midwifery

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Midwifery. Until the twentieth century, midwives delivered most of America's babies. Self‐trained neighbor women, who assisted family members or nearby friends, were the most common, but increasingly aspiring midwives served apprenticeships with older, more experienced practitioners. A few, especially in urban areas, built up large practices, but the average midwife probably delivered no more than a dozen babies a year. Martha Ballard, who began practicing midwifery in the late eighteenth century in the village of Augusta, Maine, delivered at least 998 babies in 35 years of practice. Like other midwives of her time, she not only delivered babies but performed a wide range of medical services for her patients and their families. In rural areas especially, busy physicians often relied on midwives to attend time‐consuming births, preferring to be called only in cases of emergency.

The typical midwife was a middle‐aged, married, immigrant woman from the working class. Delivering babies, like taking in boarders and lodgers, allowed her to contribute to the domestic economy and still take care of her family's needs. By the late nineteenth century a few schools for midwives had appeared, most of them controlled by physicians. Indeed, an Illinois law, passed in 1896, required that only “legally qualified” physicians could teach in state‐recognized midwifery schools. Although some midwifery schools were little more than diploma mills, others tried to provide an education comparable to that offered in Europe. The municipally controlled Bellevue Hospital School for Midwives in New York City, founded in 1911, was reputed to be exemplary. Unlike nurses and teachers, midwives seldom aspired to professional status. They claimed neither a distinct body of knowledge nor control over the training and licensing of practitioners. Although some states regulated the practice of midwifery, Massachusetts banned midwifery in the 1890s and many southern states left midwifery free of control.

As late as 1900, about half of all the children born in the United States were delivered by midwives; by 1930 midwife‐attended births had dropped to less than 15 percent of all births in the United States, and most of these were among African Americans in the South. Although obstetrics was the worst taught clinical specialty in American medical schools in the early twentieth century, and the safety record of midwives generally equaled that of physicians, parturient women increasingly opted for hospital‐based, physician‐assisted, pain‐free birthing experiences. General practitioners and, increasingly after 1950, obstetricians attended most parturient women. Because midwives traditionally served their own ethnic communities, the decline in the number of immigrant families sharply reduced the practice of midwifery. By 1950, with the federal government picking up much of the cost of building new hospitals, 93 percent of births to white mothers were taking place in hospitals; ten years later the figure had risen to virtually 100 percent. Midwives, however, still attended 28 percent of all minority women and 50 percent of rural nonwhite Americans in 1950.

By this time, however, some women were beginning to question the desirability of a fully drugged, physician‐controlled delivery, and to protest what they regarded as inhumane and insensitive hospital care. Women in the feminist and countercultural movements helped to kindle a reexamination of physician‐dominated obstetrics and to launch an alternative birthing movement. The movement did not survive the 1980s, but it did encourage the revival of midwifery in two forms: nurse‐midwives, who worked primarily in hospitals under the aegis of physicians, and lay midwives, who worked independently and often extralegally. At the end of the century, midwives were attending under 5 percent of the nation's births.
See also American Medical Association; Childbirth; Feminism; Medicine; Nursing.

Bibliography

Jane Donegan , Women and Men Midwives: Medicine, Mortality, and Misogyny in Early America, 1978.
Judy Barrett Litoff , American Midwives: 1860 to the Present, 1978.
Laurel Thatcher Ulrich , A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812, 1990.
Charlotte G. Borst , Catching Babies: The Professionalization of Childbirth, 1870–1920, 1995.
Gertrude Jacinta Fraser , African American Midwifery in the South: Dialogues of Birth, Race, and Memory, 1998.

Charlotte G. Borst

midwifery , art of assisting at childbirth. The term midwife for centuries referred to a woman who was an overseer during the process of delivery. In ancient Greece and Rome, these women had some formal training. As the medical arts declined during medieval times, however, the skills a midwife possessed were gained solely from experience, and the lore was passed on through generations. With the upsurge of medical science about the 16th cent., the delivery of babies was accepted into the province of physicians, and as formal training and licensing of medical practitioners became more prevalent, these requirements extended also to women still engaged in midwifery. At this time professional schools of midwifery were established in Europe. Midwifery was only recognized as an important branch of medicine, however, when the practice of obstetrics was established. In the United States, due to rising medical costs and a burgeoning interest in natural childbirth and more personalized care, there has been a resurgence of interest in midwifery since the early 1970s.

Contemporary midwives attend births in hospitals and birthing centers as well as at home. Most midwives are registered nurses who have completed additional training in accredited institutions. Certified nurse midwives (CNMs) can practice in all 50 states. Many are trained to deal with other gynecological issues, such as birth control and menopausal problems. Lay-midwives usually train by apprenticeship and are regulated by local statutes that limit what services they may perform.

Bibliography: See J. Litoff, The American Midwife Debate (1986).

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