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History of Midwifery
The history of midwifery can be traced back to Genesis, “And it came to pass, when she was in hard labour, that the midwife said unto her, Fear not; thou shalt have this son also.” Genesis 35:17 KJV. Midwives have been practicing in a range of scopes since the beginning of mankind. The uniqueness of modern midwifery can be attributed to its colorful history, ranging all the way from accused witchcraft to a highly respected and influential member of society. Through the ups and downs, midwifery has withstood persecution, slur campaigns, vicious rumors and unfair governmental regulations with dignity and grace. The practice of midwifery has come back from the verge of extinction, more than once, to a flourishing and prominent career dedicated to being with women in the most pivotal time of their lives. It is because of this history that midwives pass down a tradition of being strong, capable and knowledgeable women so that the time honored practice of midwifery continues to grow and not be condemned through the practice and invention of modern medicine.
In Colonial America, Americans were just learning how to be a free and functioning society with little oversight from the king. Midwives came to America on boats from Europe with their license given to them from the Church of England. In 1716, with escalating tension between the Colonies and England, New York City began licensing midwives so that they may “fulfill the role of servant of the state, a keeper of social and civil order” (Midwifery Today). As the practice witchcraft declined, doctors began attending births and midwives gave over medical, but not spiritual, control in response to being accused and persecuted for witchcraft, especially if the baby was disfigured.
In 1765 few women were literate or educated, no formal training for midwives existed until Dr. William Shippen opened the first formal training for Midwives. This was the first training in anatomy and physiology for midwives, unfortunately few women but mostly men attended Dr. Shippen’s training.
The 19th Century marked a time when the middle class shifted from primarily using midwives to using doctors and women were becoming prominent as lay practitioners. Using physicians to attend births escalated in 1848 when Dr. Walter Channing used ether to put women in a sleep while giving birth and again in 1894 the first successful cesarean was performed in a Boston hospital. This significant advancement undoubtedly saved many lives but has also led to another decline in midwifery.
And it came to pass, when she travailed, that the one put out his hand: and the midwife took and bound upon his hand a scarlet thread, saying, This came out first. Genesis 38:27-29 KJV
Nearly 100 years later, anesthesia was used to induce “twilight sleep.” Physicians were becoming more organized, medical schools were developing, licensing started being required and physicians started moving from lower middle class to upper middle class. A slur campaign against midwives came out, pinning them as unintelligent, poor, black immigrants. By 1900 physicians attended almost all of the middle and upper class births while midwives attended births for women who could not afford physician’s care. As medical schools started including obstetrics in their curriculum, hospitals realized how loyal women were to the provider who delivered their baby. Physicians knew that once this relationship had been established, the women would use the same doctor to treat the entire family, this became a very lucrative relationship for the physician and the primary reason physicians sought out banishment of midwifery. Physicians convinced women that the interventions you could get at a hospital were necessary for a safe birth, so by 1920 almost every hospital delivery used interventions to facilitate birth.
In response to the 1930’s study by the Children’s Bureau, that stated 124 out of every 1000 infants born in the United States were dying, a team of nurses and mothers formed the Maternity Center Association (MCA) to teach the importance of prenatal health and to address the problems of our maternal health system (mymidwife.org). In 1933 the MCA and the Lobenstein clinic opened the first nurse-midwifery program in the US. This program was successful in graduating nurse-midwives until the start of WWII when resources were pulled towards aiding the war.
By 1950 three more educational programs for nurse-midwives developed including the American College of Nurse-Midwifery. Although the various educational programs were graduating competent nurse-midwives, very few were practicing after graduation. An overwhelming majority sought careers in teaching, consulting and assisting. The same problem that plagued the three new schools of the 50’s were the same that plagued the schools of the 20’s- a lack of opportunities for nurse-midwife students to practice their clinicals. In 1960, only two states and one city legally recognized the practice of nurse-midwifery: New Mexico, Kentucky and New York City (Varney’s 13). This led to midwives getting organized and making a concerted effort to get into hospitals, where 70 percent of births were still taking place.
And he said, When ye do the office of a midwife to the Hebrew women, and see them upon the stools; if it be a son, then ye shall kill him: but if it be a daughter, then she shall live.
Exodus 1:15-17 KJV
Finally, in the 1970’s everything changed. This sudden change could be attributed to a number of reasons. Obstetrics officially recognized nurse-midwives, visibility from working in hospitals, word of mouth from satisfied mothers and the post WWII baby boom. The main problem of the 70’s was not having enough nurse-midwives available; they were in such high demand that the emergence of Lay midwives became prevalent. Midwifery of the 80’s looks similar to the midwifery of today, with a few substantial differences. By 1980 midwives were active participants in every arena of well-woman care and like today, they had the support of some physicians and the opposition of other physicians. Insurance companies began seeing midwifery as cost-effective and began paying for services. By 1984 nurse midwives were practicing in every state as a result of the legislation done by the ACNM.
Once again, in the 1990s midwives found themselves struggling for the recognition and respect from the medical field that they deserved. Midwives were not participating in essential decisions affecting the healthcare system. In 1994 in response to request from state regulatory agencies, ACNM started credentialing non nurse-midwives. By 2001 accredited direct-entry training programs were preparing student midwives to take the NARM and recognition as CNMs. Today, there is a clear distinction between nurse-midwives, CPMs and lay midwives. Midwives have never been more organized, had more of a voice in legislation or been more competent in their skills. This rapid advancement should be accredited to all of the midwives who paved the way before us. While there is still a considerable amount of work to do we have our history to remind us that it can be done.
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