God-fearing and Faithful Women

Midwife Problems, and Solutions, Part 3

This is part three of a series on midwifery in Sweden and the United States. To read part one, click here, to read part two, click here. 

Johan Van Hoorn, 1662

​     1697 was a difficult year in Sweden. King Charles XI had died in April. Although he had expanded the Swedish empire, the last two years of his reign were characterized by a devastating famine that spread across the empire. King Charles XII ascended to the throne at only 15 years old. The aristocrats, who made up only a small portion of the population but had a majority of the wealth, now wondered whether the King, just a boy still, would continue consolidating power to the crown or whether they would get some power too. 

      And during all this uncertainty, Johan van Hoorn was hoping someone would listen to him and his talk of jordegumman. Van Hoorn had studied medicine in the Netherlands and Paris, and had returned to Sweden to practice medicine and ended up spreading his gospel of training the midwife.
      In Old English, midwife means with-woman, in Swedish jordemor (the jord comes from the Old Norse word for child or offspring) and barnmorska both mean child-mother. In Sweden at the end of the 1600s, most were untrained women known as jordegummor. Van Hoorn wanted to elevate their status, he wanted to make them barnmorskor. First, he put out the textbook called Then Swenske wäl-öfwade Jord-Gumman in 1697.  In 1715, he published The Twenne Gudfruchtige I sitt kall trogne Och therföre af Gudi väl belönte Jordegummor Siphra och Pua, a textbook of questions and answers for midwives. 

A 1719 version of Van Hoorn's textbook, in the Svensk Barnmorskeforening archive.

     The title of the textbook came from Exodus, when the Pharaoh went to Siphra and Pua, the Hebrew midwives, and commanded them, “When you are helping the Hebrew women during childbirth on the delivery stool, if you see that the baby is a boy, kill him; but if it is a girl, let her live.” They did not listen; they were good, God-fearing women, and they had a duty to protect women, to protect babies, and would not kill the boys. ​ For Van Hoorn, the story became the catalyst for the recognition and training of midwives in Sweden.

Copies of royal decrees regarding midwives, in the Svensk Barnmorskeforening archive. The earlier texts refer to the profession as Jordegummor, the later as Barnmorskor.

     Van Hoorn was able to establish the first regulation on Swedish midwives in 1711 after trying for over six years. His efforts made it so that women who wanted to be recognized as midwives either needed two years of instruction as an apprentice to an experienced midwife or they needed to have passed an exam by the Royal Collegium Medicorum. 
     Physicians formed the Collegium Medicorum in 1663 with the blessing of the monarchy to regulate the doctors in Stockholm. Like most professional organizations, the doctors had their own best interest in mind. 

They wanted to separate the wheat from the chaff, the trained continental doctors like themselves from the quacks who claimed they could heal the sick. By 1752, the first clinical training of doctors began and Sweden’s first hospital Serafimerlasarettet opened with two beds for delivery.  A strong, centralized government meant that it took and meant to be a midwife in Norrbotten would be the same as what it took and meant to be a midwife in Skåne, and a centralized committee of doctors in Stockholm would be the ones who made that decision.  
     In 1775, the “Publiqua Accouchements- och koppympninghuset” opened, which became the Allmänna Barnbördshuset. The Collegium Medicum moved all midwifery teaching there, with training that would be both theoretical and practical. In 1777, a new regulation stated that all midwives in the whole country should be able to read and write, and be God-fearing, honorable, gentle, and sober. ​

     Schools opened in Stockholm (Södra BB, right), Göteborg, and Lund (above left). To get in, a woman had to be between 22 and 35; she needed to provide her hometown and how she had made a living until that point; she had to be healthy; she had to know how to read Swedish and Latin, understand basic math, and have good handwriting. In the United States during this time, doctors didn't even need this much education to practice. 

Midwifery students in the 1880s.

     With respect for the profession came competition. For the fall of 1876, 144 women applied to the Läroanstalt in Stockholm, and only 30 were accepted into the class. Becoming a midwife was one of the only professions for women -- other than teaching or nursing -- and it was clearly popular. 
     Even though midwives were professionals, rules still came from Kungliga Medicinalstyrelsen (what the Collegium Medicum became in 1878), and the midwives themselves didn’t have a lot of say in their own business. In the 1880s, one very dedicated women and one dedicated man set out to change that. 

Next time: the professionalization of midwives in Sweden, and the creation of the Swedish Midwives Association.