Note: this article was written as an assignment during my academic training. I thought it may provide you with a better idea of what midwifery entails, and some of the history behind this ancient profession.                ~Kelsey

History of Midwifery

Few traditions have continued throughout the ages as has the practice of midwifery. History contains many references speaking of midwives and their presence and involvement in the community and lives of women. Even the word “midwife” typifies the nature of their work: it’s literal meaning in English, as well as in Latin, Spanish and Portuguese is “with-women” (1), giving the impression of woman-to-woman care.

Tracing midwifery history through ancient history is somewhat difficult due to scarcity of written material. The earliest recorded mention of midwives is contained in the books of Genesis and Exodus in the Holy Bible. The author tells of a delivery aided by a midwife, and the mother’s subsequent death; a midwife’s care at a successful twin birth; and finally, the time in Egypt where the midwives were commanded to kill all infant boys. (2) From these accounts, it can be implied that midwifery was a common and usual part of life in that time.

Other ancient references tell us that the mother of Socrates was a midwife, and that midwives were women’s health providers in the Greek and Roman worlds. Pliny the elder and Soranus both speak of the work of midwives, and wrote extensively about common midwifery and obstetric practices of their day, some of which are used today. For example, Soranus spoke of the birth stool used for deliveries, and also instructed those in training in the use of olive oil and massaging of the perineum before birth. (3)

To continue our look at the history of this profession, we must jump many years and into the Middle Ages. Many villages had a local woman who not only called upon to assist with births, but also cared for the sick. Usually these women used herbs and other folk remedies in their treatments. At times, midwives were suspected of witchcraft and sorcery, in part due to superstitions concerning infant deformities and deaths, and thus were persecuted, arrested, and even killed. (4)

By the early 1600’s, midwives in England worked under the supervision of the State church, and were licensed by the priest. Midwives continued to be the usual attendant chosen to assist childbirth, with male doctors being called on only in cases of emergencies. Significant advances in the area of obstetrics were made throughout this period, one of which was the invention of the forceps by the Chamberlin brothers. Their work amongst the royalty aided the beginnings of acceptance of male presence at childbirth. Several textbooks for midwives were written throughout the fifteenth century, with the first English textbook being authored by Jane Sharp in 1671. (5)

When the first immigrants came to the New World, midwives were amongst the groups. Birgit Lee Fuller was on the Mayflower, and delivered two babies during the voyage. (6) The traditional custom of midwives to give care from birth until death continued throughout the colonies. Unlike earlier history, during this time we have many more written accounts of midwives’ work during the early days of our country, and it is interesting to see the role these women played in the structure of their community and culture. As Richard and Dorothy Wertz state in their book Lying-In, “The importance of midwives to the social order is shown in the fact that several New England towns provided a house or lot rent free to a midwife on condition that ‘she doth not refuse when called to it [a delivery].’ ”

Birth was considered a woman’s social event, with the expectant mother finding comfort and help in the presence of trusted women relatives and companions. In the book Brought to Bed, Judith Leavitt states that “The midwife orchestrated the events of labor and delivery, and the women neighbors and relatives comforted and shared advice with the parturient.” One of the most famous midwives of this period was Martha Ballard, whose diary contains record of many of the deliveries she assisted with during her practice in Maine throughout the years 1785-1812.  Midwives continued to train mainly through the traditional method of apprenticeship, with many skills being passed on from one generation to the next. (7) There were others, however, who had no formal training, but “learned their skills first at the bedsides of their neighbors. Through watching and helping other women in labor, these women acquired a practical excellence that allowed them to be valued attendants in part because of their developed skill and in part because of their sex…They belonged in the birth chamber; they were part of the birth tradition.” (8)

As the years progressed, changes and the desire for modernization grew in America. During the nineteenth century, male presence gradually became generally more accepted in the area of midwifery and obstetrics. Women in the upper classes began to favor “male-midwives” or physicians over the traditional midwife. The change of mindset, due in part to new ideas about women and advancements made in the field of medicine, paved the way for birth to be considered a medical problem to be managed by doctors. (9) Doctors began to see this area as a way in which to profit financially, as is described in Varney’s Midwifery: “As the presence of medicine became highly competitive, physicians and medical students were advised that their presence at a delivery would ensure the entire family as grateful patients thereafter.”

More and more information was made available regarding the female and reproductive systems, giving more scientific light on subject that before was considered mysterious and unknown. This left the traditional midwife ignorant on “modern” methods and knowledge, as women were excluded from medical schools, and most new information was given only to physicians. (10) Due to financial and cultural reasons, midwives continued to serve the many immigrant, impoverished, or minority groups that could not afford physicians. It is interesting to note that midwives were reported to have a lower rate of passing on infection than doctors (11), probably due in part to many times doctors went directly from a sick patient to a delivery.

Around the turn of the century, doctors were commanding more and more control over all fields of medicine, and wanted to see midwifery abolished.  Elizabeth Davis graphically portrays this struggle in her book, Heart and Hands: “In the US, attacks against midwifery accelerated…In medieval times, midwives were branded consorts of the Devil; now they became ‘loose women’ intent on their own ways of healing, in contrast to ‘good girls’ who pursued nursing and accepted roles subservient to the physician and his methods.”  The quest for pain relief during labor also drove women to the hospitals where they could receive anesthetic not available at home.

The issue of pain relief escalated around 1910 with the advent of “Twilight Sleep”, a method of anesthesia first used in Germany hospitals. Anne Frye, writing in Holistic Midwifery, gives us the following insights as to how this affected midwifery and birthing at home. “These drugs could only be administered in a hospital setting, causing many more middle and upper class women to seek institutionalized care for the first time. This greatly assisted the transfer of birth from the relative safety of the home environment into the hospital. Hospitals catering to the middle and upper classes of the day were well appointed and well staffed…this is where the notion that the hospital is a safe haven of rest for birthing mothers originated. Desire for these modern conveniences quickly accelerated as more and more women sought out ‘safe, sanitary and scientific’ hospital care.”  (pg.19). The “twilight sleep” method was short-lived when one of the leading supporters of this movement died during childbirth. That incident, however, just added to the growing idea that childbirth is a complicated and unnatural event that necessitates medical help and supervision. (12)

By the early 1920’s, midwifery had almost disappeared from the medical world, but they had not disappeared from the life of common people. With the rise of governmental involvement in community health services, those in authority sought to stamp out the practice of midwives whom they saw as dirty, backwards and unknowledgeable.  Those with limited resources could not afford medical care and doctor’s fees, so midwives continued to serve those women who otherwise would have done without care, although at times this service was illegal. Many of these midwives were immigrants from other countries, who lacked proper training in hygiene and other techniques, thus providing fuel for the fire of concern. In some areas of the country, steps were taken to try and give basic training and licensure to the community midwives, while in other states moves were made to outlaw all midwives. (13)

While studying the history of midwifery in general, one cannot overlook the entrance of nurse-midwifery on the scene. Frontier Nursing Services, was begun in 1925 by Mary Breckinridge. Trained in the British method of midwifery, which was still the usual birth attendant in English families, Breckinridge’s goal was to provide health care and obstetric services in the rural Kentucky mountains. With a professional background, and certification according to medical standards, this program of public health services and midwifery training provided a new inroad for women wishing to pursue obstetric training. (14) Generally accepted by the medical community, other nurse-midwifery schools were opened throughout the country, and gained in popularity. With regulations to follow and oversight given by doctors, these women did not have the freedom that traditional midwives did, but yet they were able to provide women-centered care and specialize in women’s health issues.

The publication of Dr. Grantley Dick-Read’s book Childbirth Without Fear around the 1930’s gave a new perspective on childbirth. His opinion that birth was to be a “natural, joyous process that was never meant to be painful” aided in changing the population’s perspective on drugs and interventions throughout labor and delivery. By the 1960’s, doctors and technology overruled in the hospital, with monitors, restricted movement of mother throughout labor, doctor being the one “in charge” versus the mother’s choice, and other such mindsets prevailed, making childbirth a dreaded and inhuman experience for many mothers. In the 70’s, the writing of Maternal-Infant Bonding: The Impact of Early Separation or Loss on Family Development by Klaus and Kennell caused some changes to be made concerning hospital regulations. Allowing the husband’s presence at birth, and keeping the mother alert during delivery humanized the birth process somewhat. However, interventions and technology were still commonplace, as doctors concerned about the rise in lawsuits tried to play an active role in order to protect themselves. (15)

About this time, there was a growing interest on the part of a small group of people in pursuing more natural methods of childbirth. With hospital regulations and red-tape preventing patient choices during labor and delivery, and an increase in cesarean sections, these couples opted out of the conventional medical route and went back to the traditional and time-proven choice of midwifery care. The lack of available midwives led to a growing interest of reviving this tradition, due to consumer demand. Several alternative birthing centers opened, and the publication of two textbooks written by midwives, served to offer training routes for other midwives.

In 1982, the Midwives Association of North America was started as an effort to bring together the midwifery community. Providing communication and giving some type of credibility to the profession were some of the organization’s goals, and this lead to the formation of the North American Registry of Midwives in 1987. Setting a standard as to midwifery skills and practices, NARM provides a method of certification to ensure quality care for women and babies. (16) This has served to improve the impression that many people had of midwives being unskilled and ignorant to that of a profession who takes responsibility seriously and has extensive training and experience.

By the present time, midwifery has progressed to be a widely known and appreciated alternative to childbirth. Midwives continue to be trained by apprenticeship, with those who have experience passing on techniques and teaching the next generation. With a devotion to women-to-women care, assisting women in their home or wherever they choose, involving the entire family, and development of relationship by providing continuity of care, midwives continue to serve women throughout the United States. Nurse-midwives may legally practice in all of the US, while the legality of lay-midwifery practice depends on each state, but organizations are working continually to change and improve current laws.

M. Brucker, CNM, states in her article entitled The Birth of Midwifery: “Midwives are the most common birth attendant in the world. The average child born in this world is born into the hands of a midwife.”  Midwives continue to practice in Europe, Africa, Latin America, and other places, continuing on the tradition of care that has been with us for generations. Nancy Sullivan tells us that “Today, in much of the world, professional midwives are responsible for attending women in labor and birth. In fact, the countries with the best pregnancy outcomes, midwives are the primary providers of care to pregnant women.” (17) May the tradition continue as women continue to labor and deliver “with women” in the future!

References:

1.   Sullivan, Nancy. Article entitled A Short History of Midwifery, Available online at http://www.midwifeinfo.com, accessed November 17, 2006

2.   Gen. 35:17, 38:28, and Exodus 1:16-21

3.   French, Valerie. Article entitled Midwives and Maternity Care in the Roman World, Available online at: http://www.indiana.edu, accessed November 17, 2006

4.   Singingtree, Daphne, Birthsong Midwifery Workbook, Eagle Tree Press, 1999, pg.7

5.  Ibid. Pg.8

6.  Ibid. pg. 9

7.  Brucker, M. CNM, Article entitled The Birth of Midwifery. Available online at www3.utsouthwestern.edu, accessed November 17, 2006

8.  Leavitt, Judith Walzer, Brought to Bed: Childbearing in America 1750-1950 (Oxford University Press, 1986) pg. 109

9.  Sullivan, pg.1

10.  Ibid. pg.1

11.  Wertz, Richard W. and Dorothy C., Lying-In: A History of Childbirth in America. Expanded Edition. (Yale University Press, 1989)  pg. 113

12.   Leavitt, pg. 109,140

13.   Wertz, pgs 210-214

14.   Varney, Helen, Varney’s Midwifery, Third Edition  (Jones and Bartlett Publishers, 1997) pg. 7

15.    Wertz, pg.183, 254-61

16.   NARM Mission Statement, available online at http://www.narm.org, accessed December 5, 2006

17.   Sullivan, pg.1

Bibliography:

– Bovard, Wendy, and Milton, Gladys, Why Not Me? The Story of Gladys Milton, Midwife. (The Book Publishing Company, 1993)

– Brucker, M. CNM, Article entitled The Birth of Midwifery Available online at: www3.utsouthwestern.edu/midwifery/mdwfhistory.html, accessed Nov. 17, 2006

– Cohen, Nancy Wainer, Open Season: A Survival Guide for Natural Childbirth and VBAC in           the 90’s (Bergin and Garvey, 1991)

– Davis, Elizabeth, Heart and Hands: A Midwife’s Guide to Pregnancy and Birth Third Edition   (Celestial Arts, 1997)

– Feldhusen, Adrian E., Article entitled The History of Midwifery and Childbirth in America: A            Time Line, Available online at: http://www.midwiferytoday.com/articles/timeline.asp, accessed November 17, 2006

– French, Valerie, Article entitled MIDWIVES AND MATERNITY CARE IN THE ROMAN WORLD, taken from a special issue of Helios entitled “Rescuing Creusa: New Methodological Approaches to Women in Antiquity,” (Helios, New Series 13(2),    1986, pp. 69-84).  Available online from: /www.indiana.edu/~ancmed/midwife.HTM.   Accessed November 17, 2006

– Frye, Anne, Holistic Midwifery Vol. 1, (Labrys Press, 1998)

– Leavitt, Judith Walzer, Brought to Bed: Childbearing in America 1750-1950 (Oxford University Press, 1986)

– Logan, Onnie Lee, Motherwit: An Alabama Midwife’s Story (Plume, 1991)

– McGregor, Deborah Kuhn, From Midwives to Medicine: The Birth of America Gynecology (Rutgers University Press, 1998)

– Sears, William M.D., and Martha R.N., The Birth Book (Little, Brown and Company, 1994)

– Singingtree, Daphne, Birthsong Midwifery Workbook, Eagle Tree Press, 1999

– Sullivan, Nancy, Article entitled A Short History of Midwifery written 1992 and available online from: http://www.midwifeinfo.com/content/view/32/30/,Accessed Nov. 17, 2006

– Varney, Helen C.N.M., Varney’s Midwifery Third Edition  (Jones and Bartlett Publishers, 1997)

– Wertz, Richard W. and Dorothy C., Lying-In: A History of Childbirth in America. Expanded Edition. (Yale University Press, 1989)

– Article entitled Contributions by the Midwives of Antiquity to the Art and Science of   Modern Medicine, accessed November 17, 2006, and available online at:  http://www.collegeofmidwives.org/legal_legislative01/HxMfryIndex01/antiqmdw.htm

–  NARM Mission Statement, available online at http://www.narm.org, accessed December 5, 2006