Her manual, addressed not only to midwives but to all women who might become pregnant, mixes anatomical and physiological information, instruction about care for the mother during and after labour, and non-medical topics such as strategies for protection against accusations of misconduct.
Published against a background of increasing male dominance of the midwifery profession, the book promotes the idea that female midwives, particularly those who were (like Stephen) themselves mothers, were the natural default for normal births.
While Domestic Midwife was not particularly well received by critics during her lifetime, the physician and medical historian James Hobson Aveling describes the book in 1872 as "perhaps the best upon the subject that has been written by any woman" in English.
[6] The British midwife and lecturer Anna Bosanquet describes Stephen as an "independent thinker" who was "well read" and who displayed a "high degree of professional integrity and judgement" in her work.
In the following decade, surgeons started to have some success in delivering live births in cases of obstructed labour, using a technique relying on obstetric instruments, particularly forceps, and by around the middle of the century, male midwives (called "man-midwives" or "accoucheurs") were increasingly becoming fashionable, especially among the wealthy.
[19] Additionally, a few women wrote manuals in France and Germany, including Justine Siegemund (1636–1706), Angélique du Coudray (1714/15–1794) and Marie-Louis La Chapelle (1769–1821).
[12][23] Stephen recounts a brief history of midwifery, asserting that it was Louis XIV's mistress who, in 1663, started a trend to employ male midwives.
[12] She describes the "anguish" of labour, and writes that only women who have experienced childbirth could understand the pain associated with manual interventions, which was dismissed by male midwives.
[21] She writes that the mother's privacy and dignity are best served by a female midwife,[4] and further argues that there is a possibility of inappropriate intimacy arising during the course of delivery.
Explicitly drawing on her personal experiences of childbirth, she warns that "impure thoughts" can arise in the woman, particularly in intermissions between the painful episodes during delivery, and calls attention to the fact that "some women speak with rapture of the men who deliver them of their children".
[3] Despite the avowed audience encompassing all women, its approach is more medically focused than other books by female midwives, and Stephen refers to her clients as "patients".
[3] Although Stephen recommends using forceps as little as possible, she considers that "delivery with instruments has saved some lives",[21] and covers their proper use to minimise damage both to the baby's skull and to the mother's perineum.
[31] The British physician and medical historian James Hobson Aveling, in the earliest history of female midwifery in Britain, published in 1872,[32] describes the book as "perhaps the best upon the subject that has been written by any woman" in English.