The scientific nature of the nineteenth century education enabled an expansive knowledge explosion to occur in medical schools. The formalized medical communities and universities no only facilitated scientific inquiry, but also communicated new information on a variety of subjects including Pasteur's theory of infectious diseases, Holmes' and Semmelweis' work on puerperal fever, and Lister's writings on antisepsis. Since midwifery practice generally remained on an informal level, knowledge of this sophistication was no disseminated within the midwifery profession. Indeed, medical advances in pharmacology, hygiene and other practices were implemented routinely in obstetrics, without integration into midwifery practices. The homeopathic remedies and traditions practiced by generations of midwives began to appear in stark contrast to more "modern" remedies suggested by physicians.

Obstetricians began to identify a difference not only in the practices of the two professionals, but also in the neonatal/maternal outcomes between births attended by physicians and those by midwives. Statistics regarding maternal deaths and neonatal deaths that were available demonstrated that midwifery attended births often had poorer statistical outcomes than physician attended deliveries. It must be noted that this discrepancy may have been influenced by other factors. For example, as physicians became the providers of choice for the affluent woman, midwives cared for an increasing number of poor women. These midwifery clients usually lived either in rural areas of the country, or in immigrant areas of large urban cities where poor nutrition and poor sanitation were the norm. The discrepancy between care of the two groups of providers was not as apparent in Europe, for it was during the 19^th century that formalization of midwifery education had occurred in that continent, and statistical outcomes of midwifery practices were comparable to that of physicians in the same countries. Regardless of etiology, the difference between statistical outcomes of midwives and physicians in the United States precipitated a situation in health care characterized as the midwifery controversy.