How Do You Become a Good Mom—in 1900?

Around 1900, infant mortality in the Netherlands is very high. Various initiatives are launched to reduce it. One of these is a course for mothers and maternity nurses, through which the district nursing associations disseminate the latest insights into hygiene.

A cross association was a private organization that provided health education and care and nursed patients at home—similar to today’s home care services. In 1875, the first cross association in North Holland was founded: the White Cross. Its main aim was to prevent the spread of infectious diseases and epidemics. This could not be achieved without addressing people’s living conditions. During home visits, for example to identify people suffering from tuberculosis, unhygienic habits harmful to health were observed: stuffy living spaces lacking fresh air and sunlight, with too many people crowded into a small area. Homes had no clean bedding, let alone running water or proper sewerage. These conditions had to improve, as they were particularly harmful to newborns and largely explained the high infant mortality rate. Another factor was that the so-called traditional birth attendants, the forerunners of maternity care assistants, were generally untrained and many of their practices were outdated. In 1899, the White Cross therefore began offering a course to teach both birth attendants and expectant mothers new principles of hygiene.

From the outset, the maternity and infant-care courses were pursued with great vigour. Key themes included discouraging old-fashioned infant-care practices, such as the use of pacifiers, breastfeeding at set times, and creating a clean and hygienic environment for newborns and young mothers. One of the earliest advocates was Aafke Gesina (known as Sien) van Hulst. She worked for the Groene Kruis—the community nursing association founded in 1900, exactly 125 years ago. She gave lectures everywhere and travelled the length and breadth of the country to teach the maternity and infant-care courses herself or train district nurses to do so.

Sien van Hulst is best known for her famous 1907 educational brochure Reinheid, Rust en Regelmaat (Cleanliness, Rest and Routine). Although the booklet bore this title, it soon became popularly known as Rust, Reinheid, Regelmaat —probably because the sequence of one-, two- and three-syllable words has a more pleasing rhythm. The concept is still in use today, often abbreviated to ‘the three Rs’.

Not only the White Cross, which operated in North Holland, and its nationwide counterpart, the Green Cross, but also the Catholic White-Yellow Cross and the Protestant Christian Orange-Green Cross attached great importance to maternity courses. Since only members could participate, these courses were an important means for the Cross associations to recruit members. Combined with the ‘loan depot’, where items such as bed risers, bedpans and all the other equipment needed for childbirth and the postnatal period could be borrowed, the maternity course ensured that a family’s membership began with the arrival of its first child. The maternity course thus became an important aspect of community nursing.

District nurses worked in both curative care (nursing older people and patients at home) and youth healthcare (well-baby clinics, toddler clinics and courses for mothers). This was known as working as an ‘all-rounder’. From the mid-1980s onwards, district nurses were required to specialise and choose between curative care and youth healthcare. During the same period, fewer courses for mothers were offered, sometimes due to budget cuts, but also because of a lack of interest. After community nursing services merged with family care services to form the National Association for Home Care, and commercial home care providers emerged, the courses for mothers did not return.

The widespread adoption of the three Rs was significant, but the key achievement was that the courses for mothers and traditional birth attendants helped professionalize the latter, thereby laying the foundations for formal training as a maternity care assistant.

In the analysis some 80 years later in the 1998 book Healthy and Well: Women and Healthcare in the Twentieth Century on the position of women in general healthcare, women take centre stage, but with a critical caveat: ‘By passing on hygiene guidelines, they placed women on the front lines, but in doing so they did not break through the boundaries of the gender-based division of labour.’ That women, too, had to be educated for this is evident from the idea that ‘Traditionally, housewives and others associated cleaning more with propriety, aesthetics, order and domestic comfort than with health.’ In the chapter ‘The Hygienisation and Moralisation of Healthcare’, Myriam Daru describes how the district nursing associations played a crucial role through their home visits, which gave them access to family life and the household: ‘The emergence of public-health associations—particularly the district nursing associations—which gained access to families’ private sphere created an opportunity to observe and correct the housewife’s behaviour. Various strategies were available for influencing women, crossing to a greater or lesser extent the boundary between public space and the intimacy of the home and private life. Exhibitions, talks during courses for mothers, and the assessment—and sometimes even condemnation—of the housewife by district nurses, infant welfare nurses, housing inspectors and other home visitors all penetrated, to varying degrees, the lived experience of women as a target group.’

When Dick Bruna became involved with A.N.V. het Groene Kruis (Green Cross), the national association, for its 50th anniversary in 1961, he was put in charge of various promotional materials, including posters, leaflets and registration cards. His illustrations also appeared on the cover of the anniversary book and even on the Green Cross sugar sachets. In a series of striking designs, Dick Bruna clearly depicted the Green Cross's various areas of work, such as community nursing, maternity care, family care and dietetics.

Bruna’s logo became a defining feature of the Green Cross’s promotional materials until the district nursing associations merged in 1978. How Bruna became involved with the Green Cross, and whether this was a paid or pro bono commission, has yet to be established. What is known is that both operated from the same street: the Green Cross was based at Nieuwegracht 69a, while Dick Bruna had his studio on the second floor of Nieuwegracht 15. In any case, it would have been easy to make contact.

Not much is known about participation in the mothers’ courses, nor about how the participants experienced them. Perhaps they offered an opportunity for (young) women to come together, creating a social setting in which they could share their experiences. This may have varied by region or even by neighbourhood. The gatherings may also have been a way to help women out of isolation or to keep an eye on the well-being of young children.

Were the maternity and infant-care classes necessary? Certainly around 1900, when infant mortality was high and hygiene was sorely lacking, they provided a source of reliable information. In an age of ‘old wives’ tales’—an early form of misinformation—they may well have been the only option. Today, child health clinics—once the domain of the district nursing associations—play an important role in connecting with young parents and their children.

Was the course patronising? Certainly. Mothers were expected to care for their children in prescribed ways and not deviate from them. For example, the feeding schedule developed by Sien van Hulst assumes that the child should be fed every three hours. But not every child (or mother) thrives on that. The father's role was kept to a minimum.

The obvious conclusion, then, is that the course for mothers proved to be both necessary and patronizing. It makes sense that expectant mothers (and fathers) want to prepare themselves properly. Although the course for mothers is now a thing of the past, the need for support and connection—as women experience, for example, in prenatal yoga—remains as strong as ever when entering a new phase of life.

A valuable side effect of the course for mothers was the emergence of a social network around the family, without the need for direct intervention. The well-known saying It takes a village to raise a child still rings true. And if that village is absent or ill-defined, a course for mothers can be a valuable alternative.

- About the history of maternity care in the Netherlands and the prenatal course: www.fni.nl/kraamzorg-thuis

- Rineke van Daalen e.a., Gezond en wel: vrouwen en de zorg voor gezondheid in de twintigste eeuw, Amsterdam 1998

- Wilma de Rek, Rust, Reinheid en Regelmaat: wijsheid van vroeger voor het leven van nu, Amsterdam 2024

- A.G. van Hulst, Reinheid, rust en regelmaat: een beknopte uiteenzetting hoe moeders hare zuigelingen op de minst omslachtige wijze goed kunnen verzorgen, Harlingen 1905