The Woman You sent for.

 In my last blog I wrote about my childhood visits to my grandparents in Necton, Norfolk where my grandmother was the village nurse and midwife, the 'woman you sent for' in the parlance of the times. She was not unique in what she did. Almost every community, in towns, cities and villages all over the country had such a one and had had since time immemorial.
No one could remember, least of all Grandma herself, when she had first gone to a sick bed, or which had been her first confinement, but it is a fairly safe bet it was a neighbour who needed help. Most likely it was one of her friends, knowing how good she had been when her own baby daughter had been very ill and they would have known she had assisted at the removal of my Uncle Arthur’s tonsils on the kitchen table when he was a toddler and hadn’t balked at the sight of blood. However she got started, the word soon spread that she was competent, willing and cheerful and, besides that, didn’t charge the earth, and before long she was in great demand. Live births, still births, easy births and difficult ones, boys, girls and twins; they were all part of a day’s - or a night’s - work for her.
The father or an older child would come down the Drift to fetch her and, if it was the middle of the night, would throw pebbles at her bedroom window. When Grandad got up and put his head out, he would be greeted with, ‘Mr Ong, will you ask Mrs Ong to come’ On one occasion, the urgency was stressed by the added, ‘She be hully diluted.’, meaning fully dilated, and Eliza would dress and go. Over her dress she wore a sparkling white apron, which she pinned up at the corners to keep the inside pristine until she arrived at her destination. She carried a black bag in the basket of her bicycle into which she put the things she might need: swabs, disinfectant, mild painkillers. They did not have analgesics in those early days and none were expected. The mother-to-be would have been given a list of things to have ready: torn up sheets, old newspapers, boiled water, a small bath, carbolic soap and the baby's crib or a suitable drawer with some clothes to dress the infant in. My grandmother would duplicate some of these in her bag in case they were not ready.

Grandma never refused to attend, even when she knew she would not be paid. In any case she had no fixed rate of payment. When her patients asked, sometimes diffidently, what they owed, she would say, ‘Give me what you can afford.’ She would be offered a shilling, half a crown, perhaps ten shillings, and occasionally, but not often, a whole pound, and that would probably be for twins. Sometimes she didn’t receive any money at all, but something from the garden or an ornament of some kind. When the family was large and she went year after year, the mother would sometimes miss paying her one year and pay double the next, when perhaps her circumstances had improved.
A couple of her notebooks have survived in which she wrote down the name of the patient and in the case of a birth, the sex of the infant, the date and the payment she received. This little book covers the years 1925 and 1926 and lists some 44 cases, including four sets of twins and one still birth. The most she was paid in those years was £1.7.6d (£1.371/2) for delivering a baby girl, but usually it was ten shillings (50p), and sometimes as little as one shilling and sixpence. One entry had a dash beside it, which probably meant she worked for nothing. On another tiny scrap of paper which is much older and gnawed by mice, she listed ten births in three months, none of them in her home village, so it seems she kept a separate record for those which took place outside the village. If you asked her why she did it, she would shrug her shoulders and quote:
Do the work that’s nearest
Though it’s dull at whiles
Helping, when you meet them,
Lame dogs over stiles.
My grandmother’s life seemed full of lame dogs and she was forever helping them over stiles, nor did she have to go out of her way to find them. There was hardly a family in the village untouched by her ministrations, either at confinement, convalescence, illness, injury or death; they all knew her capable manner and gentle touch. She became known as the Mother of Necton, uninfluenced by the machinations of the nursing world about her which was striving to do away with the unqualified midwife.
At the beginning of the century, the uncertificated woman who served village community in this way, was referred to as the handywoman or ‘the woman you sent for’. If you were lucky, she was clean and knowledgeable and she could soon tell if it would be necessary for a doctor to attend. You only sent for the doctor when you were ill and childbirth was not an illness. Besides, doctors cost money and the village midwife charged only a minimal fee. She was as necessary to village life in those early days as the blacksmith, the miller and the horse doctor.

They were often derided as Sarah Gamps, after Dickens’s character in Martin Chuzzlewit, by those lucky enough to have been able to qualify, but that was unfair on many of them. Certainly no one could have been more careful or caring than my grandmother, whose standard of cleanliness was very high indeed.
As early as 1859, William Rathbone of Liverpool had recognised the need for nurses to administer to poor people in their homes and began, with the aid of no less a person than Florence Nightingale, to organise a band of ladies to do that. They had to be ‘ladies’ as opposed to women, because only ‘ladies’ were supposed to have the intellect to understand the task on hand and instruct poor patients, who would be more likely to obey them than one of their own class and it was believed that only ‘ladies’ had the necessary time to devote to it.
Later, The Midwife’s Institute, afterwards to become The Royal College of Midwives, was been founded to ensure that all women, whatever their status, had access to a qualified midwife and doctor. It wanted to stamp out the Sarah Gamps, believing them to be dirty and ignorant and doing more harm than good, even if well-meaning. In some cases, this was undoubtedly true, but like all sweeping generalisations, it ignored the dedicated, experienced midwife who had been doing the job for years, and who was, in many cases, the only source of help to some women, mainly because qualified midwives had to be paid commensurate with their status, but also because they were not often on the spot in rural areas.  The scheme was dogged by administrative wrangles; what training the nurse should have; what she should wear; whether she should have a donkey and cart, a pony and trap, or should be provided with a bicycle to get about her district; what she should be paid and how the money was to be found; whether she should live in a house provided for her or have a living out allowance; what her duties should and should not entail. ‘A lot o’ squit,’ Grandma said. 'You just hatta get on with the job and do your best.’

 In 1902, a little before my grandmother began practising, the first Midwives Act had set up the Central Midwives Board to regulate training and examinations and issue or cancel certificates. Local Supervisory Authorities were employed to keep a list of practising midwives in their area, ensuring they knew the regulations. Their remit also included investigating malpractice and where necessary suspending midwives from working in the interests of hygiene and preventing infection. Puerperal infection was the scourge of childbirth in those early days and many women died of it, even after a successful delivery. My Grandmother's own mother had died of it.
Three years later, the first Roll of Midwives was published. It contained the names of those who already had a midwifery qualification from a recognised body or hospital and those who passed a CMB examination. Because their numbers were small and they were mostly concentrated in towns, the list also contained the names of those women of good character who had been in practice for at least a year and whose competence was vouchsafed by the local general practitioner. These were called ‘bona fide’ midwives. Unfortunately there are no records of these women and so I do not know if my grandmother was one of them. From then on, no one could call herself a midwife unless she had a certificate. The ‘woman you sent for’ was supposed to ‘assist’, by doing the washing and housework and looking after the rest of the family, leaving the midwife free to attend to the patient. This did not work either; there were too few certified midwives to go round and the country people still preferred their old methods.

 In 1910 the government decreed that women who were not certificated could not attend a childbirth, ‘habitually and for gain’, except under the direction of a medical practitioner. Patients often engaged a doctor whom they knew would be willing to work with local handywoman because he would accept a low fee, knowing he would not be called except in an emergency. All of this washed over the head of my grandmother, who had a family of her own to look after and could not have left home to do the required training. Besides, though far from unintelligent, her schooling had been such that she would not have coped with the theoretical side of it or the written examination. Grandma had two tutors; her own experience of life and the instruction of the doctors with whom she worked and who trusted her implicitly and recommended her to their patients, even when there was a qualified midwife available. ‘If we saw Granny Ong trotting up the road carrying her bag, we would look at each other and say, “So and so must be going to have her baby.”’ One of her friends told me. ‘And a little while later, we would see her come back and we’d call out, “Is she all right? What did she have?” Granny Ong would smile and say, “A little boy, both doing well.” And on she’d go. Or it might be a girl, or twins. But she never said anything else, not about the case. That was confidential and one thing you could be sure of with Mrs Ong, was that she would keep a confidence.’

 Grandma could hold her tongue, could smile secretly to herself, knowing the truth and not feel the need to broadcast the fact which is a virtue not many of us have. She was an ideal confidante, a secret told to her remained a secret; she could keep ‘squat’. She must have known all sorts of things about the lives of the villagers, how could she fail to? But try and draw her out and all you’d get was, ‘I don’t know anything about such things.’
Contraception was rarely used and many women relied on a sponge soaked in vinegar. Some, too desperate to think of the consequences, tried to induce abortions with large doses of gin and nutmeg or herbal concoctions recommended by well-meaning friends, often with near-fatal results. Grandma shut her eyes to it and never gossiped, but I was told by someone else that she had threatened one woman who had dosed herself so often to ‘get rid of it’, that she wouldn’t attend her if she did it again. She wasn’t taking the moral high-ground, but simply thinking of the health of the mother and the welfare of the existing children. Nor do I think she would have carried out her threat.
She moved promptly and efficiently when things went wrong. With no formal training, she had an unerring instinct which told her what to do, when to send for the doctor and that wasn’t done lightly when doctor’s fees took some finding. She mourned with a family when a baby died and many a time she saved both mother and child when both seemed lost. She was skilful, sympathetic and impossible to shock, never showing by the slightest change in her expression, either doubt or revulsion.
That was why we grandchildren were sent away to play on some days when she had to catch up on her sleep, but we were soon chatting together in companionship again, though at the time she never spoke to me of her work; that came later when I was grown up. In those far off days she talked of her own childhood, her early married life and the times in which she lived. She was never too busy to listen to tales of childish doings, to explain mysteries which seemed insoluble to a seven-year-old, to talk of her childhood, the years in which she grew up and married, the hardships she endured, to inculcate in me her own conviction of what was right and proper, her strong sense of duty, her unfailing humour. Her memory lives on in all those who knew her but there are not many of them left now. Perhaps my book will keep it alive a little longer.