A Case Study of Martha Ballard and A Midwife's Tale

Before you come to class for our discussion about women in the early republic, please read the following background information, some of which has been excerpted from the web page of the Public Broadcasting System at http://www.pbs.org.  The book, A Midwife's Tale, was written after historian, Laurel Thatcher Ulrich received a copy of the diary written by Martha Ballard between 1785 and 1812.  Ulrich spent 8 years researching and writing Martha's story - a journey that brought her into contact with the diaries of two prominent men who also lived in Hollowell, Maine when Martha was alive, with literally thousands of archival documents about life in Hollowell at the turn of the Century, and with hundreds of other books written about New England during this pivotal time in American history.

An excerpt from Martha's book gives you some idea of a typical entry included in the diary:

August 1787
"I am at Mrs Howards watching with her son. Went out about day, discovered our saw mill in flames. The men at the fort went over. Found it consumed altogether with some plank & bords. I tarried till evinng. Left James Exceedingly Dangerously ill. My daughter Hannah is 18 years old this day.  Mrs Williams here when I came home. Hannah Cool gott Mrs. Norths web out at the Loome. Mr Ballard complains of a soar throat this night. He has been to take Mr gardners hors home."
                                         .....   Martha Ballard
To help contemporary Americans understand eighteenth-century America through a woman's eyes,  Laurie Kahn-Leavitt worked with Ulrich to produce a movie that chronicles the stories of two remarkable women: an eighteenth-century midwife and healer - Martha Ballard -  and the twentieth-century historian who brought her words to light - Laurel Thatcher Ulrich.   A Midwife's Tale unfolds as a detective story with Ulrich puzzling out fragments from Ballard's diary entries to provide her with the eighteenth-century details that uncover the rich texture of everyday life at the turn of the century.

In 1785, America was a rough and chaotic young nation, and Maine its remote northern frontier. That year, at the age of 50, Martha Ballard began the diary that she kept for the next 27 years until her death. At a time when fewer than half the women in America were literate, Ballard faithfully recorded the weather, her daily household tasks, her midwifery duties (she delivered close to a  thousand babies), her medical practice, and countless incidents that reveal the turmoil of a new nation--dizzying social change, intense religious conflict, economic boom and bust--as well as the grim realities of disease, domestic violence, and debtor's prison. By cataloging Marthaís diary entries, comparing it with two other diaries written by men in the community of Hallowell, and cross-referencing other documents that mentioned the people Ballard encountered and events she experienced on her constant travels as midwife and healer, Ulrich painstakingly recreated Ballard's world.

Two topics which both the book and video explore in detail are summarized below - the role of midwifery in early America, and the customs and rituals surounding courtship and marriage.

Midwifery in Early America

Martha Ballard delivered babies in a cooperative system of female midwives and male doctors. Midwives were used by women of all social levels to deliver normal births. Doctors were called when birth became a medical emergency. A medical emergency usually meant that the birth was obstructed, the lives of mother and child were threatened, and intervention, such as the use of forceps, was necessary to save the life of one or the other. In fact, this never happened in Martha Ballard's practice. Most of the time she delivered babies successfully and left mother and child "cleverly." In one case, that shown in  the film, the family summoned the doctor during a difficult labor when Martha did not feel the summons was warranted. The doctor, young and inexperienced Benjamin Page, prescribed opium, which  stopped the labor temporarily. He then left, the opium wore off, and Martha Ballard proceeded to deliver the child successfully. Martha noted in future diary entries, apparently disapprovingly, the further bunglings by young Dr. Page. Nevertheless, after he gained experience and wisdom, Dr. Page was probably the one who replaced Martha Ballard when she died. When Benjamin Page died half a century later, he had become a successful specialist in childbirth, revered for his gentle willingness to let  nature take its course, intervening only when absolutely necessary.

In most cases, Martha Ballard was not at odds with the doctors practicing medicine in Hallowell. She and the other female midwives delivered normal births and treated the diseases of women and children in a tradition that stretched back many centuries. The tradition of female midwives was part of a social network of women far different from the professionalized, doctor-centered system of medicine that we have today.

In Martha Ballard's social medicine, birth was a summons for a gathering of women and a series of predictable, customary stages. The midwife was called by a male, usually the husband. The midwife arrived to assess the situation, and when labor had proceeded far enough, the woman was brought to bed. The neighborhood women were called and they gathered. The birthing room was darkened and sealed off from men. The mother's "caudle," the alcoholic drink for the mother after delivery, was prepared. Following delivery, there was rejoicing and usually food.

During labor and delivery, the midwife had authority over the other women, even if in ordinary life the midwife was of lower social standing. Probably she alone was allowed to touch the private areas of the woman's body. And she often made the decision to call a doctor when the birth was beyond her abilities to help. In the past, calling the doctor was a fearful decision, because it meant that the birth was not normal and that the death of mother or child was likely. The doctor's job was often to sacrifice the life of one to save the other.

Although some midwives attended 50-100 births per year, the caseload of most eighteenth-century rural midwives might appear light to our eyes - perhaps 12-20 cases a year. The midwife was physician to women and children, offering both prenatal and postnatal care. Twelve to fifteen such cases could require much time and travel. During her 35-year career, Martha Ballard's busiest year was 1796 when she attended 59 deliveries. By contrast, she delivered only three in 1808. Midwives habitually delivered normal births, which probably comprised 98% of births. Complications were rare, so midwives had little opportunity to become acquainted with and handle unusual births.

Male possession of delivery instruments such as the forceps does not entirely explain the greater use of male doctors in normal births after Martha Ballard's time. The gradual rise of male doctors also had social and economic origins. As with the Industrial Revolution, the trend began in England sooner than in New England. The preference for male doctors traveled across the Atlantic via midwifery manuals, fashion, and formal education.

The Ballard diary indicates that Martha Ballard experienced the beginnings of the change but was not displaced by the male doctors. She and women of all social ranks in Hallowell still surrounded birth with female customs, and doctors were still usually relegated to emergencies.  The trend toward using male doctors for normal births correlated with change from the part-time midwife and physician to the full- time physician. Most doctors in and around Martha Ballard's Hallowell were of the old, part-time breed. Dr. Page was different. He and other doctors in his generation aspired to practice full-time. They saw obstetrics as only part of a larger, full-time medical practice.

The rise of male doctors in New England was institutionalized in the nineteenth century with the organization of male medical societies that succeeded in becoming the licensing agencies for medical practitioners. One hundred and fifty years of legislation and more scientific changes (such as the use of anesthetics, more frequent surgery, and antibiotics) brought birth out from the circle of women and into medical settings like hospitals.

The future of midwives looked solid in Martha Ballard's time, yet in the next two centuries vast changes overtook childbirth in the United States. Some of the changes can be explained by technological change and medical developments. Some can be explained by fashion and class differences. And some of the changes can be attributed to the genders of doctors and midwives. As Laurel Ulrich has written about male doctors in obstetrics, The terms "man midwife" and "lady doctor" suggest the importance of gender in the history of medicine. In Europe and America in the eighteenth and early nineteenth centuries, male physicians began to deliver babies. In the early nineteenth-century United States, a few women assumed the professional identity "Doctor."

These role reversals were more complex than sometimes assumed. The "man midwife" and the "lady doctor" were both ancestors of our modern obstetrician. Yet tracing the rise of professionally-oriented, hospital-based childbirth is only part of the story. Lay midwives persisted in the United States well into the twentieth century, while nursing itself professionalized, helping to pioneer the new field of public medicine.

The picture was evolving with more female midwives, nurse-practitioners, family-centered births, home births, and an increase in female physicians. Martha Ballard, however, was largely untroubled by the changes. She worked in cooperation with male doctors, as did most midwives of her time. Even her disagreements with Benjamin Page were muted and leavened by cooperation. As the diary entries attest, Martha Ballard called on male physicians for herself, her family, and her clients
when custom and judgment advised.

Customs and Rituals Around Courtship and Marriage in Early America

Customs and rituals around courtship and marriage reflect how and why society exerts control. In Northern New England, as elsewhere, these were events too important to the community's well-being, lines of authority, and perpetuation to leave to chance. Customs and rituals controlled sexuality, recognized changes in the life cycle, defined and ensured economic relationships and responsibilities, defined and ensured social relationships, and affirmed membership in the community.

The English colonial heritage of Martha Ballard's Hallowell, Maine, was evident in the rituals and customs surrounding marriage. When a couple wanted to live together and start a household of their own, the community exerted legal control by expecting marriage. Most marriages occurred in early adulthood, between middle- to late- twenty-year-olds. Marriage was needed to establish legitimacy of children born to the couple and to establish rights of inheritance. A couple had to be married in the town where one or the other lived. They had to obtain a certificate from the town clerk affirming that their intentions had been "published." Published intentions to marry were those that had been either announced at three public religious meetings on three different days at least three days apart or else had been posted in a public place for fourteen days.

Publishing marriage intentions allowed time for objections to the marriage to be raised by individuals, the family, or representatives of the community. Objections could be raised, for instance, if either of the two had already promised to marry another, if the marriage were incestuous, if either partner were too young, or if the parents objected to the marriage of underage children.

In the book A Midwife's Tale, Laurel Ulrich noted that 38% of first births in the Ballard diary were conceived out-of-wedlock.  This high percentage was probably representative of the times. Most of those who conceived out-of-wedlock married either before the birth or shortly afterwards. By 1786, premarital sex, though illegal, was not heavily prosecuted, but an unwed mother could and often did confess to fornication, pay a fine about equal to Martha Ballard's fee for attending a delivery, and then sue the father for support of the child.

As another part of her colonial English heritage, one of Martha Ballard's official tasks as a midwife was to query unwed mothers at the time of delivery in order to establish the paternity of the child. It was thought that women could not or would not lie when in the throes of delivery, "in the height of travail." This information was used by the court system to assign responsibility for child support to the presumed father. In such a case, the community's interest was not to punish sexual activity so much as to ensure that the support of the child did not fall onto the community as a whole.

Most women who bore children but did not marry the father immediately went on to marry someone else, eventually, apparently without stigma. The evidence suggests that premarital sexual activity did not ruin a woman's good reputation or her chances for a marriage. Historian's question why. Some surmise that opinion might have been different if there had been a surplus of marriageable women. Whatever the reason, the evidence suggests that moral boundaries around virginity and promiscuity in our own time cannot be used to judge or understand thinking or behavior in Martha Ballard's rural Hallowell.

Marriage signaled changes in social and economic responsibilities, in expectations of social and sexual behavior, in authority, and in legal status. The couple was now autonomous, separate from the authority of the parents. The woman was now expected to obey her husband rather than her father, and the husband was expected to provide for his family. The household became the woman's responsibility as homemaker. The wife could not own property or the income from her labor, but her husband owned both hers and his. A sexual commitment within the marriage was expected by the community and sanctioned by the courts. Divorce was difficult to obtain and only under limited circumstances...

The weddings themselves were relatively minor events, performed at home. In the Ballard diary, the newly married girls did not leave for "housekeeping" immediately after their weddings. Even when they were new brides, the Ballard girls each continued living for a time in the Ballard household while their husbands came and went. The practical demands of setting up new, separate households meant that the necessities had to be bought, made, or gathered. In the diary, we see the women of the Ballard household making bedding, buying pots and dishes, and making or buying cloth for the girls to use in their new households. Presumably "going to housekeeping" waited for the day when enough was ready. This was not a standard waiting period; it varied. Martha Ballard tells us in her diary that she herself went to housekeeping on the same day as her marriage...

Courtship and marriage meant economic change for the entire family, not just the brides and grooms. Martha Ballard depended on her girls for household chores. The girls took care of much of the housework so that Martha could leave at any moment and stay away for a night or several days during her clients' illnesses and deliveries. Once the girls had gone, the household work could only be done by hired help or by Martha. After her young people left, Martha Ballard's smooth- running household maintenance and production system sputtered along, often unsatisfactorily if the hired help was unreliable. The diary shows us, then, a central meaning and consequence of marriage: as the family's life cycle progressed to the next stage, Martha Ballard as well as the newlyweds faced new economic realities.