Louyse Bourgeois

Louyse (or Louise) Bourgeois (c. 1563–1636) was a medical pioneer who paved the way for the modern profession of nurse–midwifery. As royal midwife in the early 16th century to King Henry IV of France and his wife Marie de Médicis, Bourgeois raised midwifery from folklore to science. For many years she delivered the babies of the top echelons of the French aristocracy, accumulating knowledge of the anatomy of childbirth and asserting the value of the knowledge of midwives as compared with that of the male surgeons who controlled the childbirth setting. Possessed of strong scientific instincts, she wrote voluminously, making important contributions to obstetrics. But at the root of her methods were common–sense convictions: each birth, she felt, was an individual experience unlike any other, and natural processes ought to be trusted, with birth attendants in most cases intervening, if at all, only to help nature along.

Information about Bourgeois and her life survives mostly in fascinating and fragmentary scenes derived from her own writing; she never penned a formal memoir apart from a summary of her career she wrote in the course of her defense against a 1627 malpractice charge, and public records of her are sketchy. She was born in France around 1563. Not much is known about her childhood, but since she was taught to read and write it is assumed that her family was at least of middle–class status. She spoke only French, however, not the Latin of highly educated French nobles. In 1584 Bourgeois married Martin Boursier, an army surgeon and barber (the two professions were closely related through centuries of European culture). Boursier had studied medicine with Ambroise Paré, one of the top surgeons of the day, and she may well have absorbed practical medical knowledge from him directly. The young couple had three children and seemed headed toward a comfortable existence in the town of Saint–Germain outside Paris.

A civil war raged, however, between supporters of the French crown and those of Henry of Navarre, soon to become King Henry IV, and this completely disrupted the lives of Bourgeois and her family. During an attack by Henry's army on the outskirts of Paris on October 31, 1589, Bourgeois and her children were forced to run from their house into the city, taking with them only what they could carry. They eventually reunited with Boursier, who had been treating wounded soldiers on the front lines, but amid the chaos he had few financial prospects. The family was forced to sell off its few remaining possessions to survive, and Bourgeois turned to the needlework she had learned as a girl in order to put food on the table.

Turned to Midwifery

She soon found a second source of income. The midwife who had been present at the birth of one of Bourgeois' own children told her that if she had been able to read and write like Bourgeois, she could have done wonders with her talent. Seeing a need for the services of a midwife among the women of her densely packed Paris neighborhood, Bourgeois started reading about childbirth. She studied the writings of her husband's teacher Paré, and her husband was often on hand if she had questions. She started out by offering her services to the wife of a local porter, and over a five–year period beginning in 1593 or 1594 she attended the births of numerous working–class women around Paris.

The lore of midwifery at the time was mostly passed down orally, from woman to woman, but Bourgeois had taken a more systematic approach in her studies. With talents above the ordinary, she decided to try to move up in the midwifery world. She sought certification as a midwife from the city of Paris, which would permit her to attend the births of aristocratic women and thus to be well paid for her services. These city–certified midwives made up a small group; a register from the year 1601 listed just 60 of them. Bourgeois submitted references and was examined by a panel consisting of a doctor, two surgeons, and two certified midwives.

The two midwives on her examining panel correctly pegged the well–born and well–educated Bourgeois as a potential source of strong competition, but Bourgeois had developed a cutthroat competitor's instincts during her years of scraping together a living amid fighting in the streets of Paris. She passed the exam on November 12, 1598 and swore an oath admitting her to a guild of midwives. Almost immediately, she began to find clients among the wealthy, and some of them began to spread the word about her abilities.

After Henry IV married Marie de Médicis, the offspring of Italy's greatest trading and mercantile family, the successful outcome of Marie's pregnancy in 1601 became a matter of paramount political importance; royal marriages were made in that era in order to build connections among Europe's powerful families and to cement the political alliances they desired. Henry, at age 48, had produced no male heir. A midwife had not yet been hired to attend the young queen, and Henry favored one Madame Dupuis, who had been one of the hostile midwives Bourgeois faced during her 1598 examination and who had evolved into her most feared rival.

Several ladies at court, however, argued in favor of Bourgeois, and they were supported by one of the king's physicians whose own children she had successfully delivered. Bourgeois cultivated a complex set of networks in order to advance her own cause, and she received a good break when Marie got wind of the fact that Madame Dupuis had delivered several of the king's illegitimate children and made it known that she didn't care to be reminded of those during her own labors. Henry finally acquiesced to his wife's wishes, and Bourgeois was installed at the side of the pregnant queen at Fontainebleau palace.

Delivered Child of King and Queen

The throngs of visiting aristocrats pressing in from every side did not make Bourgeois' job any easier, for one of the principles she advanced was that the pregnant mother–to–be, whether queen or commoner, ought to enjoy a stress–free environment. Nevertheless, all present were impressed by Bourgeois' take–charge attitude, and thrilled when she predicted the birth of a male child. The birth was a difficult one, during which Bourgeois had to ask the king for permission to give the struggling baby a small dose of wine from her own mouth. But her prediction proved correct when, on September 26, 1601, the future King Louis XIII was born and flourished in perfect health. Bourgeois would successfully deliver five more of Marie's children before Henry's murder in 1610, earning about 900 livres for each one (as compared with the usual midwife's payment of 50), plus a bonus of 6,000 livres given to Bourgeois in 1608 by the grateful royal family. In 1606 she was given the official title of Midwife to the Queen.

In her position as royal midwife, Bourgeois was in great demand among all the aristocratic families in Paris, and her career flourished. She is thought to have attended three or four births a week on average, and she and her husband were able to purchase half of a substantial house in the Rue Saint–André–des–Arts. Beginning in 1609, she began to publish her accumulated knowledge of midwifery in book form. Her first book, whose title translates as Diverse Observations on Sterility; Loss of the Ovum after Fecundation, Fecundity and Childbirth; Diseases of Women and of Newborn Infants, was her most famous. It was the first treatise on midwifery ever written, and it was filled with practical information of a kind not to be found in the few existing obstetrical texts. The book was translated into Latin, German, Dutch, and English and went through several editions, remaining in use until the early 1700s.

Bourgeois published two more books of Diverse Observations, in 1617 and 1626, the first of which contained a separate collection of "Advice to My Daughter." She also wrote and published an anecdotal Collection of Secrets in 1634. These writings made some important contributions to obstetrical theory. Bourgeois, for instance, may have been the first person to administer doses of iron to treat anemia, and her advice pertaining to what is known as podalic version (turning the baby around in certain situations so that it will be delivered feet first) became widely known among physicians and midwives of succeeding generations. She offered medical treatment to men as well as women on occasion.

Established Principles of Midwifery

But Bourgeois' greatest influence was exerted on the profession of midwifery itself. Although a petition circulated by a group of Paris midwives to allow Bourgeois to give a course on midwifery at the Hôtel Dieu hospital was rejected in 1635, she had a number of students in addition to her own daughter, and one of them, Marguerite du Tertre de la Marche, later became head midwife at the hospital and formalized the training of midwives there. Bourgeois' writings laid out the basic principles of midwifery that practitioners of the art have followed ever since. She likened the midwife's role to that of a ship's pilot, working with natural forces rather than becoming ensnared in a futile quest to overpower them, and she laid out various ethical precepts for midwives that remained well known and have resonated down to the present day.

In her first book, Bourgeois praised doctors and extolled the virtues of cooperation between physician and midwife, but as her fame grew she adopted a more confrontational stance. Mention of doctors became rarer in her accounts of cases she had attended, and when she did discuss the roles they had played, she frequently did so in negative terms. She implied that one doctor who had intervened surgically in a difficult birth had done so with an eye to the fee he would thus be able to charge—an idea with a familiar ring in the early 21st century. Although it is difficult to know exactly what happened at a distance of nearly four hundred years, it seemed that bad blood began to grow between Bourgeois and the doctors who operated at the top levels of the Parisian medical world.

Things came to a head on June 5, 1627, when the noblewoman Marie de Bourbon, wife of King Louis XIII's brother, died in childbirth as a result of an infection that we would call peritonitis. An autopsy was ordered, and though Bourgeois was not mentioned in the physicians' report that followed, the infection was blamed on a piece of the placenta that had been left inside the mother's uterus. Instead of letting the affair blow over, Bourgeois launched a written attack on the autopsy panel, just three days later publishing an Apology of Louyse Bourgeois that questioned the qualifications of the doctors involved in the autopsy (and along the way communicated some of direct testimony we possess about Bourgeois and her life). The doctors responded with a pamphlet of their own, and the controversy put an end to the period of Bourgeois' influence.

Not much is known of the last years of Bourgeois' life beyond the fact that she published the Collection of Secrets. She also wrote poetry occasionally in addition to her medical texts. Her husband Martin Boursier died in 1632, and Bourgeois herself followed in December of 1636. Several of the couple's children became involved in medicine and midwifery, but the larger legacy of Louyse Bourgeois lay in the new depth of knowledge she had brought to one of the world's oldest professions.

Books

Notable Women Scientists, Gale, 2000.

Perkins, Wendy, Midwifery and Medicine in Early Modern France: Louise Bourgeois, University of Exeter Press, 1996.

Periodicals

Guardian (London, England), December 13, 1993.

Journal of Nurse–Midwifery, July/August 1981.

Midwives Chronicle & Nursing Notes, January 1971.

Bourgeois, Louyse

Louyse Bourgeois (1563-1636) was the most famous midwife (a person, historically female, who helps other women give birth) of her time. As one of the first educated and medically trained midwives, she raised her profession to a new level of competence and promoted the spread of that competence through her widely read books recounting her observations and experiences.

Bourgeois, a woman of the middle class, acquired some of her medical knowledge from her husband, an army surgeon. She was also fortunate to be one of the first graduates of the new school for midwives at the Hotel Dieu Hospital in Paris, France. At the school, she may have studied under pioneering surgeon Ambroise Paré (1510-1590; famous for researching and improving amputation procedures). Bourgeois developed a very large and successful practice, especially among the French aristocracy. She attended the birth of the future King Louis XIII (ruled France from 1610-1643)—reportedly saving the newborn from suffocating—as well as the five other deliveries of Marie de Medici, wife of Henry IV (ruled France from 1553-1610).

Since Bourgeois' popularity rested mostly on successful deliveries, her reputation suffered a bit when she was held responsibile in the death of the queen's daughter-in-law, the Duchesse d'Orleans. The Duchesse died from peritonitis (a bacterial infection) following a delivery in 1627. Despite this setback, Bourgeois remained fairly influential and successful (although she never received the pension King Henry had promised her).

Bourgeois advanced obstetrical (childbirthing) knowledge with her observations about the importance of detachment of the placenta (the bag of fluids that the baby lives in while inside the mother's uterus that is expelled by the mother after birth). If the placenta is not expelled, the mother may hemorrhage (die of uncontrolled bleeding). Bourgeois may have been the first midwife to write books about her specialty, the most important of which was Observations diverses sur la sterilite ("Observations on Infertility"), published in 1626.

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