It was the 1700s, and France was facing a public health crisis: too many babies were dying in childbirth, especially in the countryside. A particularly panicky priest reported that he believed nearly 200,000 babies were dying each year. Leaders worried that they were headed toward depopulation. In 1735, the maternity ward of Paris’s oldest hospital, Hôtel Dieu, began providing three-month training workshops for midwives from the provinces. Alas, the program was not a success. Most women didn’t wish to travel that far and spend that much time away from their families.
So, the country’s problems with ill-trained midwives persisted. When a noble from the rural Auvergne region came to Paris declaring that he needed a midwife to come educate the region’s peasants in the art of delivery, one exceptionally experienced and entrepreneurial midwife heeded the call.
Angélique Marguerite Le Boursier du Coudray was head midwife at the Hôtel Dieu, where approximately 1,500 babies were born every year—sometimes a dozen a day. She had become a certified midwife after graduating from the College of Surgery and completing three years of apprenticeship. Thirty-six-year-old du Coudray had been practicing for eleven years when she headed to Auvergne, in 1751. Although she was unmarried, she took on the prefix “madame” to appear more conventional.
Auvergne’s inhabitants were largely poor. They endured harsh winters, hot summers, and unproductive soil. For many country midwives, a speedy delivery was a good delivery. If things weren’t progressing quickly enough, they might tell the woman to jump up and down, or administer herbs to induce vomiting and diarrhea. Unsurprisingly, their methods resulted in many stillbirths and birth injuries. Du Coudray knew better:
The infinite calamities caused by ignorance in the countryside and which my profession has given me occasion to witness moved me to compassion and animated my zeal to procure more secure relief for humanity.
Seeing the horrific state of birth in Auvergne inspired her to transform childbirth education. She crafted a life-sized birthing mannequin. Using dyed fabric, stuffing, leather, wood, wicker, and real pelvic bones, she built a model of the lower torso. She rigged up strings and straps to make the birth canal and perineum stretch, and installed sponges to spurt dyed liquids, simulating blood and amniotic fluid, at just the right moment.
The stuffed newborn that emerged had a little nose, ears, mouth, and tongue, as well as ink-drawn hair, and was attached via a fabric umbilical cord. Du Coudray also crafted a set of twins attached to a placenta, a shriveled umbilical cord, a crushed infant head, and a fabric model of the reproductive system. To test her students’ knowledge, she numbered and identified each part with parchment. Du Coudray just called this contraption her “machine.” It cost roughly 300 livres (roughly $2,800 today) to construct. Such machines are sometimes called “obstetric phantoms.”
“I perfected an invention that pity made me imagine,” du Coudray explained. “The advantages of this invention are immediately apparent.”
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Du Coudray also wrote a textbook. Published in 1759, the Abrégé de l’art des accouchements (Abstract of the Art of Childbirth) was a practical, illustrated childbirth manual. It was a small, unfussy text, unengraved and cheaply produced. It was meant to be carried around in an apron and consulted frequently. Du Coudray’s mechanical view of childbirth is as apparent in her mannequin as it is in her textbook. As the science historian Londa Schiebinger wrote:
When presented with a breech birth, she explained how she held the baby by the feet, pulling it out to the knee, then, taking firm hold, turned the baby so that its chin, once threatening to catch on the mother’s pubic bone, now pointed downward. She straightened the baby and brought down the arms; then going deep inside the mother with her hands, she slipped the finger of one hand inside the mouth while pushing down on the back of its head with the other to jar the baby loose.
Du Coudray knew many of her students were illiterate, so she created her book in a way that could be understood whether or not you could read. The colorful images depict the mother’s pelvis and some associated soft tissues and the descending infant, presented as if you were looking through the skin and fat and seeing only the necessary bones and reproductive parts. Also illustrated are the midwife’s hands and how they should be positioned. After being trained by du Coudray and practicing on her machine, the illiterate midwife could consult the book’s illustrations as a reminder of what to do in a particular case. As Schiebinger noted:
These delicate maneuvers, the ability to visualize the interior of the mother’s body—the position and function of her organs and bones—the ability to manipulate the baby without damage, to know how and when to administer herbal remedies, all had to be packaged in a way that could be taught quickly to illiterate female students in the countryside.
The book follows the same order as du Coudray’s lectures. First, reproductive organs and the reproductive process are explained. Next, prenatal care. Then, the bulk of the text is spent on deliveries. Du Coudray’s pedagogy attempts to prepare her pupils to handle every eventuality. Common malpresentations of the baby are covered, such as breech (feet-first), knee-first, stomach-first, or arm-first. Delivery of twins or a stillborn are also discussed. Finally, du Coudray outlines rare complications she’s encountered. Of her “little work,” du Coudray stated, “I was determined to make it simple; I have assembled in it all that is most essential in this art, and most accessible to those least schooled in this matter.”
The magistrate of Auvergne asked her to craft a machine for each of the most populous cities in his region. A surgeon from each city came to study the inner workings of the machine with du Coudray for fifteen days, then took it back with them. These surgeons would in turn train their local midwives in her methods. When the Academy of Surgery heard about her machine, they asked her to bring it in for assessment. Because of its accuracy and detail, it was awarded a seal of approval as a childbirth education tool. “This was a rare honor—even more so for a woman,” noted the midwife and medical historian Scottie Hale Buehler, and “approval of du Coudray’s mannequin was no small feat for the midwife.”
Du Coudray translated her success in Auvergne into an advertisement. She penned a letter to a cadre of the king’s men touting her machine, textbook, and transformational teaching method. She claimed that after three months of lessons, even women without “the remotest knowledge of childbirth” could be sufficiently trained. Other courses on childbirth only taught theory, and only prepared midwives for normal births, she explained, so any complications would catch them off guard. Those blind spots greatly increased the likelihood that such complications would prove deadly for mom and baby. Du Coudray wrote:
Young surgeons and women, rushing to benefit from a profession they know only superficially, spill out all over the countryside. But when difficulties arise, they are absolutely unskilled, and until long experience instructs them, they are the witness or the cause of many misfortunes.
Misfortunes included lost lives, babies deformed or disabled, and young mothers rendered infertile. She asserted that “one learns on the machine in little time how to prevent such accidents.”
She was a crafty businessperson who knew her audience. She stressed the importance of her work as a patriotic necessity that protected the country’s most precious commodity: its future citizens and soldiers. The king would do well to employ her expertise across the entire country, she reasoned.
Her pitch worked. King Louis XV commissioned her to take her training all over France. From 1760 to 1783, du Coudray criss-crossed the nation, teaching midwives how to deliver babies. Most cities paid her 300 livres a month for her teaching. Students were never charged for the training. She was also given lavish gifts, which she interprets as emblems of her success. Across her tenure, du Coudray taught upwards of 10,000 students. When all was said and done, she and the surgeon-demonstrators who carried on her work had trained two-thirds of France’s midwives.
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Not everyone was pleased by du Coudray’s activities. In his hefty text, Precis de doctrine sur l’art d’accoucher (Precise Doctrine on the Art of Childbirth), the Parisian surgeon and accoucheur (male midwife) Jean Le Bas declared du Coudray’s machine a woefully inadequate teaching tool: “the best executed mannequin is only a ghost, an enactment, a shadow of truth, capable of giving false ideas to the beginners who, once having their heads filled, would not know to avoid the practice of a bad job on a living subject.”
Le Bas worried such practice would give students a false sense of security that would quickly disappear when presented with a real live woman in labor. Her passive stuffed mannequin bears too little resemblance to a living, breathing, pain-wracked body. One could only truly learn from experience observing and assisting actual bodies in labor.
Buehler, the medical historian, draws attention to how Le Bas’s choice of words “phantom, simulacrum, and shadow of truth (phantôme, simulacre, ombre du vrai) exposes his belief in the lack of transferability of skills learned on the machine to a woman in labor.”
One anonymous citizen wrote to defend the woman “who trains midwives all over the Kingdom on behalf of the King” from such attacks. Of the machine, this citizen noted: “This innocent artifice succeeded for du Coudray to make the students repeat the maneuvers; these good women were encouraged and succeeded perfectly.”
A handful of towns, mostly across the south of France, turned her away. In some areas, the town midwife was an experienced, revered member of the community. It was insulting for them to be lumped in with the ill-qualified practitioners, characterized as backwoods numpties. Others were simply turned off by her puffed-up self-importance and brazen self-promotion.
Long before she rose to national prominence, du Coudray helped ensure Parisian midwives got proper training. Female midwives had long been in charge of uncomplicated births, with surgeons called in for emergencies or difficult births. But men increasingly wanted dominion over all births. Just a few years after du Coudray graduated, surgeons tried to eliminate midwives by barring them from attending the University of Paris’s school of surgery. Without a credentialing exam, unlicensed, and occasionally untrained, midwives took to setting up shop anyway. Du Coudray, along with 39 other midwives, signed a petition demanding that the medical faculty provide instruction in reproductive anatomy to midwives. The University conceded.
In other words, it wasn’t just life-saving training that du Coudray gave France; she also demonstrated the indispensability of midwives. Thanks to the rise of obstetric forceps in the mid-1700s, surgeons were raving about the potential of this tool to transform childbirth and render midwives superfluous. Midwives were subordinate members of the surgeons’ guild, subject to their policing and lacking a recognized group of their own. A 1755 parliamentary resolution ruled that midwives were not allowed to wield forceps, only surgeons. But du Coudray was determined that her methods would render forceps superfluous.
She died in 1794. Thanks to gaps in the historical record, it took the science historian Nina Rattner Gelbart a decade to write the only existing biography of du Coudray. And only one du Coudray machine survived. Writing in the literary magazine Prairie Schooner, the poet Leslie Adrienne Miller described encountering it for the first time:
I gasp out loud
when I find Le Boursier’s soft machine
of linen and leather, the woman’s thighs
great hams of rosy fabric gathered at the knees like parlor bolsters,
the plush swell of belly draped
in a modest apron opened in a V,
that all who would deliver her
might see the fine embroidery
of the wrinkled vulva giving way
to the crowning cloth doll, one puffed
umbilical cord to announce life,
another flat to advertise a death.
It resides at the Flaubert Museum of the History of Medicine, in Rouen, France, a reminder of Du Coudray’s transformative work.