A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812

The entries in the beginning of Chapter 5 feature a number of the 53 births that Martha attended in 1793. She attended deliveries up and down the town, outside of town limits, and to mothers of varying social and economic standings. She delivered 29% more babies than the year before and at irregular rhythms. Though 53 births in one year averages out to one birth per week, it was never that regular. Martha may have no midwifery duties for weeks before having to scramble for a number of deliveries in a short period of time, including two on December 7. Maine weather and the unpredictable conditions of the Kennebec River were complicating factors, especially in the winter. False labor occasionally brought Martha to mothers not yet in labor, but as Ulrich explains, “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” (195-96). For birth 51 at the Parker house, Martha visited four times before labor started and the baby arrived. 

Martha was methodical in her recordings of births in her diary. In the left margin, she put the sex of the baby, the father’s surname, and XX for fee paid. She also included in the entries themselves her time of summons and departure, the exact time of the baby’s birth, the condition of both mother and baby, and her method of travel—on foot, by sleigh, etc. Ulrich notes that while many of birth entries are themselves unremarkable, as a whole they offer an unprecedented look into 18th-century obstetrics. Her success appears in what she did not include in her entries. Of 814 births in her career, only 46, or 5.6%, include any reference to complications. In addition, Martha saw only one maternal death per 198 births, a number that is lower than the average in 1930 (one maternal death per 150 births). 

Martha’s entries about childbirth were terse, as she was hesitant to include a significant amount of information about her patients—her friends and neighbors. Even doctors who published work were occasionally reserved, as was the custom. Martha’s lack of detail also indicates the traditionality of her work; she was not writing an instruction manual for new techniques. She also did not use technical terms like “vagina” or “pubis” or even “labor”; the women were in “illness” or “unwell.” Even when doctors attended deliveries, Martha’s language remained opaque; she described Dr. Page “clos[ing]” a patient’s “loin,” which likely meant he delivered the placenta before bandaging the woman’s abdomen and thighs. 

The retrieval of the placenta was a contentious subject during this period. Physicians believed it was essential to retrieve the placenta immediately, even if it meant reaching their hands into the patient’s uterus. Other doctors believed it better to let nature take its course. Martha’s silence on Dr. Page’s method suggests her tacit approval, but her use of the word “choose” when describing the closing of the loin implies Martha’s concern over the increasing role of doctors in midwifery, especially Dr. Page, who at only 24, wanted to increase medicine’s role in midwifery. He made mistakes that Martha noted in her diary, such as giving laudanum to a woman already in labor—laudanum was advised only for false labor, now known as Braxton-Hicks contractions—and delivering a stillborn baby with terrible limb dislocations. Some of the fashionable families of Hallowell favored physician-attended births, but overall, the role of the midwife remained secure. 

The rise of the practice of obstetrics was not unique to Hallowell. Ulrich writes, “Historians have attributed the rise of ‘male-midwifery’ in England and America to two factors, fashion and forceps” (209). Forceps as a tool were a “humane alternative” to the former practice of a surgeon carving and dismembering a fetus to save a dying mother during labor. Martha personally only called for a physician during two labors in her entire career, so forceps alone could not explain the introduction of male midwifery to Hallowell, given how few emergency births seem to occur. 

Ulrich examines the different stages of labor, now known by scientific terms, but that to Martha were defined by social terms: Stage one brought the midwife, stage two brought the neighbor women to support the mother, and stage three brought the afternurse. The women who supported the mother were there for both mother and midwife. As Ulrich notes, “Most early American women literally gave birth in the arms or on the laps of their neighbors” (215). With births of children of unmarried parents, the women were also important, serving as witnesses. The postpartum period was less prevalent in the diary, as afternurses performed most of the care after the birth. Martha would return if there was a medical issue that necessitated it, as in the case of lactation issues or puerperal fever, an infection of the uterus that likely killed five of Martha’s patients during the lying-in period. 

Ulrich also looks at the birth rate and family size of Hallowell; families had many children, because as seen in Chapter 2, children were an essential part of the family economy and an essential form of labor. Families wanted the ideal balance of girls and boys, which explains Martha’s notes in the entries of how many children of each gender the families she attended had. Women were committed to the social expectation of childbearing, which explains Martha’s commitment to midwifery and the self-sacrifice required by her trade; womanhood existed with some level of suffering built in. Women were expected to birth and feed children, and a refusal of these expectations—seen in Mrs. Weston’s dismay over a geriatric pregnancy and Elizabeth Weston sending her child away to be nursed by someone else—was taboo. 

Ulrich then explains Martha’s fees and the expectation for a midwife’s pay, which reflected the economy and could have been anything from money to a variety of goods. Her standard fee was six shillings, regardless of how long the delivery took. 

The journeys Martha made for the deliveries appear prominently in many entries, showcasing the intense and demanding nature of midwifery, which Ulrich notes was not just about material gain, but “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” (235-36). This is why she was a midwife, why she trekked through the snow at all hours of night to assist women from all over her community.