Lying-in and laying-out: fetal health and the contribution of midwifery.

This article considers the quality of midwifery skills and practice principally in eighteenth-, nineteenth-, and early twentieth-century England. It discusses the merits of assessing effectiveness via differentials and changes in late-fetal rather than maternal mortality. Evidence from the lying-in hospitals, both in-patients and out-patients, in terms of stillbirths and the deaths of mothers and children is set against what is known from demographic studies of the background levels of early-age and maternal mortality. The conclusions emphasize the value of taking a "fetal health" perspective, rather than viewing midwifery simply in terms of maternal well-being. They also note the apparent superiority of London's position compared with the provinces and the steady improvement during the eighteenth century, and lack of progress during the nineteenth; and they reconfirm the particular dangers to mothers delivered as hospital in-patients. Finally, the considerable methodological problems faced by such studies are emphasized.