Louise Boursier

Louise (Bourgeois) Boursier (1563–1636) was royal midwife at the court of King Henry IV of France and the first female author in that country to publish a medical text.[1] Largely self-taught, she delivered babies for and offered obstetrical and gynecological services to Parisian women of all social classes before coming to serve Queen Marie de Medicis in 1601.[2] Bourgeois successfully delivered Louis XIII, King of France (1601) and his five royal siblings: Elizabeth, Queen of Spain (1602); Christine Marie, Duchess of Savoy (1607); Nicolas Henri, Duke of Orléans (1607); Gaston, Duke of Orléans (1608); and Henrietta Maria, Queen of England, Queen of Scots, and Queen of Ireland (1609). In 1609, Bourgeois published the first of three successive volumes on obstetrics: Observations diverses sur la sterilité, perte de fruict, foecondite, accouchements et maladies des femmes et enfants nouveaux naiz / Amplement traictees et heureusement praticquees par L. Bourgeois dite Boursier (Diverse observations on sterility, miscarriage, fertility childbirth, and diseases of women and newborn children amply treated and successfully practiced). Subsequent volumes were published in 1617 and 1626, also in Paris.[3]

These publications include observation-based, innovative obstetrical protocols to manage difficult births as well as advice for pregnant and postpartum mothers and newborns. Bourgeois also offered recipes for various kinds of medications that would have been easy for a woman to make herself. The three volumes include over four dozen detailed case histories that made a substantial contribution to the emerging empiricism of seventeenth-century European science and medicine.[4]

Overall, Bourgeois’s mission was to educate midwives so that they could become more competent at caring for women’s obstetrical and gynecological needs as well as to inform women about how to care for their bodies themselves.[5] At a time when the best trained and most skilled midwives of Paris were competing for elite clients—who had begun to prefer male surgeons not only for difficult but also for normal births[6]—Bourgeois called out midwives, surgeons, and physicians alike for their incompetence and ignorance when it came to the care of pregnant, parturient, and postpartum mothers.[7] Moreover, Bourgeois envisioned a collaborative rather than hierarchical relationship among trained midwives, surgeons, and physicians, one that would serve the best interests of mother and child.[8]

Bourgeois’s works were as popular in her day as those of male medical authors like Ambroise Paré and Jacques Guillemeau.[9] Even after her death she enjoyed fame and influence in France and beyond. Her work is reflected in Jane Sharp's The Midwives Book: Or the Whole Art of Midwifry Discovered (1671); Marguerite du Tertre de la Marche's Instruction familière et utile aux sages-femmes pour bien pratiquer les accouchemens (1677); and Justine Siegemund's Die chur-Brandeburgische Hoff-Wehe-Mutter (1690).[10] Also following Bourgeois's example was Angélique Marguerite Le Boursier du Coudray (c. 1712–1794); it is unknown whether du Coudray was related to Bourgeois.[11]

Bourgeois's career as a royal court midwife spanned more than twenty-six years. She was paid 900 livres for each of the last four of Louis XIII's siblings' births, a sum eight times greater than the average municipal midwife's salary.[12] In 1608, she received an additional sum of 6000 livres, most likely in recognition of her superior services to the royal family.[13] After the birth of Marie de Médicis’s last child in 1609, Bourgeois asked for a pension. King Henry IV agreed to 900 livres, which was considered a reasonable retirement income.[14]

Early life
Bourgeois was born into a wealthy, propertied family in 1563 in Faubourg Saint-Germain, an upper-class suburb just outside of Paris. Bourgeois wrote, “Not for anything would we have traded our house for a beautiful one in the city, because … we had everything that those who lived in the city had, plus good air and the freedom of beautiful places to walk.”[15]

In 1584, Bourgeois married Martin Boursier, a barber–surgeon who had lived and worked for twenty years with the obstetrical and surgical innovator Ambroise Paré.[16] The couple had a comfortable life until the dynastic and religious wars that had wracked France for over thirty years came to the quiet suburb.[17] In 1589, while her husband was away with the army, troops destroyed Bourgeois’s ancestral home and others like it. She escaped with her three children and mother by fleeing inside the Paris city walls.

Bourgeois wrote that to make ends meet she sold the furniture and other objects she had salvaged from her home as well as items she had embroidered.[18] Life was difficult while her husband was at the front lines, but their financial circumstances did not improve after he returned in late 1593 or early 1594.[19] Bourgeois recounts that because she could read and had a surgeon for a husband, “[A] respectable woman [that is, an unlicensed midwife] who had delivered me of my three children and who liked me persuaded me to learn how to be a midwife.”[20] Initially, Bourgeois writes, “I could not bring myself to [become a midwife] when I thought of the [responsibility of] taking children to be baptized. … In the end … fear of seeing my children go hungry made me do it.”[21]

Early career
Unlike the majority of practicing midwives, Bourgeois did not learn midwifery by apprenticing to a more experienced midwife nor does she acknowledge that her husband instructed her. Instead, she recounts that she read the work of Ambroise Paré who, by 1593 or 1594 when Bourgeois decided to become a midwife, was deceased (he died in 1590). In Paré’s writing, Bourgeois would have found instructions on how to perform an obstetrical technique called podalic version that he reintroduced into medical practice; the technique allows a birth attendant to deliver a malpresenting infant feet first. [22] This procedure obviated the need to use hooks or other sharp instruments to extract an impacted fetus, a procedure that killed the fetus and sometimes mortally harmed the mother.

Paré also emphasized the importance of learning human anatomy by performing dissections, a part of medical and surgical training to which most midwives never had access.[23] However, Bourgeois had a friendship with the head midwife at Paris’s Hôtel-Dieu (poor hospital); she allowed Bourgeois to witness both deliveries of infants and autopsies of women who had died in childbirth.[24] These experiences contributed to her knowledge of female anatomy and the skills required to deliver a baby safely. At the time, the Hôtel-Dieu was the only institution in Paris where women could obtain formal training in midwifery.[25] But apprenticeships were limited: only four interns were accepted every three months.[26]

Bourgeois recounts that her first client was her porter’s wife.[27] Following this first delivery, she became “quite busy among the poor and other kinds of people.”[28] In 1598, Bourgeois went before the official medical licensing board to receive a midwifery license.[29] The board consisted of two senior midwives, a physician, and two surgeons.[30] Madame Dupuis, one of the two senior midwives, was royal midwife in the court of Henri IV. Dupuis objected to Bourgeois’s obtaining a license because she was married to a surgeon. At the time, Parisian surgeons were competing with midwives for the most elite clients.[31] Bourgeois claims that Dupuis remarked: “My heart tells me this doesn’t bode well for us.”[32] Bourgeois adds that Dupuis kept her for a long time and threatened to have her burned at the stake if she tried to compete with Dupuis. Despite Dupuis’s concerns, the other members of the board allowed Bourgeois to receive her license and become a sworn midwife.[33]

In 1601, Bourgeois learned that Henri IV’s new queen, Marie de Médicis, was pregnant and did not find Madame Dupuis, the royal midwife, “agreeable.”[34] Contemplating the grief that Madame Dupuis had given her at the licensing board examination, Bourgeois confessed, “I [too] would have wanted another woman.”[35] With the help of neighbors, friends, former clients, and royal physicians as well as the queen’s own ladies-in-waiting and their servants, Bourgeois created an elaborate scheme to supplant Dupuis.[36] While Bourgeois could not find a way to meet privately with the queen, she was able to gain the queen’s attention for a moment at a large banquet at the House of Gondi where the royal couple dined once or twice a week.[37] At just the right moment, Bourgeois’s allies directed the queen to observe Bourgeois from afar. Impressed with her calm demeanor and upright stance—characteristics that in Bourgeois’s era connoted moral and physical strength,[38] the queen declared that she wanted no other midwife to ever touch her.[39]

Writing
Bourgeois’s successes in the royal birthing room provided her with a large salary; in addition, the queen’s literary patronage resulted in Bourgeois’s publishing Observations diverses in three consecutive volumes. These volumes comprise numerous genres: medical treatise, autobiography, history, poetry—to extol her supporters and lambast her enemies[40]—and parental advice. But Bourgeois’s chief goal in publishing was to improve the health and alleviate the suffering of women and newborns. In all three volumes, Bourgeois relies more on her own experience than on ancient texts—a relatively radical choice at a time when French medicine still often relied on the practices of ancient Greece and Rome as well as of medieval Europe. Her first volume includes innovative obstetrical protocols that, if followed correctly, could save lives. For example, Bourgeois gave instructions on how to induce labor in the case of a contracted pelvis; how to deliver a baby with a face presentation; and how to cut the cord between two ligatures when the cord was wrapped around the neck.[41] She also included medicinal recipes she had validated for everyday use (sometimes, she claimed, by testing them on herself)[42] as well as over four dozen detailed case histories.[43] Few texts with such practical information on obstetrics and maternal care directed to women existed at the time, let alone ones written in a female voice. During the early modern period, Observations diverses was translated into German and Dutch; and partially and inexactly into English.[44]

The second volume of Observations diverses, first published in 1617, has medical advice as well as autobiographical and historical materials. The volume includes “Advice to My Daughter,” a didactic essay on the pitfalls of practicing midwifery. It is, as far as we know, the first text of its kind written by a midwife—a tradeswoman—to her daughter.[45] The essay outlines religious and moral guidance regarding such topics as abortion, sexually transmitted diseases, and female modesty; it also describes how a midwife might avoid being blamed for unsuccessful deliveries. The second volume includes, in addition, “How I Learned the Art of Midwifery”—a brief autobiographical sketch that has become source material for almost all secondary accounts of Bourgeois’s life. A third essay, “The True Account of the Births of My Lords and Ladies the Children of France with the Noteworthy Particularities Thereof,” incorporates a dramatization of the birth of the future Louis XIII. The queen’s first pregnancy took place at a time when France was in desperate need of a direct male heir to the throne; the lack of an heir had exacerbated the dynastic and religious wars of the prior thirty years.[46]

Bourgeois’s narrative of the birth of the future Louis XIII displays her knowledge of and playful attitude toward the critical importance that the Bourbon royals placed in having a male heir.[47] This attitude, of course, could only be exhibited after the actual birth of the future king. In her dramatization of his birth, Bourgeois exhibited a carnivalesque interpretation of this key event by implying that she could control the sex of the unborn child just before its delivery, a commonly held notion of her era.[48] She went on to claim that she set Henri IV on an emotional roller coaster by not revealing the child’s sex immediately after it was born.[49] She created narrative tension by describing at length how distraught the king and his courtiers were—until Bourgeois unveiled the naked child.[50] In this narrative, Bourgeois also underplayed whatever part the attending royal physicians and surgeons had at the event; she barely mentions them.[51]

In her narratives of the subsequent births of the future Louis XIII’s five siblings, Bourgeois supplied intimate details about the queen’s labor and relays the royals’ concerns about finding appropriate wet nurses; she also described where the births took place; exchanges between the queen and others attending her; and the queen’s awarding Bourgeois a special velvet cap. Of this last event, she boasted, “Formerly, royal midwives wore velvet neckpieces and a thick gold chain around their neck. … I have the honor that no other woman except for me has touched the queen during her deliveries and afterwards.”[52] These narratives provide a unique account of royal births that emphasize not only Bourgeois’s obstetrical prowess but also her perspective on the court’s internal workings at a critical moment in French history.

In the second volume, Bourgeois told her readers that that she wanted to “revise and enlarge the previous volume” by including a long chapter on diseases of the womb.[53] In addition, she created a mythological genealogy of her ascent to the position of royal midwife, and she included her daughter in that genealogy. Bourgeois traced her ancestry to Phaenarete, a midwife and the mother of Socrates, who, Bourgeois asserted, adopted her. Upon this adoption, Bourgeois further claimed, the ancient goddess of childbirth Lucina became jealous of Phaenarete. To demonstrate her allegiance to Bourgeois, Lucina then ordered Mercury to guide Bourgeois to the palace, where she became royal midwife.[54] Creating genealogies of this kind to defend and assert one’s personal and professional authority was a commonplace practice among male and female authors during this period. Also in this volume, Bourgeois discussed how to choose wet nurses and presented a series of unusual case histories.[55]

The third volume, published in 1626, was the briefest; it contains case histories that emphasize the importance of orally transmitted knowledge, and Bourgeois wrote of her growing concern about incompetent physicians who advise women without really understanding the signs of or other aspects of pregnancy.

Late career
Bourgeois was royal midwife under the regency of Marie de Médicis and the reign of Louis XIII. In 1627, while under Bourgeois’s care, the king’s sister-in-law Marie de Bourbon de Montpensier died six days after giving birth. Marie de Médicis ordered that an autopsy be made.[56] The published report intimated that Bourgeois was to blame for the death, which was believed to have been caused by retained pieces of the placenta found in the uterus.[57]

In response to this implicit attack upon her competency, Bourgeois wrote a brief pamphlet, Fidelle relation de l’accouchement, maladie et ouverture du corps de feu Madame, in which she defended herself.[58]  She highlighted her many qualifications; cited her practice as a midwife for thirty-four years; and noted that she had honorably acquired the proper license and had written books on midwifery that were used by physicians in England and Germany.[59] More specifically, she asserted that she carried out the delivery of the placenta properly. Even if small pieces of placenta remained, she insisted, they would have been flushed out by the lochia as the ancient Greek surgeon Paulus Aeginata and her own contemporary, the anatomist Girolamo Fabrici d’Acquapendente (1565–1613), had discussed in their writings.[60] However, the self-defense did not persuade her detractors. With all of her allies at court deceased, the scandal most likely ended her career as royal midwife.[61]

One year before her death, and only because of the persistent urging of her publisher, Bourgeois published Recueil de secrets, a book of remedies. Her reluctance to publish stemmed from her concern about including recipes for certain remedies that she had been keeping secret in order to pass them on to her daughter, Antoinette, who was also a midwife. The publisher wrote, “The only thing that kept her from bowing to my prayers for a long time was the consideration of her daughter, who had embraced her profession, which she feared to harm. Finally recognizing that she had acquired by her skill and great judgment, such a reputation, that she [her daughter] was henceforth quite recommendable in herself, without her needing to be so by her mother’s secrets, gave me this manuscript.”[62]

Bourgeois died on 20 December 1636. She was buried with her ancestors, who lived outside of Paris, rather than with her husband, whose grave was in the city.[63]

Publications by Louise Bourgeouis

 * 1609: Observations diverses sur la stérilité, perte de fruict, foecondité, accouchements et maladies des femmes et enfants nouveaux naiz, 1 vol. Paris, Saugrain (1er volume).
 * 1617: Observations diverses sur la stérilité, perte de fruict, foecondité, accouchements et maladies des femmes et enfants nouveaux naiz, 2 vols. Paris, Saugrain.
 * 1626: Observations diverses sur la stérilité, perte de fruict, foecondité, accouchements et maladies des femmes et enfants nouveaux naiz, 3 vols. Paris, Mondiere.
 * 1627: Apologie de Louyse Bourgeois dite Bourcier, Sage femme de la Royne mere du Roy, & de feu Madame. Contre le rapport des medecins. Paris, Mondiere.
 * 1627(?): Fidelle relation de l’accouchement, maladie et ouverture du corps de feu Madame [s.l.]
 * 1635: Recueil des secrets. Paris, Mondiere.

Suggested Reading
Bourgeois, Louise. Midwife to the Queen of France: Diverse Observations. Edited by Alison Klairmont Lingo. Translated by Stephanie O’Hara. Toronto and Tempe: Iter and Arizona Center for Medieval and Renaissance Studies, 2017.

Bourgeois, Louise. Observations diverses sur la stérilité, perte de fruits, fécondité, accouchements et maladies des femmes et enfants nouveau-nés; suivi de Instructions à ma fille: 1609. Edited by Françoise Olive. Paris: Côté-femmes, 1992.

Broomhall, Susan. Women’s Medical Work in Early Modern France. Manchester, UK: Manchester University Press, 2004.

Chereau, Achille. Marie de Medici Queen of France and Navarre Six Deliveries. Paris: Willem Press, 1875.

Gelbart, Nina Rattner. The King’s Midwife: A History and Mystery of Madame du Coudray. Berkeley: University of California Press, 1998.

Green, Monica. Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology. Oxford, UK: Oxford University Press, 2008.

Green, Monica. Women’s Healthcare in the Medieval West: Texts and Contexts. Aldershot, UK: Routledge, 2002.

Klairmont Lingo, Alison. “Louise Bourgeois’s School of Learning and Action.” Women’s Studies: An Interdisciplinary Journal 49, no. 3 (2020): 229–255. doi.org/ 10.1080/00497878.2020.1714396.

Klairmont Lingo, Alison. “Connaître le secret des femmes: Louise Bourgeois (1563–1636), sage-femme de la reine, et Jacques Guillemeau (1549–1613), chirurgien du roi.” In Enfanter: discours, pratiques et représentations de l’accouchement, ed. Adeline Gargam, 113–126. France: Artois Presses Université, 2017.

Klairmont Lingo, Alison. “Louise Bourgeois.” In Dictionnaire des femmes de l’Ancienne France, ed. Marie-Elisabeth Henneau. SIEFAR, 2016. http://siefar.org/dictionnaire/fr/Louise_Bourgeois.

O’Hara, Stephanie. “Translation, Gender, and Early Modern Midwifery: Louise Bourgeois’s Observations diverses and The Compleat Midwife’s Practice.” New England Journal of History 65, no. 1 (2008): 28–55.

Perkins, Wendy. Midwifery Medicine in Modern France: Louise Bourgeois. Exeter, UK: University of Exeter Press, 1996.

Read, Kirk D. Birthing Bodies in Early France: Stories of Gender and Reproduction. Abingdon, UK: Routledge, 2011.

Robin, Diana, Anne R. Larsen, and Carole Levin, eds. Encyclopedia of Women in the Renaissance: Italy, France, and England. Santa Barbara, CA: ABC-CLIO, 2007.

Sheridan, Bridgette. “Whither Childbearing: Gender, Status, and the Professionalization of Medicine in Early Modern France.” In Gender and Scientific Discourse in Early Modern, ed. Kathleen P. Long, 239–258. Abingdon, UK: Routledge, 2016.

Thomas, Samuel. “Early Modern Midwifery: Splitting the Profession, Connecting the History.” Journal of Social History 43, no. 1 (2009): 115–138.

Tucker, Holly. Pregnant Fictions: Childbirth and the Fairy Tale in Early Modern France. Detroit, IL: Wayne State University Press, 2003.

Worth-Stylianou, Valerie. “Birthing Tales in French Medical Works ca.1500–1650.” www.birthingtales.org.

Worth-Stylianou, Valerie. Pregnancy and Birth in Early Modern France: Treatises by Caring Physicians and Surgeons (1581–1625). Toronto: Centre for Reformation and Renaissance Studies, 2013.