A master midwife.

To be clear, this wasn't exactly luxury, and apart from those who had been able to attend her teaching at the Châtelet de Paris, the standard of these on-the-job-trained birth attendants (still called "matrones" or even "ventrières") was truly catastrophic. Infant mortality remained as dramatic as in previous centuries, exceeding 50% even in the wealthiest families. The matrons in charge of this function were often women who had themselves been mothers several times, and who finally gave the younger generation the benefit of their own experience. They were expected to be menopausal themselves, and to uphold religious principles and ecclesiastical modesty. The woman remained seated, while the midwife crouched in front of her, taking her cues from the knee up for her vaginal touch. Hot, very hot!

But things were changing. Mortality in childbirth was no longer accepted as a divine inevitability. A certain Montesquieu, who had published "Lettres Persanes", had his Turks tell him that the world was languishing, that the number of inhabitants seemed to be dwindling, and that midwives were responsible for this, a real danger to the population. Not entirely accurate, but not entirely untrue either. Mme du Coudray, master midwife at the Châtelet, was well aware of this.

It was for this reason that she had decided to return to her native Auvergne, and had sought in every way possible to be understood by these ignorant women who could neither read nor write. To make her lessons tangible, she had the ingenious idea of designing and manufacturing her "machine". The machine was a life-size mannequin made of wood, cardboard and fabric, reproducing the pelvis of a woman in childbirth, to guide the manipulations of a beginner. The mannequin's skull was made of wood, so that it could be felt by vaginal touch as if it were the skull of a real presentation. It also featured 21 small sewn-in labels that enabled students to identify the various reproductive organs, including the uterus, ovaries and fallopian tubes, and to situate them in relation to the intestine and bladder.


Angélique described this "machine" with almost maternal love in her "Abrégé de l'Art", depicting: "a woman's pelvis, the womb, its orifice, its ligaments, the duct called the vagina, the bladder, and the intestine rectum. I added a natural-sized model of a child, whose joints I made flexible enough to be able to put them in different positions, a hindquarters with the membranes and demonstration of the waters it contains, the umbilical cord, composed of its two arteries, and the vein, leaving one half withered, and the other swollen, to imitate in some way the cord of a dead child, and that of a living child, to which we feel the beating of the vessels that compose it. I added the model of a child's head separated from the trunk, with the skull bones passing over each other."
An accurate and ingenious piece of tinkering, confirming the fact that to be a midwife, you had to know how to use your head and your hands!





This was the way to get down to practical work, which was always better than speeches. The Intendant of Auvergne had been seduced by her idea, finding Angélique "very skilful and willing", and had decided that the main towns in his province should have a "machine". In 1758, the teaching was approved by the Académie de chirurgie, and the following year the king himself, well informed by the advice of La Pompadour, gave her a patent and a pension of 8,000 livres a year, with formal instructions to teach throughout the kingdom. So Angélique packed her trunks, packed her machine and set off.


Angélique had loaded her luggage into the sedan and was huffing and puffing as she pulled her trunk along. Over the years, she had put on weight and now presented herself as a strong-willed, but obese mistress, tortured by gout. Long gone were the days of her slender waist and long nights of vigilance when she was Dame Bairsin's young pupil at the Châtelet de Paris. The latter had taught her precision in analyzing difficult cases, patience at the bedside and the importance of knowledge in a profession that needed it. It was essential to convince midwives that all the old superstitions inherited from the mists of time were useless and even dangerous: viper fat on a woman's belly and the skin of a hare still seemed indispensable to some to promote expulsion; untying all the ropes in the house, opening locks and untying cows were supposed to prevent dystocic presentations. These were all superstitions that attracted the wrath of barber-surgeons, who gradually moved in to discredit the matrons and take their place.

Brinqueballée dans la berline avec la petite équipe qui l'accompagnait dans ses déplacements, Angélique du Coudray repensaient à cette nuit du 6 septembre 1757. She had just returned to the Auvergne after her stay in Paris, and had been called to the Château de Chavaniac, an ancient 14th-century building, for a birth that was not going well in the home of Marie-Louise de la Rivière, wife of the Marquis Motier de La Fayette, an old noble family from the Auvergne. The head was not descending into the pelvic canal. It took all Angélique's science and dexterity to save little Gilbert and his mother. Everyone was talking about it, as the La Fayette family was famous throughout the province and, above all, very wealthy. The birth was even considered miraculous. Angélique had been widely thanked and rewarded, but in reality this event, while exemplary, was only the latest in a long line of nights she had sacrificed in the service of children.


In reality, and Mme du Coudray was well aware of this, the ideal would have been to create "maternity houses" where all obstetrical skills would have been brought together to serve both simple and difficult deliveries, knowing that it was almost impossible to predict them. But there were few maternity units in France. There was one in Paris, at Hôtel-Dieu, which had been receiving pregnant women since the Middle Ages. There were also maternity wards in other cities, but they received very few women, because giving birth away from home had a shameful status: when you gave birth away from home, it meant you couldn't give birth at home (it was obvious!). It was either that you were too poor to give birth in your own home, or that you were unmarried, and therefore a single mother, and had no choice but to seek refuge in this hospital gesine.
Angélique's success was beginning to arouse opposition. Some doctors in particular were becoming increasingly irritated by the presence of these matrons in a specialty they wanted to make their own. One of the most aggressive was Alphonse-Louis Leroy, already well known for his impatience, his exaggeration in all things and his obstinacy in discussions. He had made a name for himself with his opposition to vaccination and his support for symphysectomy, which he considered essential to facilitate childbirth. Angélique was for him the archetype of those dangerous women who understood nothing of what he considered to be progress in obstetrics.

Angélique du Coudray was anything but naïve, and if she defended her colleagues, it was because she was convinced that childbirth could not be reduced to a technical act, and that a human dimension was essential to comfort the parturient. She was well aware that matrons knew all the family secrets, and were often their accomplices. How many newborns of very young women had been registered in the name of the mother of the woman giving birth, to avoid shame and opprobrium for the daughter?
She also knew that while waiting for the moment to deliver the woman, she should be consoled as "affectionately as possible", but also with an air of cheerfulness to ward off any fear of danger. She added: "We must avoid all whispering in her ear, which could only worry her and make her fear untoward consequences. You should talk to her about God, and encourage her to thank Him for putting her out of danger. If she has recourse to relics, she should be told that they will be just as effective on the bed next to her as if they were placed on her, which could cause her discomfort...". And she wasn't sure that the barber-surgeons would be able to provide this presence.
But no one was mistaken: this benevolence towards women was not without a strong affirmation of her principles, and to be a master midwife, she appeared above all to her contemporaries as a mistress-woman with whom it was not good to argue. In reality, she had gradually surrounded herself with a veritable court who followed her travels and sold her manuals and "machines" for hard cash. In fact, she had also managed to build a machine of success and wealth that drew down upon her the resentment of both the other matrons and the surgeons who swallowed their jealousy of her royal protection. A talented woman, Angélique was also a businesswoman! She had asked her niece Mme Coutanceau and her husband to join her in the family business.

During the 25 years of her journey, she constantly improved her method, adding illustrated plates to her manual and enhancing her mannequin with ever more realistic details. She was undoubtedly a major contributor to the decline in infant mortality in her day. Always active and passionate about what she knew to be her mission, time passed quickly on the roads of the kingdom. But Angélique was well aware of the great destitution of the French provinces she crossed. Louis had changed, but the king seemed so far away in his capital, and the bourgeois where she stopped tried to define the need for a change that was still a little confused, but that was just waiting to be expressed. By the time of the Revolution, Madame Du Coudray was approaching 74. She had trained over 5,000 midwives in her years of itinerancy, and around 500 surgeons. She was now living with her niece Mme Coutanceau, a midwife herself. Both women quickly realized that teaching obstetrics, like all other medical disciplines, would disappear from the priorities. Something had to be done. Mme Coutanceau drafted and presented a memorandum to the French National Assembly on the importance of obstetrics. In passing, she recalled that the difficult birth of La Fayette, now the "hero of both worlds", was due to Mme du Coudray's talent. We had to play all the cards we could, because Alphonse Leroy, the old enemy who wanted to reserve childbirth for men, was back in the audience in these troubled times, ironizing as usual about the lady who taught childbirth with her doll! Fortunately, in his Instruction sur la manière d'inventorier et de conserver, dans toute l'étendue de la République, tous les objets qui peuvent servir aux arts, aux sciences et à l'enseignement (1794), the great anatomist Félix Vicq d'Azyr, founder of the Société royale de médecine, launched a survey in the provinces on the teaching of childbirth, which proved highly favorable to Angélique's action.

But things didn't get any easier. Titles were abolished, and the d'Allarde law allowed anyone to claim to be a midwife or doctor. As for the Faculty of Medicine itself, the Convention had just abolished it! What's more, the State was becoming poor; Angélique's pension was no longer forthcoming. The assets she had amassed over the course of her career had had to be sold to provide for her needs. Madame Coutanceau had received nothing since submitting her memoir, but in July 1793, a beacon of hope, she became the first director of a newly founded maternity home. But the Terror took hold. Everyone was harassed. Both women had to show proof of their citizenship. But one day, when her niece and husband were absent, Madame du Coudray died, ruined and disillusioned by the incomprehension and contempt of the new rulers.