From far back in time the delivery of children and care of the mothers was a profession often handed down from mother to daughter, with the daughter spending many years as the pupil or apprentice with midwifery skills being shared from generation to generation. The Church supported the system by a system of licensing and required midwives to swear to certain rules relating to contraception, abortion and concealment of births and also to deliver the new born infants for baptism or in extreme cases to perform the ceremony themselves.
In the middle of the 18th century the legal status of midwives was withdrawn and the responsibility for delivery was vested in the surgeon. The work of the nurse element had to be covered for “who was to look after the baby?” Clearly the first thought that would naturally occur to a mother was that the best person to look after her baby was a woman who had had one herself. Often, the task was allotted to motherly or grandmotherly hands and, from this requirement for post natal care, the ‘monthly’ nurse originated. The Nursing Record reported that “there was little or no attempt at knowledge or instruction, and we know as a fact that ignorance, prejudice and neglect resulted in a goodly crop of errors, wrongs, and woes as regards the hapless infant”.
The term “monthly nurse” is one which is frequently used to describe the nurse who cares for lying-in cases, no doubt because such a nurse frequently remains with the patient for four weeks. The word ‘monthly’ is somewhat inaccurate, for there is no reason why the nurse’s services should not be dispensed with after ten days or retained for a much longer period. It is entirely a matter of arrangement. The Nursing Record reported that “nurses who attend the ‘artisan’ classes in their confinements as a rule pay a visit daily for ten days and then give up the case, as few working class mothers can afford to lie up for longer”.
Although ‘Registration’ was not available for women to act as midwives or monthly nurses a system of “Certification” was in being in the late 19th century and continued into the early 20th century. To qualify a candidate monthly nurse would attend a course in a lying-in hospital for four or five weeks and a midwife for up to three months. The prospective midwives and monthly nurses as a rule paid their own charges in respect of Hospital expenses and afterwards entered into practice on their own responsibility. In 1893 a Miss Gosling reported that “although the certificated monthly nurse could be relied upon as being trustworthy and efficient, there were a number of women who attend lectures for a short time and through one cause or another fail to pass their examination and obtain a certificate nevertheless enter a “Nurses Home” or open one for themselves!
As might be expected rogue institutions issued certificates and diplomas “for a price”. Another that reporting on a lying in hospital and signed herself a ‘victim of the system’ said that she “witnessed the first phase of the system which turns out yearly hundreds of midwives and monthly nurses on an unsuspecting public. These would be nurses represented almost every grade of the lower classes and every degree of lack of education, and one woman, I remember could not write. Personally I found many to be dishonest, untruthful, indescribably dirty in their habits and persons, utterly unprincipled, shockingly coarse and deficient intelligence, and with not the faintest idea of discipline”’
A monthly nurse could earn more than a midwife as the monthly nurse was employed for periods between 10 days and often much longer and might attend several women on a part time basis. She often “lived in”. The midwife’s only duty was perceived as “being trained to assist the parturient woman while nature does her own work and able to call upon a surgeon who could step in where nature fails and skill and science are required”. Many certified midwives transferred to the ranks of monthly nurses to benefit from an increased income.
In the late 19th century, reformers were calling, not only for registration and recognition of the profession of midwife, but also for the two functions of midwife and monthly nurse to be amalgamated on the grounds that “The work of midwives lies, for the most part, amongst the poor and the poor lying-in woman needs not only to be delivered, but to be visited for some ten days subsequent to her confinement.” The registration of midwives was opposed by members of the House of Lords and Parliament over many years, who argued that the delivery of infants was the responsibility of trained doctors and to allow women to do the job, even in straightforward cases, would take away the doctors’ income. It was not until the 1902 Midwives Act, following 12 years of representation by women, that midwives were “registered,” although it would still take several years for it to be accepted. The professional training and formal qualification of midwives, and eventually the post-natal care offered by the National Health Service, saw the end of the ‘monthly nurse’.
- Churchill, Fleetwood. On the Theory and Practice of Midwifery. Philadelphia: Blanchard, 1860. "Qualifications and Duties of the Monthly Nurse" p..629-648 GBooks
- Adams, Annmarie. Architecture in the Family Way: Doctors, Houses, and Women, 1870-1900. McGill-Queen's/Hannah Institute studies in the history of medicine, health, and society, v. 4. Montreal: McGill-Queen's University Press, 2001. p. 112-13 
- The many articles and letters published in the ‘Nursing Record’ between 1860 and 1930