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NOVEMBER 15 6 At Mr Parkers. Mrs Holdman here.
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a sever storm of rain Cleard of with snow). My patient deliverd 8 hour
5 minute Evening of a fine daughter. Her attendants Mrss Cleark, Duttun,
Sewall, & myself. We had an Elligant per and I tarried all night.
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me to see his Lady who was delivd of a daughter at 8 hour 10 minutes
Evening I tarried all night. DECEMBER 1, 2, 3, 4, 5 At Mr Parkers 5 Days
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6 6 At Mr Whites The fifty-three deliveries Martha performed in 1793 took her along the length of the town and beyond, from Henry McCausland's mill at Cobbossee Great Pond as far north as Winslow, where Lucy Towne gave birth to her ninth child. The year's deliveries encompassed the town socially as well as geographically. She delivered Captain Molloy's and Esquire Hayward's ladies as well as Mr. Cummings's servant "Bulah" and "Black Hitty."1 Her patients in 1793 included the wives of Samuel Norcross, lime-burner and potter; Jeremiah Dummer, mer-
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chant and potash manufacturer; and Theophilus Hamlin, housewright, as well as common woodsmen and farmers in the outlying precincts of the town.2 She found it "very bad wriding" to Asa Mason's house, though this year she didn't complain, as she had in another, of encountering a plague of fleas. She delivered the wife of William Pitt, who had a house, shop, and capital in trade worth 810 pounds, as well as the wife of John LeLejunee (she spelled it Lashnee), who had a bakehouse valued at thirty-one pounds. Each family had a story. Thomas Hinkley's son ("his 9th by two wives") was Birth 22. Stephen Hinkley's child ("by Judy Busell out of wedlock") was Birth 39.3 "Birth 50. Birth 51." Two entries crowded into the margin for December 7 provide visual evidence not only of the irregular rhythm of Martha's work but of the expansion of her practice. The fifty-three babies she delivered in 1793 represent an increase of 29 percent over the year before. Old neighbors, new residents, and her own children were contributing to a population expansion that would double the town by the end of the decade.4 Jonathan and Sally's second child, a boy given the patriotic name of DeLafayette, was "Birth 7th" for the year. Peter Jones's baby, born at the mills, was "Birth 15th." The Ballards' new neighbor and dressmaker, Lydia Densmore, produced "Birth 20th." Fifty-three deliveries a year seems like a comfortable load, even for a part-time practitioner, an average of one case per week. Yet Maine weather and the unpredictability of labor made nonsense of averages. Martha might sit at home for weeks, then do a month's work in forty-eight hours, speeding between one laboring woman and another. She also had to deal, inevitably, with cases of so-called "false labor." One winter day, she hastened downriver to Sheppard's Wharf in a wilderness of snow, taking refuge in the trader's house until Samuel Hussey came to take her across the river to his wife, who was- or had been or at least thought she was- in labor. Martha was patient in such circumstances. Experience had taught her that intermittent labor was a normal part of pregnancy. She sat at the Husseys'
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A woman caught between the premonitory tightening in her belly and the feel of snow in the air was suspended between two uncertainties. If she called her midwife, labor might stop; if she did not, she might give birth unattended. In the segment of the diary that opens this chapter, Martha recorded four trips to the Parker house before that reluctant baby -Birth 51 for the year- arrived. "His Lady is about house," she wrote on the fourth day of her third visit. The condition of the river compounded the risk of going home. Martha settled into her knitting, producing two pairs of gloves and five and a half pairs of mittens before being called away, at two in the morning, by Mrs. White, who lived two miles away by sleigh. That was the signal for the Parker baby. Martha performed two deliveries in twenty-four hours, without sleep, walking home across the river the next day in snow, hail, and rain. "I had a wrestless night by fataug & weting my feet," she wrote. A third of the year's deliveries came in such strenuous clusters of two or three. Martha numbered births the way she weighed candies or counted cabbages or mittens, but with even more intensity and seriousness. Numbers were a measure of productivity, though in the moral sense of diligence, of mastery of a chosen task, rather than in the mercantile sense of income or outgo. She didn't isolate births from the other activities in the diary, but she did give them precedence. Despite their ragged appearance, the birth entries were carefully structured and remarkably consistent. The left margin invariably included the father's surname, the sex of the child, and an XX for fee paid; the right gave the location of the birth and its number. The body of each entry offered additional detail, usually the exact time of delivery ("9 hour 30 minutes"), the hour of her summons or departure ("I left his Lady at 4 pm"), the condition of the mother and child
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("as well as Could be Expected"), and the method of travel ("walkt over the river"). In addition some entries included the form or amount of payment ("Receivd 7/6 as a reward"), the names of the attendants ("Mrss Cleark, Duttun, Sewall & myself"), and comments on unusual occurrences at birth ("Doct Page was Calld before my arival"). Individual entries may seem flat and unrevealing. Taken together,
they provide an unparalleled record of an eighteenthcentury practice.
Even the most routine and formulaic pieces of information are useful.
Rare comments on obstetrical complications mean more when seen in relation
to hundreds of bland notations that say simply "delivered" or "safe delivered";
a twenty-four-shilling fee acquires new significance when framed with
all those other entries recording six shillings or a plain XX, while the
appearance of a doctor at a delivery becomes more noteworthy when the
hundreds of other deliveries in which no one thought to call a physician
are considered. In midwifery as in so many other aspects of Martha Ballard's
diary, it is the combination of boredom and heroism, of the usual and
the unusual, that tells the story. In medical terms the success of Martha Ballard's practice is conveyed in what she didn't write. For 768 of the 814 delivery entries in the diary she included no medical detail at all, simply noting "delivered" or "safe delivered," sometimes with an additional reassurance such as "left My patients very well." In only forty-six deliveries, 5.6 percent of all the births in the diary, did she give any hint of complications. Even then she seldom elaborated. A woman was "safe delivered tho very ill indeed" or "Her case was some alarming but shee revivd and seems comfortable." In a particularly difficult case she might add a special thanks: "She had a Laborious illness but Blessed be God it terminated in safety. May shee and I ascribe the prais to the Great parent of the universe."6 Such a record is exactly what one might expect of a skilled practitioner. One medical historian has estimated that 96 percent
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of all births occur naturally and spontaneously. The remaining 4 percent involve obstructions of some kind and require intervention. In addition, 1 percent may result in accessory complications, fainting, vomiting, tearing of the perineum, or life-threatening hemorrhages or convulsions. The eighteenthcentury English physician Charles White was not far wrong when he said that a healthy young woman might deliver unattended in the middle of the town common and still do well.7 As twentieth-century reformers insist, birth is a natural process, not a medical event. Yet, as Martha would be quick to add, a natural process might still be uncomfortable and frightening, and when mismanaged even a normal birth could be dangerous. Like most of her contemporaries, she feared unattended birth.8 She fretted when a missing horse delayed her response to a call. "My anxiety was great for the woman but I found her Safe," she wrote after one such event. On other occasions she was not so positive. Unattended women were "in a deplorable condition" or "suffering for want of help."9 To her mind, those frenzied journeys and patient watchings mattered. Her results attest to her skill. Her comment on August 20, 1787, that the death of Susanna Clayton and her infant was the "first such instance I ever saw & the first woman that died in Child bed which I delivered" allows us to add the 177 prediary deliveries to the total: in almost 1,000 births Martha did not lose a single mother at delivery, and only five of her patients (including Mrs. Clayton) died in the lying-in period. Infant deaths were also rare. The diary records fourteen stillbirths in 814 deliveries and an additional five infant deaths within an hour or two of delivery. By our standards, mortality was high. Martha saw one maternal death for every 198 living births. Today that rate is one per 10,000. But as late as 1930, there was one maternal death for every 150 births in the United States; the major gains in obstetrical safety have come in the past fifty years. In fact, many historians believe that the routine employment of physicians in the nineteenth century probably increased rather than decreased
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TABLE IV SUMMARY OF DELIVERY DATA FROM TWO MANUSCRIPT SOURCES
mortality. Records of an early-nineteenth-century New Hampshire physician, whose case load was almost identical to Martha Ballard's, shows higher stillbirth ratios and four maternal deaths at delivery, though only one during the lying-in period (see Table IV). What is even more striking is the large number of complications recorded in his records: 20 percent of his deliveries (as opposed to 5.6 percent for her). The difference was partly in perception- as a physician he was attuned to biological anomalies in a way that she was not- yet there is good
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The more appropriate comparison, of course, is with her own contemporaries. Estimates based on parish registers for seventeenth- and eighteenth-century English villages range from ten to twenty-nine maternal deaths per thousand births. In some eighteenth-century London and Dublin hospitals, maternal mortality ranged from 30 to 200(!) per thousand births, compared with 5 per 1,000 for Martha (see Table V).11 There are few comparable New England records, though such as there are suggest that maternal mortality, like other forms, was lower in rural America. Lydia Baldwin, an eighteenth-century Vermont midwife, claimed only one maternal death in 926 deliveries, though the lack of detail in her records makes it impossible to determine whether she included deaths in the lying-in period as well as deaths at delivery. Hall Jackson, a Portsmouth, New Hampshire, physician claimed no maternal deaths in 511 births, though again his records are sketchy. Martha's stillbirth ratios are comparable to (though slightly lower than) both Baldwin's and Jackson's12 (see Table VI). Martha's obstetrical entries were routine and predictable because most deliveries were routine and predictable. The terseness of her records also reflects a traditional reticence about the details of sex and birth. Martha's patients were not anonymous bodies but friends and neighbors. She was no prude, yet she was probably unaccustomed to saying, let alone writing, all she knew and saw. Even among publishing physicians a certain reserve was expected. The author of one English midwifery manual defended the lack of anatomical detail in his text on the grounds that his work was designed not to "give the least Offence to the most modest Reader."13 Beyond that, the lack of detail reinforces what we already
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TABLE V COMPARATIVE MATERNAL MORTALITY RATES
know about her craft, that it was traditional rather than experimental. Unlike the publishing physicians of the period, some of whom kept obstetrical case notes, she had no interest in instructing others (at least through the written word) or in testing
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TABLE VI COMPARATIVE STILLBIRTH RATES
and promoting new methods. Her training was manual rather than literary. Having mastered her craft she had no need to explain it. Although the outcome of each delivery mattered (it was important to note whether a woman who had been "very
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Excessive bleeding was "flooding" in her diary as in the obstetrical literature, but she did not use Latinisms like matrix and vagina or technical terms like Os Pubis and Os Tincae. In fact, what is most striking is the absence of any reference to the explicit processes of birth. Her women are seldom even in "travail." They are simply "unwell," and as the delivery proceeds it is their "illness" rather than their "bearing pains" or even their "labor" that increases. Where an English midwife might "touch" a woman (a euphemism for an internal examination), Martha "inquired into her case." Once in a while she refers to a presentation as preternatural as a physician might, but her designation of one woman's labor as supernatural was surely a slip of the pen.14 Her reference to the encounter with Dr. Page at Mrs. Poor's delivery in the November 17 passage is a case in point. In the context of the larger history of obstetrics, it is also extraordinarily interesting. "I Extracted the Child," she wrote. "He Chose to Close the Loin." The language is almost Biblical in its circumlocution. Presumably she meant that Dr. Page had delivered the placenta or afterbirth and then applied the traditional bandages around the abdomen and thighs. Because the delivery of the placenta was a source of some controversy in the period, the incident is worth examining in detail. Early-eighteenth-century advice books urged the immediate extraction of the placenta, even if it meant reaching into the womb. "With my left hand I was oblig'd to keep her Belly down," wrote one English midwife, "whilst with my right hand I peel'd off and loosen'd the secundines from the Matrix." Many physicians promoted similar methods, arguing that if there was room for a baby in the womb there was certainly room for a hand. No one advised rough pulling on the umbilicus, however, a method usually attributed to "ignorant midwives." By the last quarter of the eighteenth century a few physicians claimed that doing nothing was the best approach of all. "Nature does
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Martha Ballard's silence on the subject suggests that she was quite comfortable with Dr. Page's method, whatever it was, yet his insistence on "Clos[ing] the Loin" may suggest his own mistrust of her skill. The word "Close" is itself suggestive, since in the form of a noun it denoted the wrapper or binding applied to the abdomen and thighs after birth. William Hunter described the process this way: "As [the placenta] comes away I know it will be followed by a suction of air. On this account as it comes out I close the Vulva, and keep my hands on the parts below. Then I call for a bason, and give it [the placenta] away and apply a dry warm cloth to the Vulva.... After this I apply several cloths & then ask for what is called the close. I keep the parts close with my hands, and then take out one cloth and apply it over them dry. I take another and put it about her thighs etc. I give her another to put over her stomach and belly."16 Hunter recommended plain dry cloths, apparently rather loosely applied. Older writers suggested tying the knees together after applying a large, soft, dry double clout "very warm to the Labia Pudendi." Regardless of method, the phrase "Close the Loin" suggests a kind of intimacy, a physical caring that was more often associated with midwifery and nursing than with medicine in this period. It was not simply a matter of guiding an attending nurse in the application of the "clouts." The extraction of the placenta and the "closing" of the vulva were parts of one operation, the "suction of air" to be followed by a kind of capping of the parts. There was a strong belief in the period that allowing an ingress of air into the birth canal after delivery would cause afterpains and inflammation of the womb.17 According to the diary, Dr. Page "Chose to Close the Loin." The implication of intent is suggestive. Martha used the verb "to choose" in describing a similar encounter in Pittston the year before. She had been called to see the wife of Peter Grant,
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Her second encounter with Ben Page was more dramatic. She had been sitting up all night with Hannah Sewall, a young bride who had recently arrived in Hallowell from the coastal town of York. (Her husband was another of Henry's cousins.) "They were intimidated," Martha wrote, "& Calld Dr Page who gave my patient 20 drops of Laudanum which put her into such a stupor her pains (which were regular & promising) in a manner stopt till near night when she pukt & they returned & shee delivered at 7 hour Evening of a son her first Born."20 The "intimidation" may have had something to do with the fact that Hannah had grown up in an elite family in a coastal town and was already familiar with medical delivery. Dr. Page's behavior, however, can only be attributed to inexperience. English obstetrical literature recommended the use of opiates for false pains but not for genuine labor; he was apparently having difficulty telling one from the other. Martha's characterization of the pains as "regular" suggests she may have been using her timepiece to monitor the contractions. That she pronounced them "promising" suggests she had conducted an internal examination (or "touch") to check the dilation, though we cannot be sure. Perhaps her measurement of the pains was merely impressionistic; she had sat through enough "lingering" labors to know productive pains from spurious ones.
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Benjamin Page was unfortunate, but he was also ill prepared and overly confident. Martha's reference to his dislocation of an infant's limbs suggests lack of familiarity with the difficult manual operation required in breech births. The English midwife Sarah Stone warned against such "boyish Pretenders," who, having attended a few dissections and read the major treatises, pretended to understand the manipulative arts so important to midwifery. Even Henry Bracken, an English accoucheur who insisted that midwives call in a doctor in difficult births, cautioned, "I would never advise any one to employ a young physician."22 Still, Ben Page had certain advantages: a gentlemanly bearing, a successfully completed apprenticeship, and credit with certain
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younger members of the Kennebec elite. His list of patients is impressive. Benjamin Poor was a printer and eventually the publisher of Hallowell's first newspaper, his wife a schoolteacher. David Sewall was a merchant, his wife the daughter of one of York's first families, and the sister of Sally Keating Wood, Maine's first novelist. James Bridge was a Harvard graduate, attorney, and eventual judge of Probate for Kennebec County. Significantly, his wife was Hannah North, the judge's daughter. All three husbands were, like Benjamin Page, ambitious, educated, and new to the town. Furthermore, they could afford a physician's fee. (In the early 18oos, when Martha Ballard was charging under $2 for a delivery, Page was collecting $6.)23 We should not conclude, however, that Hallowell's elite families were abandoning traditional delivery en masse. Whether status is determined by position on the tax list, by education, or by election to public office, Hallowell's "elite" were as likely as ordinary families to employ Martha Ballard. To the end of the century she performed two-thirds of the deliveries in the town, whether the babies were the children or grandchildren of public officials and merchants or of ordinary timbermen and farmers. Ten of the twelve wealthiest men on the tax list for 1790 are known to have had children or grandchildren born before 1800. Martha performed deliveries for eight. Of twenty-five men who held town, county, or state office between 1785 and 1796, nineteen are known to have had children or grandchildren born before 1800 She performed deliveries for fourteen. The exceptions are predictable. In addition to Colonel North and his son-in-law James Bridges, they include Daniel Cony, who delivered his own children, and Beriah Ingraham, whose wife or mother ("Old Lady lngraham") was a midwife.24 Several of the more prominent Hallowell families employed Martha Ballard. She delivered two of Supply Belcher's children before his removal to Farmington in 1794. Known to contemporaries as the "Handel of Maine," he published a collection of compositions in 1794. Sarah Sheppard, whose husband was Charles Vaughan's agent at the Hook, was also one of Martha's
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In the diary, the transition to medical obstetrics is a far more complex process that it appears in secondary literature. Historians have attributed the rise of "male-midwifery" in England and America to two factors, fashion and forceps. Forceps capable of delivering a living child were a humane alternative to the crude techniques of barber surgeons called in to save a mother's life by dismembering her child. Midwives and physicians both assailed the frequent use of "the Hook and the Knife," describing "Infants born crying, with their Brains working out of their Heads" and mothers dying "under the Hands of the Operator after some of the Limbs and Ribs of the Child were brought away."27 In fact Benjamin Page's mentor, Dr. Thomas Kittredge of Andover, Massachusetts, owned forceps and the medical treatises that promoted their use.28 Yet instruments can hardly explain the introduction of malemidwifery in a town with so few emergency births. Martha Ballard summoned a physician twice in twenty-seven years, once in the first year of the diary, when she arrived late to a delivery and found the patient "greatly ingered by some mishap" by an inexperienced midwife, though the woman did "not allow that shee was sencible of it." Significantly, she sent for Dr. Colman, a doctor who did not perform deliveries, to deal with what was by then a medical emergency. Although Colman was unavailable, "Dr. Williams fortunately Come in & prescribed remidies which aford some relief." The mother apparently survived.29 The description of the second case is more expansive. "My patients illness Came on at 8 hour morning," Martha wrote.
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In the margin of that day's entry she wrote, "The most perelous sien I Ever past thro in the Course of my practice. Blessed be God for his goodness."30 Martha was frightened by this "perelous sien," but her ability to negotiate it alone may have increased her confidence. Never again did she feel it necessary to summon a physician. She certainly encountered her share of breech births, obstructions, and fainting mothers, but she knew what to do. "The foets [fetus] was in an unnatural posetion but I Brot it into a proper direction and shee was safe delivered," she reported calmly after one difficult birth, and following another she wrote, "There were some obstructions to remove. When performd the patient was safe delivered." Her nondescript entries are a quiet corrective to eighteenth-century obstetrical manuals, which are filled with the horrors of birth, babies lodged in the birth canal or stuck crosswise in the pelvis, mothers bleeding to death or succumbing from putrefying tissue left in the womb. "[She] was Exercised with pain & fainting after delivery," Martha summarized. "I made use of Camphor & other remedies. Shee revivd & I left her & Child Cleverly."31 The construction of the last sentence is pleasingly ambiguous. In some English dialects to leave a person "Cleverly" meant to leave them in health. That was certainly the intended meaning of Martha's statement. Yet leaving a mother and child "Cleverly" also meant applying one's own adroitness and dexterity. A midwife's skill was mirrored in her patients' well-being. Typically, Martha gave God the credit for her success, but she knew that He had worked His will through her hands. Without seeming to do so she compared her own record with
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those of her peers, working into the diary hearsay evidence of difficult births that occurred outside her practice. "Mr George Brown informd me that Capt Smiths wife had 2 Children Born Last night. They are dead," she wrote. In this case the practitioner may have been Mrs. Hinkley, who is known to have delivered another of Captain Smith's children. Sometime later Martha noted that Mrs. Hartford had been "delivered of two Dead Babes by Esquire Cony this morning, one of each sex.32 Behind these statements is her own quiet awareness that she herself had never lost a pair of twins. She reported multiple births as though they were as ordinary as any others: "I was calld in haste at 11 hour Eveing to Mr Isaac Clearks Lady in travil. Shee was safe delivered of a fine son & a daughter before 12. All likely to do well."33 A statistical comparison between Martha Ballard and her competitors is something of an anachronism, however, as is an effort to isolate and categorize her delivery techniques. She simply did not see her work in that way. In fact, the most descriptive account of the birth of twins in her diary says almost as much about her own journey as the delivery itself. Mrs. Byrnes
Characteristically, the one obstetrical comment in the entry ("There was but a short space between the Births") is embedded in seemingly extraneous references to the weather, her journey, the names of the men who assisted her across the river and of the women who sat up with her through the night. The biolog-
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ical event fades into the clutter of social detail. Where is the center of the picture? Is it Martha Ballard scrambling up the icy bank, Mr. Dingley grasping one arm, Mr. Graves reaching toward her from above, while Ephraim slowly turns his boat in the ice-rimmed river below? Is it Mrs. Byrnes, exhausted from her eight-hour labor, bearing down for the second delivery? Is it Mrs. Conry easing two perfect babies into the cradle, or the three drowsy women leaning toward the kitchen fire, the midnight cold at their backs, small clouds of mist above their whispers? There is no center, only a kind of grid, faint trails of experience converging
and deflecting across a single day. The first stage of delivery lasted from several hours to several days and at first might not even be accompanied by genuine labor. The expectation of labor was enough. "I helpt Mrs Lithgow make Cake & Pies & knit on my Stockin," Martha wrote two days after her arrival at Esquire Lithgow's in Winslow. The long distance necessitated the early summons, but Mrs. Lithgow was not far wrong in her estimation, as the next day's entry attests: "I finisht my stockin. My patient was unwell all day." She was delivered at ten the following night of a "fine son."35 Whether she was actually in labor the whole time or only uncomfortable and anxious, we do not know. The important thing is that her midwife was there and willing to stay.
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Martha probably administered herbal remedies and perhaps even mixtures laced with wine or rum, though the only explicit references to alcohol during labor suggest dismay at the women's capacity for drink. At William Chamberlain's house: "My patient is not very well. We find shee has an inclination to drink rhum. She drank about one quart. Her illness increast ... was delivered at 3 hour morn of a son her first child." And a week later at another house: "At Mr Catons yet. His wife is not fitt to be left. He went to the river. Shee wisht to Drink wine and Eat Bisquit. He procured it and shee Drank Eleven glasses this day and Eat Bisquit and wine at Evening 3 times." The next day she was delivered "of a son at 2 hours 30 minutes pm and of a daughter at 3 hour pm ... I could not sleep for flees."37 In both cases Martha attributed the inclination to drink to the mother herself, though she may have approved an effort to relax and partially sedate a patient who was experiencing lackadaisical and not very productive labor. The transition from the first to the second stage of delivery was marked by the calling of "the women." Here too there were occasional disappointments -"the women went home Except her Sister Blanchard"- but generally the arrival of the women signaled the imminence of birth. The calling of the women may have marked a biological transition. In normal labor the
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There were practical reasons for delaying the call, there being no good reason why five or six women should share the passive watching and waiting that accompanied the early hours of labor. Once the second stage of labor began, however, additional women were needed. Most early American women literally gave birth in the arms or on the laps of their neighbors. The physical equipment for delivery was very simple. As Henry Bracken explained it, "Some Midwives use a particular Kind of Stool, and others a Pallet-Bed with only a double Quilt upon it, placed near the Fire, if the Season require," though with "a little Alteration of the Clothes" a mother's own bed "or a Woman's Knee" would do.39 Though a Vermont midwife who practiced during this period is said to have owned a birthing stool, there is no evidence that Martha Ballard had one. The diary alludes to a "time piece," "medicines," and "specktakles," all in connection with midwifery journeys, but never once does it mention a stool, a piece of equipment that surely would have added complexity to her scrambles up the ice-covered banks of the Kennebec. "The women" are the most obvious piece of equipment in the diary. Whether her patients reclined, crouched, knelt, or delivered upright, Martha required at least two assistants.40 "Find his mother and Ben Churches wife there. We calld the McCausland wives after Sunsett."41 Eighty percent of the entries that offer names mention between two and four women. One entry (perhaps incomplete) lists a single assistant; the remainder, five or more. "My company were Old Lady Cox, Pitts, Sister Barton, Moody, Soal, & Witherel," Martha wrote, omitting the usual formality of "Mrs" in her tumble of names. Listing the ten as-
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Although a few women, like Merriam Pollard, seem to have been drawn beyond the circle of their own neighborhoods, most birth attendants, except for relatives, lived nearby. Some young mothers delivered at their parents' houses, others summoned their "marm" or sisters from afar; but nearly everyone relied on neighbors. There is a striking correspondence between the names on Martha's lists and known residence patterns in the town. The Mrs. Sewall who appeared at Martha Molloy's delivery on November 18, 1793, was probably not Tabitha, who lived a considerable distance away, but Ruth, the wife of Henry's cousin Moses. She and Mrs. Dutton lived near the Molloys at the Hook. Tabitha Sewall may well have been present a few weeks later, at the delivery of her neighbor, Mrs. Parker (though a little later there would be an estrangement that would prevent that kind of intimacy). When Tabitha Sewall delivered her fourth child, the attendants included Mrs. Parker, Mrs. Vose, and another near neighbor, Susanna Cony Howard Brooks.43 The attending women offered emotional as well as physical support. After two days of intermittent labor, "Mrs Coin [Cowen] was Lingering and very much deprist in Spirits. We called Mrs Fletcher. Mrs Soal Called there. Mrs Savage & Fletcher tarried all night." The patient was delivered a few hours later "with 5 pains after my inquiring into her Case."44 The women helped to dress the infant and to lift the mother in (or out) of bed. Performing their simple duties, they no doubt traded stories, measuring one woman's pains--or the size of her child-against another's. George Thomas's son "weighed more than the lite side of Mr Densmore's stilyards would weigh"; Captain Ney's baby "measured round the Breast (after being 'drest in thin Cloaths) 18 1/2 inches." In contrast, Hannah Getchel's illegitimate child was "the smallist I ever saw alive." (It died the next day.)45 In one birth out of twenty-four, the child died. Of these, forty
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The presence of the women was even more important in cases of illegitimacy. "At Benjamin White's with his Sister Rebeckah who is in Travel tho unmarried," she wrote on December 21 1787, noting that Becky's women were with her when she declared Seth Partridge to be the father of her child. In the most sensational case of her career, Martha was especially careful about noting the presence-or absence-of witnesses. Sally Ballard's sister Mehettable Pierce declared that her child "was begoten by John Varsal Davis, Esquire. This shee positively affirm[ed] in the presence of the wife of Jonathan Ballard who with Hosea Houland were my assistants in the case. The latter was stept in to an other room when I Examined my Patient," Martha explained, adding that they had also summoned Mrs. Titcomb, who "did not arive till after the Birth." Davis came to see the mother and child that afternoon, whether on a cordial visit or to determine whether Hitty had remained true to her accusation, we do not know. Davis, a Plymouth Company heir and clerk of the country court, was not disposed to marry the mother, but he seems to have paid child support until the baby died at the age of three (see Chapter 7).47 Martha was not summoned, however, to what may have been an even more sensational delivery. On August 29, 1795, Henry Sewall reported in his diary that "last night Charlotte Cool, who lives in character of Household Servant, gave birth to a second bastard child at Peter Parkers, said to be by Colo. Wm. H---d." For Sewall, there must have been great satisfaction in the event. Mrs. Parker, the woman whom Martha delivered in December
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Traditionally, the attending women at a delivery joined in a celebration afterward ("the Ladies who assisted took supper after all our matters were completed"), sometimes staying the night if there was room in the house or the weather was bad ("took a nap by the fire after midnight. Her women all tarried"). There would be a clutter of beds in the kitchen and chambers as the women fitted into the niches of an already crowded household. "There were 22 in number slept under that roof the night," Martha reported after one delivery, including in her count the children and hired helpers and visiting relatives as well as the attending neighbors. Some women could afford an it "elligant dinner" for their women; others sent their midwife home searching her clothes for fleas. There was piety in some households ("We all took some repose ... took Breakfast and afterwards attended prayers"), confusion in others ("his mother had fitts after [the] delivery. I attended in Each room and left all cleverly"). At the house of Scip Moody, one of Hallowell's free blacks, there was more neighborly concern than space. "I tarried all night, Mrs Cain & Ben White's wife allso," Martha wrote. "We had no where to sleep so we sett up."50 During another all-night vigil, Martha herself became the patient. "I had a severe Cramp in my Limbs in the night ... the Ladies who were there used me with great kindness."51 Perhaps there was a kind of pleasure in nursing the friend who had so often cared for them. The third stage of birth -the lying-in period- began with
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For this reason the diary tells us less about the postpartum period than about delivery itself. The few descriptions that survive suggest that the term "lying-in" was a misnomer. Most women spent very little time in bed. Even in the first hours after delivery, mothers were not allowed to languish. "Got my patient up, Changd her lining [linen] and came home," Martha wrote, in this case twelve hours after delivery, or "help[ed] Mrs William up & maid her Bed and returned home." Commenting on a casual visit to another patient, Martha described what must have been the normal process of recovery. Six days after delivery Martha found Mrs. Joy "down in her kitchen. Shee Came out of her Chamber yesterday. Shee informs me that shee has made her Bed this three days. Her infant is finely."53 It wasn't the size and position of the woman's uterus but her ability to make her own bed that signified recovery. Mrs. Joy may have been a day or two ahead of schedule. Under normal circumstances a woman "kept chamber" for a week, gradually assuming responsibility for the care of her infant and her own surroundings until she was able to "return to the kitchen," a ubiquitous and apt description for the end of lying-in. The length of convalescence depended upon the economic circumstances as well as the physical condition of the mother. As the birth entries make clear, the range of resources and of housekeeping skills among Martha's patients varied widely.
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For many Maine women, as for their English counterparts, alcoholic drinks were a part of lying-in. A store manager in another part of Maine wrote his employer, "The women in these parts have been very fruitfull this winter and had I not assisted many of them with tea, sugar, rum &c in their lyings in I do not know what would have become of them, for they seem destitute, of all comforts, and their husbands are to repay in labour." Two days after her niece Pamela Porter was delivered, Martha sent her the same list of commodities, minus the tea. The continuous caution of the prescriptive literature against the use of "strong spiritous liquors" during lying-in reinforces the evidence. The concern of some authors was that strong beverages would induce fevers by adding heat to the body. Thin water gruel was much better, they insisted, than caudle or thick gruel mixed with liquors.54 Maine women did not agree. Rum, sugar, and tea were necessary comforts for a lying-in. The scarcest commodity in Hallowell households was not rum, however, but help. As we have seen, the same young women who warped looms and swept kitchens in Hallowell occasionally did nursing ("Parthena gone to nurse Mrs Foot"; "Philip Bullin conducted Becky Fought to his brothers as nurse after birth"). Few of these young nurses could stay long, most having other obligations to their families or employers. After one of her own daughters delivered, Martha noted that Debby Low had come and gone in a day and that the mother had no help except for her sister, who had brought her two young chil-
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There were a few older women who specialized in nursing, and those who could afford them were fortunate. Martha Ballard and Henry Sewall both mentioned Mrs. Conry or Conner. Since neither surname appeared on either the 1790 or 1800 census for Hallowell, Augusta, or other nearby towns, she may have been a widow living as a dependent in a daughter's or sister's house. Mrs. Vose, probably the wife or mother of one of the men by that name in the town, also did nursing, as did Mrs. Stone. Nurses were probably paid less than midwives, though in some families, at least, they inherited the traditional place of honor at an infant's baptism. At the baptism of one of the Reverend Mr. Foster's children, "Mrs Vose carried it." Henry Sewall gave Mrs. Conner the same honor when his daughter Mary was baptized.56 A successful delivery did not assure the survival of the child, nor
did all women pass through the lying-in period without incident. Experienced
afternurses could handle the usual complications, though occasionally
Martha was called back to administer remedies two or three days after
delivery. "Shee had an ill turn. Her milk is Cuming," was the common explanation.
There were more exotic complications, of course. Two weeks after a birth,
Martha went back to the Norcrosses and "Cleard her infants breasts of
milk." Women then as now suffered from afterpains, hemorrhoids, and phlebitis.
In thirty-eight of the 481 births between 1785 and 1796, Martha returned
to her patients to treat some sort of complication. In thirty-four of
these cases, at least one specific symptom is mentioned. Seven women had
sore breasts, three experienced fever, two had taken cold, another had
contracted a sore throat, five had an "ill turn" when their milk came
in, another a severe headache, two experienced unusual weakness, and one
had cramp pains a month after delivery. Six days after delivery, Moses
Sewall's wife was "Exercisd with a swelling in her Left Legg & Severe
pain." In the final case, Martha attributed the postpartum crisis to the
misbehavior of a husband.57
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As we have seen, five of Martha's patients died during the lying-in period. One woman was seriously ill with the measles when she gave birth. Another was in convulsions when she delivered a stillborn daughter and was still experiencing "fitts" four days later when she died. She was no doubt a victim of eclampsia, the most severe stage of an acute toxemia of pregnancy, a condition that is still considered one of the gravest complications of childbirth today. The other women may have died of puerperal infection, historically the major cause of deaths in childbed. The infectious quality of puerperal fever was first suggested in the 1840s by Dr. Oliver Wendell Holmes in the United States and Dr. Ignaz Semmelweis in Austria, but the bacteriological nature of the disease was not settled until the 1880s, when Louis Pasteur demonstrated the presence of what is now known as streptococcus in patients suffering from the affliction. Puerperal fever is a wound infection caused by the invasion of the uterine cavity by a number of bacteria, alone or in combination. The patient may feel normal in the first few days after delivery, but then an elevation in temperature, headache, malaise, and pelvic pain signal infection. (With certain strains of bacteria there is a profuse discharge characterized by a peculiarly foul odor.)59 The description of Mrs. Craig's death fits the pattern. She was "safe Delivered of a very fine Daughter" on March 31, 1790. Five days later Martha reported finding her "not so well as I could wish." The midwife returned the next day and administered a "Clister [enema] of milk, water, & salt" and applied an "ointment & a Bath of Tansy, mugwort, Cammomile & Hysop which gave Mrs. Cragg great relief." A week later she was
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Martha attempted no diagnosis in this or in the remaining cases, though infection seems the likely cause. As we have seen, Mrs. Caton died four days after delivery during the scarlet fever epidemic of 1787. The remaining women fell ill a few days after delivery and died two weeks later. What is significant about these five deaths, of course, is their rarity. A woman might experience acute discomfort during lying-in-afterpains, sore nipples, swollen legs, and even "Deliriam"-but few died. Most women went through delivery every other year, summoning a midwife, calling their women, welcoming the afternurse, returning to their kitchens. For the next year they would breast-feed the newest baby while caring for the older siblings, fitting in work at the loom or in the barn and garden as they could. Some historians have discerned an effort in New England toward the end of the eighteenth century to control family size. There is little evidence of that in Hallowell. Even with incomplete registration, there are more than seven children per family in the town clerk's records. Martha delivered four women of a twelfth, one of a thirteenth, two of a fifteenth, and one of a sixteenth child. For most women, breast-feeding retarded conception, creating birth intervals that averaged twenty- four months, in Martha Ballard's practice as in most of the western world. Martha was impressed enough to note it when Ezra Hodge's wife delivered her fifth baby just two months after her oldest child turned five, but such feats of fertility were rare.61 The rhythm of childbearing kept the traditional beat. If there was any effort at family limitation, it came toward the end of the childbearing years. In some families, birth intervals grew further apart; in a few, deliv-
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Since a family labor force was the basis of the New England economy, parents were understandably concerned about producing the proper balance of boys and girls. In about a quarter of her delivery entries, Martha noted the birth order of the child, and often the sex ratio as well. "Her 8th Child; the number of sex are Equal," she wrote, or "7th Child of which 4 are daughters."62 (These descriptions give no indication of a gender bias; Hallowell women gave birth to "fine daughters" as well as "fine sons," though the adjective "lusty" may have been reserved for boys.) Martha was pleased when Mrs. James Hinkley "was safe dilivrd at sun set of a daughter," explaining that the woman had seven sons and until then only one daughter, then "in her 15th 5th year." Martha's neighbor Lydia Densmore had the opposite problem. In 1797, she gave birth to her twelfth child and ninth daughter. Fortunately, the family business -tailoring and dressmaking- was well adapted to girls.63 What was expected, then, was a heroic commitment to childbearing, an outlook reflected in Martha Ballard's own willingness to spend herself in delivering others. She was compassionate, gentle, concerned for her neighbors' welfare, but though she assumed that a certain amount of suffering was the
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More distressing was the behavior of her old friend and neighbor Elizabeth Weston, who was overwhelmed by her last pregnancy, an unexpected and probably unwelcome event. She was forty-five years old, her youngest child already six. Furthermore, since her daughter Betsy had recently married Thomas Fillebrown, she was more disposed to welcome grandchildren than another child of her own.65 Her anxiety grew more intense during the last weeks of pregnancy. Though her previous delivery had been uneventful, she grew fearful that this one would not go well. There were as yet no physical signs of labor, but she wanted her midwife with her. Martha spent almost two weeks in and out of the Weston house, leaving when necessary to deliver other women. "Mrs Wesson remains much as shee has been," Martha wrote on October 28, after four days of sleeping and waiting with no sign of labor. "[She] Consented that I should go home & see how my famely were." If there had been a half-frozen river between them, the long vigil might have been justified, but the Westons and the Ballards were still relatively near neighbors despite the Ballards' removal from the mills. Still, Martha returned the next day, listening, watching, and apparently growing increasingly annoyed. "Mr Wesson brot me some work, she wrote on November 4. By November 6 she had had enough. "I Came home," she wrote. "Mrs Wesson as well as she has been." The woman presumably got the point. When she called again she meant it. The summons came on November 9 at 3:00 a.m., and "Shee was safe delivered at 4 hour 30 minutes of a fine son." A safe delivery did not relieve
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A harsh judgment from an old friend. When Martha returned a month later, Mrs. Weston was as determined on illness as ever. "She is weak," Martha reported, adding by way of explanation, "Shee has not walked her room any since shee was put to bed. Her infant is at Mr Hewins."67 Perhaps one of the town's physicians took over the management of her case. Martha had nothing more to say about it. She delivered Elizabeth Weston's daughter Betsy Fillebrown of her first child on February 2, making no reference to the presence or absence of the grandmother. (Mrs. Weston was, however, clearly present when her daughter gave birth to a second child two years later.) Perhaps there was a brief estrangement between the two women, though if so the old patterns of neighborliness had clearly been restored by the end of the summer.68 In sending out her infant to be nursed, Elizabeth Weston violated a particularly strong taboo. Only a severe and intractable illness could justify separating a mother and child. When Lucy Towne fell ill of a fever a week after delivery, she struggled to continue nursing her child. Not until ten days later, when the baby itself seemed to be suffering, was a neighbor summoned to give "the poor Babe suck," Martha explaining that "its mammy has not but very little for it." Even then, steps were taken to preserve lactation against the time when Lucy would once again feed her child. "Lucy is a little mending," her mother wrote. "Parthena drew her Breasts got a small matter of milk." During this period two different neighbors nursed the baby.69 A considerable part of Martha's medical practice involved treating infants for "sore mouths" and their mothers for "painful breasts." Women could develop abscesses at any time during lactation. Martha had various remedies. In one case, after a poultice of sorrel proved ineffective, she "opened" (lanced) the breast. When one of her own daughters developed an abscess
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For Martha the final stage of any delivery was collecting her fee. In the margin of her diary entry for December 17, 1793, she wrote, "Receivd 12/ March 5th 1794 of Mr Hamlin." That Theophilus Hamlin paid twelve shillings for his daughter's delivery was unusual; that it took him three months to do so was not. Martha's standard charge in the 1790s was six shillings, paid in cash, in kind, or in credit at one of the local stores.71 Perhaps more payments were in kind than the cash values recorded in the diary would indicate. On November 28, for example, in the diary excerpt that opens this chapter, she wrote, "Mr Lathrop paid me my fee for attending his wife the 19th of March last." In the margin of the March 19 entry, she wrote, "receivd sugar Nov 28." Midwifery payments reflected the economy of the town. In the course of her career Martha received everything from "1m shingles" to "a pair flat irons." Most payments were in food, textiles, or household necessities: cheese, butter, wheat, rye, corn, baby pigs and turkeys, candles, a great wheel, unwashed wool, checked cloth, 1/2 quintal of cod, teapots, thimbles, a looking glass, handkerchiefs, and snuff. Martha rarely commented on a payment unless it was unusually generous or notably meager. "Received 2 lb coffee, 1 yd ribbon, & a cap border as Extraordinary for waiting on her," she wrote after one delivery. In contrast, Savage Bolton gave her "1 1/2 Bushl of apples in the fall not very good."72 She occasionally "forgave" a family the fee. When she delivered Charles Clark's fourth child, she noted "her 3d is destitute
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Fees exceeding six shillings usually meant additional expenses. "I receivd 9/ as fee & hors hire & medisin," she wrote after an arduous journey on muddy roads to the Buzel delivery. Probably most husbands avoided the cost of "horse hire" by fetching the midwife themselves or by relying on a neighbor. That fewer than a fifth of Martha Ballard's patients in 1793 paid more than six shillings suggests that she used medicine sparingly. The length of labor did not affect the fee. She spent a day and a half with Mrs. Hinkley and only five hours with Mrs. Coutch, though she received exactly the same fee, six shillings, from each. Payments larger than nine shillings were very rare during any part of her career. In fact, the conclusion is inescapable that it was the generosity or affluence of the father rather than extra services by the midwife that accounted for very large fees. Certain men among the Kennebec gentry-William and John Brooks, Theophilus Hamlin, Chandler Robbins, Samuel Colman--almost always paid twelve shillings or more. Henry Sewall stayed closer to the six-shilling standard, though in October of 1799, when Tabitha delivered her eighth child, a daughter, he gave Martha Ballard twelve shillings. Perhaps he was especially
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Peter Parker's payment didn't make it into the margin of his daughter's birth entry in 1793, but he eventually paid, and paid generously. "Mr Parker gave me 18/ for attending his Lady in her illness with her Last Child," Martha wrote on January 27, 1794. A few days later, after another trip to the Parker house, she added, "his Lady made me a present of 1 1/2 yards ribbin." After crossing the river eight times and spending nine full days at the Parker house, off and on, she deserved the extra payment. Not all her patients had the wherewithal or the inclination to act accordingly. She received only six shillings from Mrs. Norcross after that famous April delivery (described in the Introduction), even though she had made four trips downriver and had spent nine days waiting for a "lingering labor." The Norcross case was by no means an isolated one. One year Martha spent two days each with Mrs. Hersey, Mrs. Pierce, Mrs. Cocks, and Mrs. Plaisted, four days with Mrs. Savage, and made three trips to the Sewalls', spending a total of seven days with Tabitha. Two husbands paid six shillings, one seven, one nine, and another apparently nothing at all. Henry Sewall gave Martha eight shillings and three pence.76 The length of labor was clearly one of the acts of God over which neither the midwife nor her patients had any control. Martha's standard fee -six shillings- is comparable to what Ephraim could claim for a day spent "writing plans" or appraising an estate. Of course, the time involved in a delivery was more variable (and the hours less appealing). Still, midwifery paid better than most female occupations. For example, a weaver working full-time at her loom could earn at most four shillings a day. Because most men seem to have taken pride in paying for their wives' deliveries, midwifery also gave Martha greater access to cash or store credits than women whose trade was entirely within the female economy.77 Perhaps most of the cash values listed in the diary really were a form of credit. When Martha stopped in at Captain Molloy's store on December 9,
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1793, to buy a shawl, she was probably collecting part of the twenty-four-shilling
fee he had given her three weeks before. It is not surprising that the
really big fees in the diary, those double, triple, and even quadruple
fees offered in about 15 percent of cases, were offered by storekeepers
and merchants. They could afford that kind of extravagance since, with
the markup, twenty-four shillings at the store cost them considerably
less. John Sheppard was the most consistently generous of the merchants,
probably because as agent for the Vaughans he could afford it. The "Elligant supper" served after Mrs. Molloy's delivery reinforces the notion that John Molloy was showing off a bit in multiplying the midwife's fee. Prosperity did not ensure domestic tranquillity, however. Martha Molloy gave birth to a second child two years later and then disappeared from Martha's midwifery records, presumably because she and her husband had moved to Portland or some other coastal town, though his shipping business occasionally brought him back to Hallowell. (On June 13, 1796, Martha noted: "Capt. Molloy sleeps here this night.") In 1801 Martha Molloy sued for divorce in the Supreme Judicial Court, charging her husband with desertion and adultery. Supporting testimony came from Mary Wyman of Salem, Massachusetts, who admitted that John Molloy was the father of her illegitimate child. Her deposition did not spare details:
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Martha Molloy was one of two Hallowell women to get divorces that year.
Nabby Sylvester (another of Martha's patients) also charged her husband
with infidelity, claiming he had "committed divers act of Adultery" in
Boston and in the West Indies.79 Martha never mentioned these divorces
or any others in the diary. Still, her quiet entries suggest the realities
of maritime marriage. After a delivery at Nathan Burges's house, she wrote
drily, "Her husband is at Sea if living."80 Some weeks she barely thawed from one journey before she began another. Setting out in a "doleful storm," she went by horseback as far as Pollard's tavern, then took a sleigh upriver to the Boltons', Mrs. Savage with her. "We were once over sett," she wrote, carefully accounting each mishap. "Once I got out & helpt push behind the carriage. We arivd safe at sun sett." The baby was born at eight; at six the next morning ("clear but very high wind") Martha was on her way through the brilliant cold to a house five miles downriver. "Men shoveled through
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The Kennebec country offered adventures for every season. Even in good weather there was a certain thrill in crossing a modest stream "on the string piece of the bridge." Given the rough country beyond the river, riding was also unpredictable. "My hors mird in a swamp and I fell off," Martha reported after one delivery. The mire "by the Bridg between here and Densmores" was also a pitfall, though ordinary ruts and ridges could be just as troublesome. "The hors Blunderd & I fell & hurt me," Martha would write, usually without further comment or explanation. The family horse was a stumbler, but he was at least familiar. Mounting Captain Springer's horse after another delivery, she found herself thrown to the ground as the beast ran under a shed. "Broak my specktakles and allmost my limbs," she reported drily.83 Since she generally rode sidesaddle, failing off a horse was easier, but perhaps less dangerous, than it would have been if she had ridden astride. At least she was well padded with petticoats and skirts. She certainly preferred sidesaddle. "I wrote a mans saddle which fatagud me very much," she complained after one journey home.84 A cloudy night could transform any journey into a pilgrim's progress, as on the April night when she and Woodward Allin "carried a candle to the top of Burnt Hill." Lacking light, she resorted to wilderness savvy. "Calld in hast to go to Mr. Whites," she wrote. "The Boys Landed me at Jackson Landing. I took off[f] my shoes & walkt in my stockins. Steerd as strait a Coars as I Could and reacht Mr Whites very soon but was much fatagued."85 Martha was proud enough of her adventures to write about them, though she was also pleased to note when more commodious transportation was available. "Was conducted home in a carriage by Mr Pitt," she wrote after delivering Jonathan and Sally's second baby. But there was little danger of her growing
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What took Martha Ballard out of bed in the cold of night? Why was she willing to risk frozen feet and broken bones to practice her trade? Certainly midwifery paid well, at least by the standards usually assigned women's work. Martha cared about her "rewards," and she kept her midwifery accounts carefully. Yet money alone cannot account for her commitment. Nor is it enough to say that serving others was her way of serving God. She interpreted her work, as all of life, in religious terms: God rescued her from the spring flood, sustained her through difficult deliveries, preserved the lives of mothers and children, and gave her the strength to continue her work. (Even such a prosaic end-of-the-year summary as "I have Lost 42 nights sleep the year past" was a kind of spiritual accounting.) Yet religious faith is also an inadequate explanation. Midwifery was a form of service and a source of material rewards, but even more than that it was an inner calling, an assertion of being. Martha Ballard's specialty brought together the gentle and giving side of her nature with her capacity for risk and her need for autonomy. The fathers who fetched her in the black of night leaned on her skill, offering her the command of their horses and bedchambers, bestowing lumber credits and teapots for her service. The women who circled around her at the height of travail respected her caring and sustained her strength. The women who reached for her in the anguish of travail extended her motherhood in their own. Martha Ballard needed her patients as much as they needed her.
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| Notes |
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Notes for Pages 162-170 Chapter Five
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Notes for Pages 170-179
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Notes for Pages 180-185
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Notes for Pages 185-193
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Notes for Pages 193-201
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Notes for Pages 201-217
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