Comic authors like Rabelais give the impression that all midwives were dirty, greedy, ignorant old hags, and all too often they were even associated in popular gossip with witches. In small towns and villages of France, there was little regulation; the one essential requirement for entry to the profession was a certificate from the local priest attesting a good moral character. But in larger towns, various provisions were made in the course of the 16th century, such as the 1560 law in Paris which required candidates for admission to the status of registered midwives to have followed a course of study delivered by the city's surgeons and to pass an oral examination in front of a jury. This is exactly the training undergone by Louise Bourgeois, who was recognised as a registered midwife in 1598. From 1630 the public lying-in hospital in Paris, the Hôtel-Dieu, which had been built in the 14th century and had always had a resident midwife, was required to admit a small number of pupil midwives, thus making it the first French school of midwifery. But in many other cases, practical knowledge continued to be passed down from one woman to another, with or without the support of obstetric manuals, at least until Madame du Coudray undertook her famous educational tours of France, using her famous machine, with the express aim of training midwives in the provinces.

The first duty of midwives, of course, was to supervise births. In cases where all went smoothly, she would be alone, unless the mother chose to have friends or female relatives present as well. But if the midwife anticipated a difficult birth requiring an assisted delivery, she would need to call upon a surgeon, just as she would have called in a physician if complications arose during the pregnancy. A woman might well consult a midwife for other gynaecological problems. Midwives were considered to know "women's secrets", such as uterine pessaries, little remedies for stopping or increasing milk, and so forth. Undoubtedly some midwives secretly performed abortions, but those who valued their professional reputation, like Louise Bourgeois, would have absolutely nothing to do with such requests. Furthermore, midwives were legally required to declare any suspected cases of infanticide. They might also be called upon as professional witnesses in trials concerning sterility or requiring proof of virginity, even if some physicians like Laurent Joubert in his Erreurs populaires, treat their statements with scorn. And, one other key duty - in a Catholic country - was that of baptising the newborn if they should seem too frail to survive, so that their souls might be saved.

What do we know of relations between midwives, surgeons and physicians? In many cases, there is evidence that they were cordial, that there was mutual respect. But professional rivalries also surface, especially around the turn of the 17th century when the arrival of the man-midwife or accoucheur threatens to undermine the female midwife's traditional role. Henry IV suggested calling upon Honoré "this man from Paris who delivers women" during the birth of his fourth child, a footling breech presentation, but the midwife Louise Bourgeois is proud to record that he was not needed. Nonetheless, male-midwives or accoucheurs became fashionable in Paris in the later 17th century, so much so that Louis XIV selected one for the delivery of his mistress Louise de La Vallière, in 1663. This move towards the use of the male surgeon brought with it the decline of the birthing stool, and of deliveries in a standing or seated position. And soon the invention of forceps was to change practices even further.