Lessons from A Midwife:  Birth, Life and Death in Tiger Bay 

In the current climate of maternity care it is important to consider the past of midwifery. In this article Dr Alys Einion, FRCM, Senior Adviser of Studies, School of Health Sciences, University of Dundee, Scotland and Sian Jones, Practice Development Midwife, Cwm Taf Morgannwg University Health Board, Wales, explore the records of Sian’s midwife ancestor, and consider them in the light of current practises.  

 

On November 23rd, 1929, Hilda Maud Sutton was granted registration as a midwife by the Central Midwives Board of the United Kingdom. Hilda went on to practise as a Community Midwife in Tiger Bay, Cardiff, and over several years, attended, supported and cared for over one thousand mothers in her area, through birth, both joyful and tragic. Hilda’s birth records were passed on to her family.   Practice development midwife Sian Jones is Hilda’s great niece; she gave Alys the archive to use for her research, and for teaching the history of midwifery. Together, we conceived a project to create a narrative analysis and reconstruction, of Hilda’s work and impact, based on her archive of certificates and birth record books, spanning several decades, including a rare record of the birth of the NHS.  

Hilda lived and worked in Splott, an area of Cardiff next to the heavily industrialised docklands areas, known colloquially as Tiger Bay because of the large proportion of ethnically diverse residents. During the industrial revolution, and the Victorian and Edwardian eras, Tiger Bay was a key port for the coal and iron industries, but by the time Hilda was practising, these industries were beginning to die off, and the infrastructure of the docks, and its maelstrom of cultures, languages and peoples, was changing.  

Why are we doing this? 

“Knowing the past does not automatically bring solutions to present tensions, but without understanding the past… it would be difficult even to consider addressing challenges” (Borelli, 2013). We feel that Hilda’s legacy of records has lessons to teach contemporary midwives and midwifery practice, not the least being the need to combat medicalisation, implement midwife-led, community-based models of care. The significance of midwifery as a profession is echoed in Hilda’s role as a key figure in her community. She would have been well known by her families, a familiar figure walking the streets with her midwife’s bag and her smart coat, her midwife’s badge and her determined expression, or responding to a knock on the door at any time of the day or night (Leap and Hunter, 1993). We believe that Hilda’s legacy to modern midwives needs unpicking. As we uncover the context, stories and clinical realities of her work, we aim to share insights with the midwifery community and ensure her life contributes to the collective wisdom of this uniquely wonderful profession.  

Birth 

The birth rate was rising during the period of Hilda’s midwifery practice.  

Hilda practiced through the second world war, during some of which time we believe she was seconded into a hospital-based role, or into some other war work, because there is a gap in birth records covering two years. We have records of her time as a pupil midwife, working in a hospital labour ward, starting with her first personal birth (pre-qualification) on 8 January, 1929, at 9.10 am of a live female infant at 36 weeks gestation. Her first books are a mix of hospital and home births, as indicated by the interventions (intravenous infusions, episiotomy, doctors and supervising midwives being present), but after 1937, all of her records are of babies born at home, with Hilda, and sometimes another midwife or a GP present. Her final recorded birth was on 13th September, 1955, 29 years after she was registered as a midwife. Her final birth was a live female infant, born at 8.25 am, at full term. This was recorded as her 1005th personal birth (after qualifying).  The majority of these she attended alone or with another midwife.  

Life 

Life at this time was challenging. Population density was increasing rapidly in Cardiff, compared to the rest of the UK.  

(Source GB Historical, n.d.) 

Hilda would have worked in crowded streets, in a densely populated, industrial area, close to the docks and the infrastructure that supported the docks. The majority of her families would have worked in this industry.  

The cost of the birthing fees was typically One Pound Ten Shillings. Occasionally the fee is recorded as One Pound Fifteen Shillings, and just as occasionally, births are recorded as Free. We have not yet been able to determine the reasons for these. One Pound Ten Shillings was around an average weekly wage in the 1930s. Dockworkers’ pay as around 13shillings, 4 pence a day, which in todays money would be £50, or as much s £2, 18 shillings a week. Thus, the midwife’s fee would be a significant outlay, particularly in larger families, of which there were many. Hilda’s records show the last birth she charged a fee for was of a full-term, live female infant to a 21 year old woman, on 26th June, 1948. fter this time, no family was asked to pay for her services. Prior to this, Hilda was employed by the local authority. Subsequently, her wage was set by the National Health Service.  

Hilda and her community witnessed significant local tragedy. In 1937, due to a massive decrease in shipping and a downward trend in coal exports, unemployment was rising and reached 20%. Incidentally, in this year, Shirley Bassey was born in Bute Street (sadly before Hilda started her practice). The first family planning clinic in Cardiff was opened despite opposition. By 1939, coal shipments had decreased further, a fall of 50 per cent in just 25 years. With the start of the Second World War, large numbers of air-raid shelters were built. In January 1940, food rationing was introduced, and in that year, the Royal Ordnance Factory was opened at Llanishen (where members of Hilda’s family subsequently worked). About 75 per cent of the supplies for the American forces in Europe were shipped out through Cardiff docks following the D-Day landings in June. The docks were so busy at this time that about 15,000 people were employed there. 

In 1947 there was six weeks of arctic weather during the winter, which caused significant problems with post-war food and fuel rationing. In 1950 the last shipment of coal was shipped out from Bute East Dock, and in 1951 the Glamorganshire canal was closed. In 1955, the year that Hilda last delivered a baby, Cardiff became the Capital City of Wales.
 

Death 

In 1940, 20 people died in air raids.  In January 1941 Hilda and her community witnessed the heaviest German air raid in Cardiff, with 157 people killed, and severe damage to Llandaff Cathedral  and other key buildings, including  the nurses’ home at Cardiff Royal Infirmary. A further 50 people were killed in a raid in March. Six people were killed in an air raid in March 1942, and a further 46 in May 1943.  Nine people died in Llanishen in March 1944. The last raid on the city took place in May.
By the end of the War as many as 30,000 homes in Cardiff had been damaged, with a further 600 destroyed: 345 people, including 47 children, had been killed and more than 900 injured.  

Infant mortality decreased rapidly in Cardiff during Hilda’s professional life.  

Despite this, Hilda herself witnessed death first hand. Not only the deaths of infants, infrequent but evident in every one of her records books, often due to prematurity, but also, significantly, a maternal death. Tucked into the pages of her final record book is a scrap of blue paper with her handwritten notes recording the death of one of her mothers. No detail of the clinical case is provided. No cause of death is noted. We can glean from this sparse, scribbled record, that the mother was unwell after birth. Was it eclampsia, or a post-partum haemorrhage? The latter is the most likely cause, but we may never know.  

What can we learn from her records?  

We can see, reviewing the archive, that midwives embrace change, and midwifery encompasses the evolution of knowledge and competence (Prosen, 2022). Midwives continue to provide vital care during times of hardship, and of conflict (Eagen-Torkko et al, 2021; Segev et al, 2024; Nenko et al, 2024), witnessing new life and yes, being present at the end of life.  In the wider context of global tension, midwifery continues as a vital health service contributing to the wellbeing of women, babies and communities (World Health Organisation, 2025).  

In this current era of poor staffing (Reddy et al, 2022), lack of home birth services, and a climate of increasing distrust of midwives and of medicalisation of pregnancy and birth (Nelson and Romanis, 2021), evidenced by the rising rates of women choosing to freebirth or ‘birth outside guidelines’ (Shorey et al, 2023), it is pertinent to consider that this false divide between midwifery as a practice, and women as those experiencing birth, should not exist.  Midwifery is and always was a relational profession (Eri et al, 2020). We are not arguing that Hilda’s was some golden era, as conditions at the time would have varied, and the midwife and doctor managed birth very strictly (Leap and Hunter, 1993) but this was not an affluent area. Hilda served a working-class population. Her story underpins the need to return midwifery to its roots, as a community-based, well-supported service which is equipped to provide effective care that supports women and families towards optimal health.  

A good example of this is the group-care model described throughout the special edition of The Practising Midwife Journal in July 2024, guest edited by Suze Jans and Marlies Rijnders.  Every article in this issue demonstrates the value of a community-located, relationship-based model of midwifery.  Sufficient evidence exists to support that midwives bring improved outcomes through humanising, community-located midwifery care models (Mathias et al, 2020; McInnes et al, 2020), to suggest that the midwives of the past have much to teach the midwives of the future.  

Through premature birth, multiple birth, still birth and infant loss, Hilda’s records bring into sharp focus the challenges and value of community midwifery and the demands it made on midwives, providing a range of key lessons to apply to our current working practices. The value of her role as a familiar, trusted face in her community, the community she lived in, cannot be underestimated. Almost 100 years on, her voice inspires us to stand up and speak out about where we are now, providing a critical reflection on the history and evolution of midwifery and the lessons we can learn from this history and the rich depth of this woman’s work, applying historical knowledge to enhancing meaningful contemporary midwifery practice.  

References 

Borelli, S. E. (2013). What is a good midwife? Some historical considerations. Evidence Based Midwifery, 11(2), 51. 

Central Midwives Board. (1955) Suggestions and instructions regarding the conduct of the course of training of pupil-midwives. Central Midwives Board: London 

Eagen‐Torkko, M., Altman, M. R., Kantrowitz‐Gordon, I., Gavin, A., & Mohammed, S. (2021). Moral Distress, Trauma, and Uncertainty for Midwives Practicing During a Pandemic [image]. Journal of Midwifery & Women’s Health, 66(3), 304. 

GB Historical GIS / University of Portsmouth, Cardiff through time | Historical Statistics on Population for the District/Unitary Authority | Rate: Population Density (Persons per Hectare), A Vision of Britain through Time. URL:  https://www.visionofbritain.org.uk/unit/10150530/rate/POP_DENS_H Date accessed: 11th June 2025 

Leap N, Hunter B. (1993) The midwife’s tale. An oral history from handywoman to professional midwife. Scarlett Press: London 

Mathias, L. A., Davis, D., & Ferguson, S. (2021). Salutogenic qualities of midwifery care: A best-fit framework synthesis. Women and Birth, 34(3), 266-277. 

McInnes, R. J., Aitken-Arbuckle, A., Lake, S., Hollins Martin, C., & MacArthur, J. (2020). Implementing continuity of midwife carer–just a friendly face? A realist evaluation. BMC Health Services Research, 20, 1-15. 

Nelson, A., & Romanis, E. C. (2021). The Medicalisation of childbirth and access to homebirth in the UK: COVID-19 and beyond. Medical Law Review, 29(4), 661-687. 

Nenko, I., Baranowska, B., Szlendak, B., Sahraoui, N., & Węgrzynowska, M. (2024). “We were left to our own devices”: Midwives’ experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine. Women and Birth, 37(4), 101629. 

Reddy, B., Thomas, S., Karachiwala, B., Sadhu, R., Iyer, A., Sen, G., … & Tunçalp, Ö. (2022). A scoping review of the impact of organisational factors on providers and related interventions in LMICs: implications for respectful maternity care. PLOS global public health, 2(10), e0001134. 

Segev, R., Videl, H., & Spitz, A. (2024). Nurses under fire: Insights from testimonies of community nurses and midwives in nonhospital settings in the southern Israel conflict zone. Research in Nursing & Health, 47(5), 513-521. 

Shorey, Shefaly, Gabija Jarašiūnaitė‐Fedosejeva, Burcu Kömürcü Akik, Annaleena Holopainen, Gozde Gokce Isbir, Jing Shi Chua, Carly Wayt, Soo Downe, and Joan Lalor. “Trends and motivations for Freebirth: A Scoping review.” Birth 50, no. 1 (2023): 16-31. 

World Health Organization (2025) https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/maternal-health/midwifery Accessed 15 June 2025.  

Dr Alys Einion, FRCM, Senior Adviser of Studies, School of Health Sciences, University of Dundee, Scotland and Sian Jones, Practice Development Midwife, Cwm Taf Morgannwg University Health Board, Wales 

Alys  will be a speaker at the forthcoming Northern Maternity and Midwifery festival on July 8th 

HOME – Northern Maternity and Midwifery Festival 2025

July 2025