A price must be paid for motherhood : the experience of maternity in Sheffield, 1879-1939.

This study considers the reproductive experiences of women in Sheffield between 1870 and 1939, encompassing the development of concepts of maternal and infant welfare, and debates over birth control and abortion. It focuses on the impact of state and voluntary enterprise, on the development of health professions and hospitals, and on the position of mothers. The study shows that high infant mortality was caused primarily by poor sanitation. Unlike other areas, Sheffield had low rates of both maternal employment and bottle feeding, suggesting that these were not significant factors. The decline in infant mortality was due to a combination of factors; the removal of privy middens and slum areas, and the development of welfare clinics and health visiting services. High maternal mortality was prevalent mainly in areas of skilled working class employment; not middle class areas as in other cities. There was no inverse correlation between infant and maternal mortality in Sheffield. Maternal mortality was caused by high rates of sepsis following illegal abortion. The reduction in mortality was due to a cyclical decline in the virulence of the causative bacteria, and the application of sulphonamide drugs to control it. The development of antenatal and birth control clinics had little impact. Despite early action to train midwives in Sheffield, midwifery remained a largely part time, low status occupation throughout the period. The hospitalisation of normal childbirth occurred early in Sheffield, and demand for beds outstripped supply, demonstrating that women were able to shape the development of services. Local authority and voluntary groups generally co-operated in the delivery of services, which were developed along pragmatic lines with little reference to debates about eugenics or national deterioration. The growth of welfare schemes was circumscribed by the available resources. Central government provided enabling legislation, but schemes were planned and implemented at the local level.