ENTRAR            

		ORAL HISTORY
		Andrea Martínez, a midwife of the 20th century María José Alemany Diplomada Universitaria de Enfermería, Matrona, Profesora  Escuela Universitaria de Enfermería La Fe, Valencia (España) Mail delivery: Escuela Universitaria de Enfermería La Fe Valencia. Avenida Campanar, 21; 46009 Valencia (España) Manuscript acepted by 19.03.07 Temperamentvm 2007; 5
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Alemany MJ. Andrea Martínez, a midwife of the 20th century. Temperamentvm 2007, 5. In </temperamentum/tn5/t6391e.php> Consulted

Abstract (Andrea Martínez, a midwife of the 20th century)   Andrea Martínez, an 82 year old woman, is living memory of the recent history of Spanish midwives. Through an extensive semi-structured interview, Andrea's oral testimony becomes a primary document to the historian, who adopts a gender perspective. Her voice, Andrea's personal and professional history, allows us to carry out an in-depth analysis of the present knowledge on midwives' role and place in both rural and urban environments of the society of her time: from the first years of Franco's government to the democratic transition. Andrea began as a district midwife in small Castilian towns, and retired after several years of service in a big hospital maternity ward. Her life is almost like a metaphor of the evolution of Spanish public health during the 2nd half of the 20th century. Keywords: History, 20th century, Franco's government/dictatorship, oral sources, midwifery, labour.

Introduction

     Andrea Martínez is an 82 year old woman who devoted forty years of her life to practising her profession and developing that special type of relationship that can only be established between a woman in labour and a midwife.

Her professional life is an example of the personal, family and professional difficulties that midwives who practised their profession during Franco's dictatorship had to endure.

Andrea began her professional career as a midwife in Urda, a town of the province of Toledo, where she lived for more than twenty years. When, due to healthcare developments and the subsequent creation of macro-hospitals, childbirth became a medicalised process and women in labour began to be admitted into hospitals to give birth, Andrea applied for a midwifery position at the Hospital of Toledo, where, after several years of service, she retired.

This article has been developed from a semi-structured interview, which reflects her personal view of social events and processes that took place during her professional life, as well as her memories as a midwife in both rural and urban backgrounds. Oral sources were used in this work, which were contextualised and analysed from the legal background and political strategy of Franco's dictatorship, as well as the social context of a period of time so greatly influenced by gender and class issues.

Andrea, as main character of her history and her work, presents a picture of her professional life that is intimately linked to her personal life. At the same time, her professional activity earned her the acknowledgment and social appreciation of the families that she looked after and of the whole population of Urda.

The information obtained from the interview, which has been treated as primary source material, reveals a continuous process of change. As a result, it can be observed how midwifery goes from the decaying image of a traditional trade established within local communities to an essential part of the process of childbirth centralisation. However, after having monopolised both knowledge and expertise on childbirth for centuries, this movement brought social acknowledgment to these women to an end. Instead, it put them under the authority of male midwives with a higher professional status in the new big hospitals.

Andrea's midwife training and professional beginnings

     Andrea was born in 1924, at the end of the first quarter of the 20th century. Substantial changes took place in the social, economic and demographic structures of Spain, as well as of many other European countries, at this historical time. These changes were reflected in the modernisation process of the Spanish society and, not surprisingly, introduced important modifications in cultural and gender models and ideological discourses about women. In addition, this period of time would see the transition of the traditional figure of women from Home angels to Modern women, although the concept of maternity was kept at the very core of feminine identity¹.

The most relevant element of this change of tendencies can be found in the justification of a discourse which, for centuries, had been fundamentally influenced by religion. Since the late 19^th century, the medical class consolidated its position as an important element in the political, social and cultural environment. As a consequence, some medical associations elaborated a scientific argument about maternity on the basis of secular parameters, although they never questioned the principles of Catholicism. This argument, endorsed by the eminent endocrinologist Gregorio Marañón, understood maternity as women's social duty and obstetrics as the medicalised process of childbirth.

One of the bases of gender discourse about maternity was eugenic thinking, which was supported by other contemporary outstanding medics².  We cannot ignore the fact that the woman pioneer in the medical profession in Spain, Dolores Aleu y Riera, who graduated in 1879, was given a special dispensation to access postgraduate doctoral studies in 1882. Her doctoral thesis studied women's education: About the need to redirect women's hygienic-moral education through new paths (1883), and used scientific discourse, as her male colleagues did, to justify existing gender principles. In her thesis, she claimed for women's education mainly in reference to their maternal role as well as other feminine roles which were in accordance with their female nature (care for children, for the sick and for the elderly)³. It must be clarified that, at this moment in history, maternity constituted a serious problem due to the high rates of maternal, foetal and children's mortality rates during and after childbirth.

As a consequence, the existing legislation had to be adapted to the demands of new social reformists. In March 1929, the Maternity Insurance was regulated through a Royal Decree, which resulted in an increased need for professionals specialised in pregnancy and childbirth. This historical event is supported by Andrea's testimony: "I had finished high school when I met with a class mate who suggested that I become a midwife, as midwives were needed. She used to work in maternity and I went to speak to the head of maternity who answered all my questions"⁴.

The ambiguity of the discourse cannot be ignored given the fact that, on the one hand, it praises maternity, attempts to prepare mothers for their role and watches over the evolution of pregnancy and childbirth, whereas, on the other hand, it prevents women's access to knowledge acquired through the biological experience of maternity, transforming them into mere sources of scientific knowledge, useful only to the medical profession, and contributes to consolidate male doctors in the power⁵. As a result, their area of practice was expanded and they became the owners of an area of knowledge and expertise that, until then, had exclusively belonged to women.

Towards the end of the 19^th century, an association of female midwives was created in order to express their concern about hygienic measures applied to maternity, and also manifest their feminist position with regard to women's rights. They even dared to question the existing model of gender in several publications⁶.

Before taking the decision of becoming a midwife, Andrea attended high school in Ciudad Real. When her parents passed away she was obliged to reconsider her life plan, and soon after she started to work. Nevertheless, she managed to finish high school and her studies in Anatomy, Physiology and Hygiene through the study of the classic textbook of Orestes Cendrero, published in 1935, as it was an essential requirement to gain access to the midwifery degree: ".When I finished fourth grade I studied Anatomy and Physiology for two more years."⁷. After that, she carried on with her midwifery degree, which she completed in 1947. She used to live in Seville at this time, although she had to go to Cadiz to undertake the exam: "I was in Seville, but Seville was partnered with Cadiz and there we had to go to take the exam"⁸. In order to become a midwife, as it has been mentioned before, one had to study and pass an exam on the topics of Physiology and Hygiene first, and then attend Anatomy lessons on subjects as varied as dilatation or pelvis diameters. Theory was exclusively imparted by doctors. After the theoretical lessons, midwifery students had to pass a clinical placement at a maternity hospital of Municipal Beneficence, where they were given a certificate. This certificate was indispensable to gain access to the final exam that they would take as external students in the Faculty of Medicine where they were registered. Andrea remembers that:

"We used to go to a doctor's house, to a particular house. It was not like it is today. There were no schools back then. It was only three of us and that's it. Then, you had to take the exam in Cadiz, at the Faculty, in June and September. We had passed clinical placements in maternities under the supervision of qualified midwives. There were assisted in deliveries, did the beds, washed the women and oversaw the dilatations"⁹.

Among all the textbooks, Andrea remembers one by Agustín Planelles, which gave good anatomical descriptions. In her opinion, Anatomy was a fundamental module. Midwifery students knew that, once qualified, they would be appointed to rural positions, far from the hospital, and it was for this reason that they used to work as hard as they possibly could.

"I used to study two books, one was. and the other one was written by Agustín Planelles, and I clearly remember the image of the pelvis; we learnt this as well as the Our Father. Where to place the parameters. Then you had to do the pelvimetry with the intercristal and the interspinous diameters, and the one from the pubic arch and then. The intercristal was 30 cm long"¹⁰.

There were one or two qualified midwives in maternity centres of Municipal Beneficence, where poor women, who lacked a Maternity Insurance¹¹ and the economic resources to hire a private midwife, used to go when they went into labour. Women from rural areas whose delivery had got complicated for any reason also were admitted into these centres. Finally, there were distinguished clients, wealthy women from the city, who were also admitted into these maternity centres.

"Women who had absolutely nothing used to come to the hospital to give birth. We also used to receive distinguished patients, as we used to call them. They were accommodated in separate rooms with two beds, one for them and one for a relative. Everybody else was admitted into wards of more than 20 beds placed on both sides of the room"¹².

When she finished her studies, after a brief assignment in a small town of the province of Toledo where she was rejected by the practicante, she moved to Urda, another small town of the same province, where she worked as a qualified midwife for 20 years. It must be mentioned that practicantes were, by law, allowed to assist at births and to charge a price for their services, as long as there was not a midwife available to carry out this job. Obviously, he did not wish to lose this sector of the population to the newly arrived midwife.

When Andrea arrived in Urda, she had to confront an intruder. It was traditionally accepted that in some determined rural areas, given their geographical situation and the lack of qualified professionals to assist in childbirth, amateur midwives looked after local women in labour. However, midwives were protected by the legislation¹³, which stated that in order to ensure hygiene and to reduce mortality rates during and after childbirth, only qualified midwives and, in their absence, qualified practicantes were allowed to perform these procedures.

".In Urda I started to work as a midwife, but the same thing happened and I had to confront an intruder. Intruders took away a lot from you because they worked in partnership with the doctor. In these cases, it was the doctor who received his and the intruder's payment, and then he paid the intruder next to nothing, or a dozen eggs, and that's how they used to work"¹⁴.

Midwives became the first women to access nursing as an established profession. The midwifery curriculum was academically regulated by the mid 19^th century, when it was officially approved through the Moyano Law. Andrea qualified in 1947. Consequently, her appointment in Urda went from the 1950s to the 1970s. Once the first years of the post-war period were over, Franco's legislation defined the role that all Spanish women should assume according to their feminine nature. In 1938, the Work Privilege limited married women's work through a new requirement: their husbands' permission to work. In addition, the Civil Code of 1889, which placed women under their husbands' authority, came once again into force. The Civil Code of 1889 was completed with regulations designed to protect the family, namely subsidies, birth rate awards and large family awards, which were later announced through the Nodo. However, women's professional lives were also restricted through the withdrawal of these family awards to families with working wives. Women's compulsory marriage license was finally abolished in 1961, together with the prohibition to carry out a number of determined activities¹⁵. This tight control over women was founded on Franco's politics, which tried to avoid any sign of modernity that could be rooted in the Second Republic¹⁶.

Franco's government tried to take a historical step back based on its nationalist-Catholic ideology and an attempt to eradicate any changes made in the traditional idea of gender decades before. As a result, women were once again ascribed to private spaces and men to public ones, especially the economic space. However, women's contribution was practically unquantifiable, it also was fundamental to the country's development. Women developed an invisible work at home looking after their children, the sick and the elderly, administering their husbands' meagre salaries, making clothes for their families and, occasionally, working as cleaners or seamstresses for higher class families, although their salaries were as poor as they were irregular.

From autarky to economic development

     After the Spanish Civil War, autarky, misery and hunger became even worse in the dismembered rural areas. The landlords returned to rural Andalucía, Extremadura or Castilla la Mancha, where Andrea resided for more than 20 years, and recovered control over lands that had been collectivised by farmers, who after that were left unemployed. Hunger during these years was not only due to drought and bad harvesting, but also to the government's economic strategy, which was based on an interventionist policy, which brought about rationing cards, queues and black marketing. As a witness of this misery, Andrea remembers the case of a particular family:

"During the first years, there was no soap in the houses and I had to use cloths and whatever else I could find. She was a young woman with two small children. Her husband took the two children out of bed while the woman was giving birth. When the baby was born, he was placed in a clean bed and then the rest of them joined in, all together, like little rabbits. Sometimes, when I finished my work, the husband used to come home with me and I gave him a piece of bread and some milk for the mother. It was very sad (.)"¹⁷.

During the 1960s, major economic development took place in Spain. It promoted women's economic activities, although they were employed as cheap labour in comparison to men. As a result, a new piece of legislation: the Women's Political, Professional and Labour Rights Law, was issued in July 1961. This law did not question the wife-mother-housewife basic model of woman promoted by Franco's ideology. However, this picture of political and economic evolution during Franco's dictatorship would not be complete without an introduction of women's particular contribution from invisible spaces, such as their own home or other women's homes where they were employed as domestic servants. Qualified women with a position in the public sphere, such as teachers, secretaries or healthcare professionals, including midwives, also contributed to Spain's economic development. Mª Carmen García-Nieto¹⁸ classified women's response to Franco's politics into three categories. The first category, integration and consensus, was comprised by women that had accepted both Franco's idea of economic development and his wife-mother feminine model based on the patriarchal, masculine society of this time. The second group included other women: Republican and lower class women who made use of their different labours as a way of social integration. The third group of women, Chicas Topolino as called by Carmen Martín Gaite¹⁹, was comprised by women who, during the 1960s and 1970s, found different ways to personal independence and identity²⁰ through access to education and the professional world.

Andrea belonged to the third group, after getting a place in the public sphere through her midwifery qualification and her monthly payroll. She had to leave her home to go to work every day, which consolidated her position in front of male doctors and granted her social recognition.

 "Unlike many other midwives, I used to get paid on a monthly basis because my job was permanent. In addition, we used to get paid after every child delivery. The last month before retirement I earned 1999.99 pesetas, in 1979. We used to earn 75 pesetas per delivery around 1950, then our salaries were increased to 100, and finally we were paid 300 pesetas per child delivery. I carried out from 18 to 20 deliveries per month"²¹.

Andrea was aware of this:

"I was socially accepted as a healthcare professional because midwifery has always been an independent profession; we were different from doctors or practicantes. However, there were nurses that used to work in sanatoriums who did not enjoy such a good reputation. They were unqualified, and all they used to do was wash and feed the patients (.). As a proof: many years after my leaving Urda I was asked to give a speech at the opening of the town's yearly festival"²².

During the 1970s, as a consequence of economic evolution and the political agenda of new politicians belonging to the Catholic group Opus Dei, many hospitals were built in different Spanish cities, which brought about changes in healthcare politics. These technocrats promoted hospital-centred healthcare policies, which resulted into the building of new hospitals according to new Development Plans that were implemented at this time. After the new Hospitals Law in 1962, the number of hospitals trebled²³. At the same time and due mainly to economic reasons, a general migratory movement from rural to urban areas was registered. Consequently, the number of pregnancies decreased dramatically in rural areas: ".people acquired the insurance and migrated to Toledo or Madrid."²⁴, and numerous auxiliary, nursing, midwifery and medical positions were offered at big hospital maternity wards. ".All I'll say is that, when I moved to Toledo, there was only one gynaecologist and the head of the department. No one else. Only one midwife was left on duty, although this number gradually increased to two, three, four, five or six"²⁵. The 1942 Compulsory Health Insurance was finally implemented in 1944. Fifteen years later, in 1963, the Social Insurance (universal coverage) regime was also implemented in Spain²⁶. This was in the benefit of women, who had always given birth at home, surrounded by their relatives and looked after by a female acquaintance and neighbour: the midwife. "Being with their families made all the difference. It took them a great effort to get used to the idea of having to check into a hospital to give birth. Only the younger ones accepted this idea"²⁷. It was also a time of constant change for midwives, who were used to dealing with the process of childbirth on their own, even when it got complicated. However, from this moment on, they had to adapt themselves to hierarchy and hospitals' management. This historical change, which is still to be studied, brought about economic and professional advantages to midwives.

"In the first instance I didn't like it because it lost me my job. Women left and I couldn't stay in Urda (.) (After that), all right, I accepted the idea to some extent, because new hospitals were built and many midwives had to move (.) To me, working there was like being on holidays because, although I used to be on duty for 24 hours, I also had time off. In Urda I used to be 24 hours on duty every single day, without summer, or holidays or Easter vacation. Even during my daughter's wedding I was required to assist a woman who had gone into labour"²⁸.

Complicated labours

     Andrea's professional care was not exclusively limited to childbirth. She knew her patients because they were her neighbours and shared with them much more than her job:

"People were not used to looking after themselves and I used to check their blood pressure and test urine and glucose samples. I assessed them sometimes, although most of the times they would not let me do it, they were shy. I don't know. Whatever. Nowadays people look after themselves, but my women really trusted me"²⁹.

There were cases where complications could be predicted and prevented. For example, abnormal foetal positions during pregnancy.

"I have done external versions. When the baby was in a breech position, I carried out an external cephalic version performing different manoeuvres or applying pressure. Most of the times I managed to change the position of the baby. I used to keep an eye on the patients due to the increased risk of tearing or breaking the umbilical cord"³⁰.

Giving birth is a physiological event which is within a woman's normal biological capacities and, as such, it happens naturally. However, complications might appear that could put the life of the mother and the baby at risk. Today, these situations are dealt with in a totally different environment: complex hospital rooms equipped with the necessary material and human resources, prepared to deal with any eventuality. Andrea remembers how she managed to solve some of these eventualities during her work in Urda:

"I remember dealing with two umbilical cord prolapses. I climbed on to the bed, knelt in front of her, introduced my hands and took the baby out. I saw a broken uterus once (.). When you realised that something was not right you called el Punto, which was like a taxi, and I went with them (..). I dealt with many post-labour haemorrhages. In these occasions I used to massage the uterus until my hands ached and, in the meantime, someone would call a doctor. I used to inject Methergin in the uterus through the abdomen. I think it was called Ginergeno back then. Finally, I used to apply ice and a sand bag. I have had many bad moments and I have been frightened many times"³¹.

Evidently, both imagination and will became indispensable qualities for these women, who used to work in rural areas during the first few years of Franco's government, in order to carry out their job under these circumstances.

"We used to put a washable table or some tiles on top of the mattresses, which were made of wool. These surfaces provided a solid base to avoid the patient sinking in the bed and to facilitate my job. If I had to apply any stitches, I used to place something solid under her bottom to lift it up. I carried my instruments in a suitcase: scissors, tweezers, a clamp, needles and a special case containing my glass syringes. I also had cordonete (cord) in a small bottle full of alcohol. All you did was to tie a knot on the one side and another one on the other side, and that was it. I also had a small box where I kept my clean towels. When everything was finished, they used to wash my towels at home. Then, I took them home, ironed them carefully, and kept them all nice and clean in the box"³².

Midwifery's professional practice and specific procedures have also undergone important changes. In general terms, it could be suggested that they were more conservative at that time and that, in the absence of any complications, the natural evolution of the process was totally respected.

"Only extensive vaginal tears were stitched. This meant more work for me because I had to visit them twice, once in the morning and once in the afternoon, to dress the wound. We did not use to stitch the wound by layers but rather as one single block, and they used to heal very well. I used to apply an ointment that one doctor had recommended to me. in Madrid (.). When women could not stand the pain we used to administer Buscapine and, when the number of contractions had to be increment, I used to administer Tococinal. It came in ampoules but I hardly used them (.)"^33.

The influence of Catholicism in Spain gave an added responsibility to midwives: Baptism. In case of an emergency or when it was suspected that the newly born would not survive long, it was the midwife's responsibility to baptise the baby.

"In those cases I used to ask someone else to hold the baby and I took water and made the sign of the cross 'whoever, I baptise you in the name of the Father, and of the Son and of the Holy Spirit'. If the baby survived you had to tell the priest: 'I have baptised the baby but I have done so under condition (under risk of death)'"³⁴.

Andrea, whose daughter and granddaughter are also qualified midwives, was able to adapt to any circumstance. Many changes have taken place in terms of midwife training and professional practice. However, knowledge transmission from midwife to midwife has been maintained, just like it used to be in former times.

Notes

1. Nash M. Maternidad, maternología y reforma eugénica en España, 1900-1939. En: Duby G, Perrot M. Historia de las mujeres. 5. El siglo XX. Madrid: Taurus; 2000. p. 687.
2. See for example Dr. José Gómez Ocaña or Dr. Joaquín Castellsaguer, who between 1919 and 1936 praised maternity through both writings and speeches. Op. Cit. p. 692-693.
3. Siles J. Historia de la Enfermería. Alicante: Aguaclara y Colegio Oficial de Enfermería de Alicante; 1999. p. 244.
4. Interview to Andrea Martínez in July 2004 (EAM 2004).
5. There were very few female doctors due to the fact that most of university students were male around 1910. Besides, women's public opinion was generally received with hostility, which suppressed women's reaction to the idea that maternity was an essential part of their feminine identity. Op. Cit. p. 696-697.
6. See for example the journal "La mujer y la higiene" (Women and hygiene). The main editor of this journal was Rosa Vinyals, a midwife from Barcelona's Municipal Beneficence, who criticized the reduction of women to the role of maternity, and predicted that, at some point, women's moral, intellectual and social capacities would be taken into account by the Spanish legislation, and both men and women would be made equals.
7. EAM 2004.
8. EAM 2004.
9. EAM 2004.
10. EAM 2004.
11. The number of families that could afford having a Health Insurance kept increasing little by little. By 1953, no more than 30% of the Spanish population had it. By 1968, more than 70% of the population had a Health Insurance. Siles J. 1999. Op. Cit. p. 285.
12. EAM 2004.
13. Since 1925, when Municipal Beneficence was regulated, each medical area comprised a medical assistant and a midwife. Each one of them had different roles and responsibilities.
14. EAM 2004.
15. García-Nieto París MC. Trabajo y oposición popular de las mujeres durante la dictadura franquista. En: Duby G, Perrot M. Historia de las mujeres. 5. El siglo XX. Madrid: Taurus; 2000. p. 722-725.
16. Muñoz Ruiz MC. La representación de la imagen de las mujeres en el franquismo a través de la prensa femenina, 1955-1970. En: Amador Carretero P, Ruiz Franco R. Editores. X Coloquio Internacional de la AEIHM. Representación, construcción e interpretación de la imagen visual de las mujeres. Madrid: Instituto de Cultura y tecnología Miguel de Unamuno; 2003.
17. EAM 2004.
18. García-Nieto Paris MC. Op. Cit. p. 726-727.
19. Martín Gaite C. Usos amorosos en la posguerra española. Barcelona: Anagrama; 1987.
20. Aguado A. Trabajo, género y clase: mujeres socialistas, mujeres feministas. En: Segura C, Nielfa G. Editores. Entre la marginación y el desarrollo: Mujeres y hombres en la historia. Homenaje a Mª Carmen García-Nieto. Madrid: Ediciones del Orto; 1996.
21. EAM 2004.
22. EAM 2004.
23. Siles J. 1999, Op. Cit. p. 285.
24. EAM 2004.
25. EAM 2004.
26. Marset Campos P, Sáez Gómez JM, Martínez Navarro F. La Salud Pública durante el franquismo. Acta Hisp Med Sci Hist Illus 1995; 15: 211-250.
27. EAM 2004.
28. EAM 2004.
29. EAM 2004.
30. EAM 2004.
31. EAM 2004.
32. EAM 2004.
33. EAM 2004.
34. EAM 2004.

LIST OF ERRATA

     After being published, the author of this article reported a transcription mistake to the editor of this journal: The interviewee's name is Andrea Rojas and not Andrea Martínez, as it appears several times throughout the text.

 

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