Thatcher Ulrich’s American-based The Midwife’s Tale. At times, I felt that Cox was more focused on physicians, and I was surprised that midwives did not seem to figure as extensively as I assumed they would. Cox notes that two particular laws were important to the regulation of medicine in the first part of the nineteenth century, including the 1815 Apothecaries Act and the 1858 Medical Act. These set guidelines for licensing medical caregivers, but, she notes “neither prohibited unlicensed practice, meaning those without training or qualifications remained free to work.” Women could not become licensed doctors until the 1876 Medical Act.
While Cox devotes Chapter 6 to the topic of midwives and maternal care, she generally argues that trained physicians were superior to midwives. She points out that women dominated the field of childbirth until the mid-1700s. As medical training for men formalized and expanded into childbirth, women remained excluded from such professional training. This created a Catch-22, as Cox continually highlights the lack of midwives’ formal training in the nineteenth century. As she notes, in their own time midwives “faced criticism for their lack of qualifications and medical knowledge but were simultaneously, for much of the period, denied access to these things.” Cox notes that midwives were generally good caregivers, but the statement stands out in contrast to the rest of the work. Taken as a whole, Confinement suggests instead that formal training made a practitioner superior to someone without formal training.
But what did that formal training look like? In what ways was it superior to the type of experiences most midwives might have had since they were largely barred from formal training? Because Cox focuses on women’s personal experiences, this is not an area she considers extensively in her work. She acknowledges that some midwives received informal training, such as apprenticeships. For many midwives in the nineteenth century, personal experiences were crucial to their profession; Cox notes that midwives’ experiences as mothers tended to count as a form of training. Yet, it is never clear just what formal medical training looked like and how or why it was superior to less professionalized forms of training or personal experience.
Pregnant people in Britain today would expect, like Cox, to only receive care from highly trained professionals. Perhaps this expectation in particular shapes Cox’s tendency to hold formally trained practitioners in higher regard overall. Her personal experience, so much at the heart of her study, showed Cox how vital medical experts and technology can be in saving the lives of mothers and their infants.
Confinement is, in the end, a study of contrasts. It is a portrait of women’s lives and experiences in a period now long past. The women who lived in nineteenth-century Britain, like people there today, had lives shaped by pregnancy, childbirth, motherhood, and loss. But these lives, and the care people received (or did not) look quite different from our lives and medical care today. Significantly, it was a time when there were important contrasts between medical practitioners, from those who prized formal training, to those whose qualifications included ideas passed down perhaps for generations.
These contrasts, and the personal history that Cox brings to her work, are what make Confinement such a fascinating work. Just as Cox’s own experiences led her to explore and make sense of maternal life in a period she loves, interested readers will find a space to consider how their own experiences inform their understanding of what life was like when women experienced Confinement.
- Jessica Cox, Confinement: The Hidden History of Maternal Bodies in Nineteenth-Century Britain (Gloucestershire: The History Press, 2023), 11. ↑
- Cox, 158. ↑
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- Cox, Footnote 8. ↑
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