Relationships Between Midwives and Physicians
Here we have examined the history of midwifery in the US emphasizing its role and the relationships between midwives and physicians.
During the colonial era of American history, midwives were considered to be the recognized experts in the conduct of childbirth. Not until the late 18th century did significant numbers of physicians find their way into the birthing room.
The growth of the medical professionalism and the advancement of obstetrics as a recognized medical specialty seemed to ensure that the midwife would eventually be displaced by the physician. Yet just as it appeared that the midwife was disappearing from the American setting, a new and vociferous debate over her present and future began to take shape.
Most European midwives held distinguished positions in their communities and were usually well trained and well supervised. By the early decades of the 20th Century, many cities and towns of the urban Northeast and Midwest, where immigrants most often settled, had begun to experience an unexpected revival of midwifery. Other poor people, most notably African Americans, also sought the assistance of the midwife. As many as 90% of all African American births were attended by midwives in the early decades of the 20th Century.
The midwives lack of formal education and her unfamiliarity with modern obstetric techniques meant that she usually subscribed to a noninterventionist approach to childbirth of letting nature take its course. The midwife probably encouraged the laboring woman to walk around. She may have offered herbal teas, wine, or even hard liquor to help ease the birthing pains. During complicated pregnancies she may have had to turn the fetus or administer ergot. Not only did the midwives change less substantially than the physicians, they also offered a variety of services that were not offered by medical doctors.
The early 20th Century experienced a higher fetal mortality rate than any other time period before. In a search for safer maternity care, increasing numbers of middle and upper class women had turned to physicians for assistance during childbirth. The widespread use upon the forceps symbolized a dilemma facing physicians schooled in the "new" obstetrics. Almost any type of intervention by the physician brought with it the possibility of harm because of the dangers associated with infection. Outbreaks of life-threatening puerperal fever were common among the practice of physicians.
The use of anesthesia in childbirth in the decades after 1850 was another medical intervention that did not always benefit with laboring woman. Careless administration of ether or chloroform could result in the decelerations of labor and breathing disorders.
As late as 1910, many medical school graduates began the practice of medicine having witnessed few or no births.
Two decades later, physicians were still being held accountable for the nations persistently high maternal mortality rates; the record of physicians was not equal to that of midwives. The midwife took better care of the pregnant woman because she waits patiently and lets nature take its course while physicians employ procedures which are calculated to hasten delivery but also sometimes result harmfully to the mother and child. Nonetheless, it was the midwife who was most often blamed for the high maternal and infant death rates of the early 20th Century. Physicians argued that only by eliminating the midwife, or, at least, substantially reducing her numbers would the health of pregnant women and infants be adequately protected. They further argued that as long as women untrained in the medical sciences continued to attend 1/2 of all births, the obstetrician would never receive his due recognition.
Midwives found it extremely difficult to counter the charges of their physician critics. Assistance might have come from early 20th Century women's rights advocates, who supported the entry of women into the medical profession.
For analyses of changes in midwifery, see Judy B. Litoff, ed., The American Midwife Debate: A Sourcebook on Its Modern Origins; Judith W. Leavitt, Brought to Bed: Childbearing in America, 1750 to 1950.