Overseeing Childbirth: The Revolutionary Forms of Surveillance That Reshaped Obstetrical Care
When childbirth becomes a state affair
Childbirth, an intimate, familial, and physiological event, has historically also been a space of control and surveillance. Paris between 1789 and 1804 represented a turning point in the history of childbirth and of midwifery: in a few years of dizzying political changes – absolute monarchy to republic, and eventually to empire under Napoleon – Parisian obstetrics underwent important institutional reforms that transformed it into a laboratory for experimenting with new forms of medical, moral, and political control.
The period marked one of the most radical political transformations in European history. What is less known is how profoundly these political upheavals reshaped healthcare institutions. Revolutionary authorities, driven by Enlightenment ideals of rationality and public welfare, dismantled the old charitable medical system and replaced it with a free state-organized network of healthcare institutions that would become the blueprint for modern European healthcare systems.
This story from two centuries ago may seem distant, yet it speaks directly to our present. In contemporary delivery rooms, in our perception of women’s bodies and pregnancies, we can recognize the echoes of these Revolutionary policies, and the forms of surveillance they implemented: bodies measured with sophisticated technologies, clinical stays and therapies regulated by standardized protocols, healthcare professionals and institutions balancing care and control. Current debates on the medicalization of labour and the autonomy of women who are giving birth have roots that we can trace to that crucial moment in European history.
This blog post, based on the research that shaped my doctoral thesis, explores how childbirth became a new object of systematic surveillance through three interconnected dimensions: medical-scientific authority, moral-professional control of personnel, and political-institutional regulation of the very moment of childbirth.1 Paris, the epicenter of the Enlightenment, and that of the French Revolution, was the place where these transformations manifested and were implemented with particular intensity and velocity, becoming the main European venue for scientific and institutional innovation in obstetrics.
This historical perspective allows us to understand the roots of contemporary practices and the tensions that still characterize the relationship between bodies, medical knowledge, influence of institutions and political power.
The interweaving of surveillances
To understand how childbirth became a site of systematic control, we will consider a complex web of clinical and educational styles that emerged in the midwifery theory and practice in end-of-the-century Paris. Our exploration of this transformation reveals overlapping and interwoven systems of surveillance that operated simultaneously across multiple domains that reinforced and legitimized each other.
Medical-scientific supervision – bodies as machines and the mathematisation of childbirth
The first level of surveillance can be identified in the mathematisation of childbirth and the medical reconceptualization of the female body in light of rationalist ideas. The latter was (beginning to be) interpreted as a “machine” to be measured and be potentially ‘fixed’. Childbirth itself became a mechanism to be controlled, regulated, corrected. Male obstetricians (accoucheurs), who had timidly entered the field of midwifery just a few decades before, by the end of the 18th century had reconceptualised childbirth from a natural event into a mechanical phenomenon, analyzable through the laws of physics.2
Surgical instruments embodied this transformation. Tools such as the forceps, presented as an instrument to ‘assist’ nature, actually became an instrument of control over the timing, methods, and subject of ‘giving birth’: the surgeon, with his knowledge of the gears of the body and his devices, was the active element of the process of childbirth, no longer the mother.3
The development of “pelvimetry” was emblematic: man-midwives would measure pelvises and classify them as “natural” (quatre pouces – 11,2 cm) or “against-nature” (trois pouces – 8,4 cm).


Measurements were no longer merely descriptive, but prescriptive, dictating interventions that were often experimental and invasive, such as the symphysiotomy (the cutting of the pubic cartilage) and the cesarean section, which at that time was almost always fatal for the woman operated. It was precisely in the Revolutionary context that cesarean section on living women was officially approved for the first time ever, by the Revolution-founded Société de santé, in 1798. Though still extremely dangerous, with maternal mortality rates close to virtually all cases, the procedure’s official recognition marked the triumph of geometric “rationality” and surgical interventions in obstetrics.
And with measurements, ‘exactness’ and ‘scientific nature’, the new authority of surgeons in obstetrics was consolidated. This transformation was deeply gendered. Mathematical and geometric approaches became the instrument for legitimizing a new professional authority, that of male obstetricians, which progressively displaced the art of midwives which had been practiced for centuries with just hands, warm water and oils, and which was now suddenly downgraded to “pre-scientific” knowledge.4
Moral-professional authority – midwives as objects and subjects of surveillance
The second level of surveillance is exemplified by the transformation of midwives from autonomous figures to dual agents – simultaneously surveilled and surveillants. At the beginning of the 18th century, midwives practiced with relative autonomy, training through apprenticeships and passing down practical knowledge from generation to generation.5
Their incorporation into surgeons’ guilds (1730) marked the beginning of their acknowledgement in the health services, and of increasing control, which culminated with the founding of the first national midwifery school in Paris, at the Maternité of Port-Royal (1802), and their recognition as “state health officers” (1803). Midwives found themselves in a paradoxical position: at the École de Port Royal they received advanced clinical training, studied female anatomy, minor surgery, and herbal pharmacy, but they simultaneously saw their professional autonomy reduced, especially in clinical contexts and in hospitals6, where they worked under the authority of male colleagues.
Training itself became an instrument of discipline: in schools, students were subjected to rigid rules, dress codes, and behavioural monitoring. Their private lives were scrutinized as much as their professional ones. At the same time, they themselves became instruments of surveillance over birthing women, noting behaviours, monitoring bodies, enforcing institutional rules.
Midwives thus embodied the tension between knowledge and power: more educated but less autonomous, officers of the new Republic but subordinate to male authority, present at the most intimate moment of female life but as representatives of an external and institutional authority, that of the State. Their training made them simultaneously objects of discipline and instruments of a new institutional order: a circular form of surveillance.7

Political-institutional control – maternity clinics: care and supervision
The third level of surveillance finds its highest expression in the transformation of hospitals. From charitable institutions that welcomed those in need, they transformed into specifically therapeutic structures where assistance became a citizen’s right. “Guests” became “patients”, objects of therapeutic care but also of clinical observation and experimentation.9 An entirely new medical system was created, with standardized training, state certification, and public care institutions that remain the foundation of French (and much of the Western) healthcare today. Hospitals were no longer places of charity but places of right (of health, of state-administered care), following the Revolutionary principles of universal access, standardized care, and state responsibility, and at the same time instruments of both public health and social order, at the price of increased surveillance and control of the people recovered there.
In the Maternity of Port-Royal, the first European hospital dedicated exclusively to pregnant women, new-borns and foundlings (1796), childbirth was extracted from its traditional context and reconstructed as a clinical event shaped by three innovations: it became simultaneously a therapeutic procedure, an object of scientific investigation, and a teaching opportunity. Women entered as “patients” rather than women in labor, their bodies and the physiological processes were observed, recorded, and analysed within a new obstetrical epistemology. Women could enter without declaring their identity – a fundamental right for all – but inside they were subjected to pervasive control. They had to work to “repay” the assistance received, and above all, they became objects of clinical study for students and professionals in training.10
This exchange – anonymity and free care in exchange for becoming an object of clinical study – materialized a new social contract between citizens and the State. The individual body became a matter of public interest, aligning with physiocratic economic theories that saw population as the true wealth of the nation. The birthing women lost a vast part of control over their own bodies in exchange for free State assistance, in a process that started to transform childbirth from a family and social event into a medical and institutional one.11

Conclusion: interwoven surveillance, yesterday and today
What makes this historical moment particularly significant is that it occurred during the crucible of the French Revolution – a time when every institution was being reimagined according to new political principles. By reconfiguring obstetric care specifically, Revolutionary authorities were shaping the birth of new citizens for the new-born nation, both in its significance and in its material conditions.
The three levels of surveillance analysed in this post did not operate separately but reinforced each other. Science legitimized professional authority; professional authority served political interests; political institutions provided the space for scientific study, for perfecting training, for greater protection and greater control of the population. This formed a circle that radically transformed not only obstetric practice but the very nature of the relationship between women giving birth and birth assistants, between healthcare professionals and the State, between the private sphere of family life and public interests.
The tensions identified have not remained confined to the archives. They form the basis of contemporary European healthcare systems and continue to reverberate in delivery rooms, in discussions on the medicalization of birth, in debates about who should control and decide about women’s bodies. Surveillance of childbirth in revolutionary Paris offers us a mirror through which to reflect on current forms of medical and social control, reminding us how surveillance, as much as care, often operates through interconnected networks of professional, scientific, and political power.
If this historical perspective on childbirth surveillance in Revolutionary France has piqued your interest, you might enjoy my more extensive analysis in “Obstetrics during the French Revolution: political and medical controversies around the new obstetrical surgery,” published in Annals of Science, 2024. There, I also examine further dimensions of this story, including controversies and ambivalent perceptions of these changes among doctors and Parisians: https://doi.org/10.1080/00033790.2024.2382436
Cite this article as: Elena Danieli, Overseeing childbirth: the Revolutionary forms of surveillance that reshaped obstetrical care, in Vigilanzkulturen, 23.09.2025, https://vigilanz.hypotheses.org/?p=12002.
- This research was developed in the thesis Arte, scienza e politica: l’ostetricia a Parigi tra Ancien Régime e Rivoluzione,completed within a joint doctoral program between the Università di Bologna and the Université Paris Cité, and during a fellowship at the SFB Vigilanzkulturen. The thesis was defended on April 7th, 2025. [↩]
- Jacques Gélis, La Sage-femme ou le médecin : une nouvelle conception de la vie (Paris: Fayard, 1988). [↩]
- Jean Louis Baudelocque, L’art des accouchemens, III, vol. I, II vols (Paris: Méquignon, 1796). [↩]
- Jacques Gélis, ‘La Main et l’outil Aux XVIIe et XVIIIe Siècles : La Réponse de Deux Accoucheurs : Paul Portal et George Herbiniaux’, in Accompagner l’accouchement d’hier à Aujourd’hui (Érès, 2022), 77–118. [↩]
- Henriette Carrier, Origines de La Maternité de Paris. Les Maîtresses Sages-Femmes et l’Office Des Accouchées de l’ancien Hôtel-Dieu (1378-1796) (Paris: Steinheil, 1888). [↩]
- Marie-Louise Dugès Lachapelle, Pratique des accouchemens ou Mémoires et observations choisies, sur les points les plus importans de l’art (Paris: Baillière, 1821). [↩]
- Nathalie Sage Pranchère, L’école des sages-femmes : naissance d’un corps professionnel 1786-1917, Perspectives historiques (Tours: Presses universitaires François-Rabelais, 2016). [↩]
- Hucherard, Sausset, and Girault, Mémoire historique et instructif sur l’hospice de la Maternité (Paris: Imprimerie des hospices civils, 1808), p. 47 (Gallica.fr). [↩]
- Erwin Heinz Ackerknecht, Medicine at the Paris Hospital, 1794-1848 (Baltimore: Johns Hopkins Press, 1967). [↩]
- Scarlett Beauvalet, Naître à l’hôpital Au XIXe Siècle, Histoire et Société – Modernités (Paris: Belin, 1999). [↩]
- Dora B. Weiner, The Citizen-Patient in Revolutionary and Imperial Paris, The Henry E. Sigerist Series in the History of Medicine (Baltimore: Johns Hopkins University Press, 1993). [↩]
OpenEdition schlägt Ihnen vor, diesen Beitrag wie folgt zu zitieren:
elenadanieli (23. September 2025). Overseeing Childbirth: The Revolutionary Forms of Surveillance That Reshaped Obstetrical Care. Vigilanzkulturen. Abgerufen am 14. Januar 2026 von https://doi.org/10.58079/14q78

