This article is taken from the July 2023 issue of The Critic. To get the full magazine why not subscribe? Right now we’re offering five issues for just £10.

The idea that Victorian women were advised to “sit up and cough” after sex, as a method of contraception, is one of the more entertaining anecdotes in Jessica Cox’s otherwise sobering book. Readers will not be surprised to find that the experience of pregnancy and childbirth in 19th century Britain was no picnic.

Indeed, the organisation of this book reflects the grim nature of its subject matter: each chapter is arranged around themes, which include (in)fertility, maternal mortality, abortion and infanticide. Women who experienced domestic abuse, marital rape and serial unwanted pregnancies fill the pages.

It is encouraging, however, even amidst these gloomy subjects, to find that most things have changed for the better. The medicalisation of childbirth in the last century has had one enormous benefit: more women, and their babies, survive.

Advice manuals, which make up a large portion of Cox’s source material, have evidently also improved. Pregnant women with toothache are no longer offered a solution of cocaine as a remedy. Victorians were divided on the issue of consuming alcohol before, during and after childbirth, however. Women were advised not to drink too much brandy during labour, but encouraged to drink a glass of stout to facilitate breastfeeding.

The shape and size of the attendant midwife was also a concern in the 1800s, where it would be considered impolite and impolitic to comment today: on the subject of attendants in the birthing room, one advice manual states that a “fat dumpling of a nurse is to be avoided”, although the reason for this is not given.

There was, of course, also a darker side to these advice manuals in which women were encouraged to “keep up their spirits” and “look forward with confidence to the birth”, whilst being kept utterly in the dark as to the physiological realities of labour. The evidence Cox amasses suggests that plenty of Victorian women thought their baby would be born through their navels.

Cox’s stated purpose in this book is to “uncover the maternal voices of the past which have largely been forgotten, overlooked, or dismissed as insignificant”. In this endeavour, she is at great pains to point out the effect of social inequality on the experience of pregnancy and childbirth. We are pressed with reminders of this on almost every page, as Cox juxtaposes her accounts of queens and royals, giving birth surrounded by servants and medical experts; with hapless prostitutes, left to labour in the streets or birth their stillborn children into the “night soil” of a public toilet.

Cox does her best to right social wrongs in her use of sources, which makes it all the more ironic that the most entertaining anecdotes in the book come from wealthy, influential women. The image of the pregnant Viscountess Amberley riding her pony, skating, going to balls and generally “gadding about”, as the advice books disapprovingly put it, has a cheeringly “tally-ho” feel to it.

Extracts from Queen Victoria’s diaries and letters are amongst the other highlights. The fractious queen’s impatience at having to endure so many pregnancies (nine in total) is humanising: “one feels so pinned down,” she wrote, “one’s wings clipped — in fact, at best … only half oneself.” The lack of romanticism on the pregnant state from Victoria’s pen is refreshing, too: “I think much more of our being like a cow or a dog at such moments; when our poor nature becomes so very animal and unecstatic.” Victoria’s opinions on giving birth to daughters, however, would best be left off the advice that tends to adorn the walls of a modern birth centre: “if all one’s plagues are rewarded only by a nasty girl, I shall drown it, I think.”

The subject of pregnancy and childbirth invites comparisons with the present day, and Cox leans into this aspect. She is a mother of three and frank about the subjective nature of her inquiry into this Victorian past, sprinkling her chapters with personal anecdotes. Much of the content of the book is built around parallels with modernity. The effect of this approach, however, is to flatten out the curves and contrasts wrought by time that would make this book a work of history, as it claims to be, as opposed to a commentary on the universalising experience of childbirth.

I write this as someone as invested as any reader could be in the modern parallels that Cox draws: I read her book with my four-month old staring up at me from his bouncy chair. Much of the book is indeed very interesting, seen from that point of view. I found it especially striking that breastfeeding is as much a moral and cultural battleground now as it was in the 19th century.

“It was the fashion at this time for fine mothers to suckle their own children — so much the worse for the poor brats,” voices a character in Maria Edgeworth’s novel Belinda (1801), whereas others construed breastfeeding as a moral imperative: “It is the bounden duty of every woman to nurse her own child; and the mother who, through indolence or carelessness, neglects to perform this duty … [robs] her infant of that nourishment which God designed for its special use and support,” intoned the advice book Mother and Child (1868).

Cox leaps on these opportunities to draw modern comparisons: she cites message boards and the “breast is best” versus “fed is best” debates when discussing the role of wet nurses and working women. This is all very well, but it leaves this reader asking what exactly the book is trying to achieve, not least because Cox does not seem to want to get drawn into these debates. She is content, instead, to observe that similarities exist across time and space in the female “lived experience”.

In many ways this is a timely publication, when maternal health provision by the NHS in the wake of the Ockenden review is under scrutiny, and abortion rights are up for debate. Cox shies away from such political points, however. In seeking out the “continuities between women’s experience of pregnancy in the nineteenth century through to the present day”, she prefers to highlight the more mundane.

Other omissions are more troubling from a feminist perspective

On discovering that Emma Darwin, married to Charles, kept track of the weekly progress of her pregnancy in a diary, Cox informs us that here we “find a parallel with today’s smartphone pregnancy apps”. If she’d written the book in the 1980s, perhaps she would similarly have celebrated a comparison to the use of the Filofax. Cox also lectures on such obvious points that one wonders who the intended reader is, so ignorant must they be of the realities of pregnancy. On the subject of confinement itself, Cox observes that pregnancy is hard to conceal because the pregnant body becomes “visible as the pregnancy progresses”.

From an historian’s perspective, Cox labours points that are very well known to anyone familiar with the 19th century: the existence of severe social inequalities, the preference for male children over female, the fact that people born in workhouses typically didn’t have servants. Yet so many questions are left unanswered.

She notes, for example, that the advice books written in the 1880s suddenly start to include a lot more detail about the course of labour and the realities of childbirth, but she leaves us without an answer as to why that might be. Religious belief, too, is of no interest to Cox. The observation in one diary that she recounts, to the effect that difficulties with breastfeeding are the result of original sin, passes without comment.

Other omissions are more troubling from a feminist as well as an historical perspective. Elizabeth Garrett Anderson, the first female doctor in Britain, is only mentioned in passing, with no discussion of who she was or how, indeed, she came to be a doctor.

Other celebrated women of the era are also given cursory treatment. It is curious that Cox anticipates a reader who does not understand that a pregnant body grows more visible over time, but is so familiar with the writings of Mary Wollstonecraft and Elizabeth Gaskell that they barely need mentioning.

It is a limitation of this book that some of the most influential women of the 19th century are reduced to their childbearing status. The great feminists and suffragettes of the period are also written out of the story, even though they were the driving force behind major historical shifts in the treatment of female reproductive health — for example, the repeal of the Contagious Diseases Acts of the 1860s, which had placed the blame for the transmission of STIs on prostitutes, rather than the men who sought their services.

There is nothing on the great driving social, political and cultural issues of this century that were, after all, transformational for women in public life. Cox concludes her book with the observation that the “maternal experience played a crucial role” in the birthing of modern Britain, but this is not demonstrated. Without the necessary historical context, the book’s treatment of its subject matter is, well, a little confining.