A Brief History of Midwifery

The term "midwife" means "With Woman". Midwifery, or the care of a woman during pregnancy and childbirth, is a tradition of women caring for women that has persisted since earliest times.

In the ancient world, childbirth was considered "a female mystery" of which women alone had special knowledge and understanding. It was "presided over" by female deities Isis, Juno Lucina, and Diana, all symbols of feminine power (Donnison, pg 1). Midwives appear in the bible, in Genesis as well as Exodus. Two midwives in exodus were rewarded by god for not obeying pharoahs decree to kill all of the newborn Hebrew boys.

In society's progression from matriarchy to patriarchy, a process that took several thousand years, pregnancy and childbirth was the last domain retained by women. It became a man's, or doctor's, domain only recently in world history.

In the early middle ages, the process of removing women and midwives from the birthing room began, and evolved over the next several hundred years. Several factors occurred concurrently to assist in the removal of the midwife: the beginning of university trained physicians, the invention of the obstetric forceps, and the advent of the witch hunt.

While men trained in universities began the barber-surgeons guild in the 13th century, and were learning about childbirth from texts written by other men, women were not being allowed into universities. Women continued to practice and learn midwifery through apprenticeships and experience. The increasing respect for university trained and book knowledge began to overpower the respect once afforded to the experienced midwife.

At the same time, men began degrading the act of childbirth and the art of midwifery. It was said that the act of giving birth "defiled the mother who could be re-admitted to the church only after a service of purification" (Donnison, pg. 4). While this may not have been a general policy of the Catholic Church, it is an example of how some religious leaders created policies agains women. Others saw midwives, the first to greet newborn babies, as a possible threat.

These people accused midwives of witchcraft, a threat to their power that they set out to destroy. Babies attended by midwives had to be brought to the church to be examined by the local priest for signs of bewitchment (Brooke, pg. 70). In The Hammer of Witches (Malleus Maleficarum, 1486), Springier and Institoris, two German members of the inquisition wrote, "No one did more harm to the Catholic faith than midwives who surpass all other witches in their crimes" (Donnison, pg. 4). This book became the "practical guide" to witch hunting in Europe up until the 17th century. Midwives in attendance of a stillbirth, or the birth of a baby with abnormalities, were often occused of offering that baby to the devil.

Next the regulation of midwives began, and in 1512 in England, licensing requirements were initiated. Midwives were examined by local Bishops, who were mainly concerned with a woman's social and religious functions, not midwifery training or education.

Men were first called upon to attend normal labors by the French upper-class. Louis XIV called a man to attend the birth of his child in the 1680's. Male physicians were gaining respect because of their superior "formal education", while women were still not allowed into universities.

The invention of the obstetrical forceps in 1720 played a pivotal role in the downfall of midwifery. Physicians only were allowed to use instruments as part of their practices. Therefore, midwives began to call in physicians in those rare occasions where forceps were needed. This made male attendants in the birthing room more socially acceptable. Unfortunately, because labors that required forceps were abnormal, men began to learn only about the abnormal or challenging labors.

At the same time, the upper-class, noting the increased education of men and their ability to use forceps, began to call male attendants more and more for normal labors. Because men were paid far more for their services than females, it became a symbol of wealth and status to be able to afford a male attendant.

Eventually, male physicians realized how financially lucrative attending births could be. "Many doctors wanted to limit [midwives'] activities so that they might cash in on the rich rewards" (Brooke, pg. 71). Doctors became competitors with midwives.

Around the turn of the 20th century, physicians in the United States moved childbirth from the home to the hospital, almost demolishing midwifery entirely. Doctors convinced society that while women had been birthing at home for thousands of years, the only safe place to have a baby was the hospital. Midwifery attended births dropped from 50% in 1900 to 15% in 1930 (Poole, pg. 18). Contrary to popular belief, however, this did not improve outcomes, in fact it worsened them. In 1918 the United States had one of the highest rates of infant mortality (death rates) of the industrialized nations. Studies show that the maternal mortality rate of mothers attended by midwives from 1930-1932 were lower than the mortality rate of those attended by physicians in hospitals.

The mortality rates of the time were blamed on midwives, even though there is much evidence to the contrary. Physicians wrote about the "midwife problem" and perpetuated the normal act of childbirth as a dangerous medical procedure best handled by physicians. People began to overlook the fact that for thousands of years women have been giving birth without physicians and hospitals, and the human race has survived and thrived.

In 1925, in response to poor outcomes of childbirth in the Appalachian Mountains of Kentucky, Mary Breckenridge established the Frontier Nursing Service. She recruited Nurse-Midwives from Great Britain, and succeeded in lowering maternal and newborn mortality rates in the region to the lowest in the U.S.

In the 1930's, two Nurse-Midwifery education programs were established in the U.S. Then in 1955, the professional organization of Certified Nurse-Midwives (CNM's) became known as American College of Nurse-Midwives, as it stands today. Since then the number of births attended by CNM's has risen, increasing by 500% from 1975-1987.

While most CNM's have challenged doctors by providing low technology, safe care in hospitals, Licensed or Direct-Entry Midwives have safely brought childbirth back to the home. Lay midwives, who had been attending homebirths for decades, pushed for professionalization in the 1980's. The Midwives Alliance of North America (MANA) was established in 1982 to unite midwives. It focused, mostly, on direct-entry (non-nurse) midwives. MANA is still fighting to license Direct-Entry Midwives in some states in the U.S.

Midwives currently practice in all 50 states. They provide safe, satisfying care to women of many races, religions, and economic status. Midwives boast equal or better outcomes then physicians, with lower rates of Cesarean Sections and other interventions, when women of equal risk status are compared (See Why Choose A Midwife?).

Midwives still have many obstacles to overcome. "Physicians have many effective ways to resist midwives, including denial of CNM applications for hospital privileges, demands for unreasonable levels of professional liability insurance, ...misrepresentation of midwifery practice to the public, refusal of physician-controlled malpractice insurance companies to write policies for physicians who work with midwives, and professional ostracism of doctors who work with midwives" (Rooks, pg. 78).

As you can see the history of midwifery is vast and complex. While I have given you a brief description, the history of midwifery includes topics such as women's rights over their own bodies, technology and it's proper use, inter-professional rivalries, religious freedoms and other controversial issues. For more information on these topics and midwifery, please see my reference list below.

There are many wonderful midwives available for you today, with the back-up of supportive, competent physicians. Female and male midwives of many backrounds, religions, and philosophies are practicing in homes, birthing centers, and hospitals. For help finding a midwife go to Find A Midwife (Phoenix Metro Area), or Find a Midwife Worldwide. For hints on choosing the midwife who's right for you, see Hints on How to Choose a Caregiver.

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