NURSE- AND DIRECT-ENTRY MIDWIFERY
TRADITIONAL AND PROFESSIONAL MIDWIVES
Midwife, an Anglo-Saxon term meaning “with woman,” aptly describes the role that women have long assumed as birth attendants. Throughout history and across cultures, women have traditionally provided direct assistance and support during childbirth; men were generally excluded. Attendance at birth has been suggested to be essential in facilitating mother-child survival as the physiology of birth changed during human evolutionary history. The upright stance necessary for bipedal locomotion made human birth more complicated than the births of other higher primates, whose quadrupedal locomotion allows a pelvis aligned for the direct descent of the fetal head, whereas the human infant must rotate as it descends through the pelvis, causing pain to the laboring woman. Immediately after birth primate babies can climb onto their mothers’ backs and cling; human infants, born earlier in their developmental cycle because of their larger brains, are relatively helpless at birth and require immediate nurturance. These factors encouraged the evolution of birth as a highly social process; in few societies do women give birth alone and unaided. Indeed it is reasonable to assume that midwifery must have evolved right along with Homo sapien birth. The presence of other females would have enhanced the success of the birth process as they acquired such skills as turning the baby in utero, providing emotional support to the mother through the pain of labor, assisting rotation of the head and shoulders at birth, massaging the mother’s uterus, and administering herbs to stop postpartum bleeding. Such skills typify the traditional midwifery of thousands of cultures throughout human history.
The birth attendant is not always a specialist, and some cultures do not have specifically delineated roles for midwives; in Nepal and Bangladesh, for example, family members are often the ones to care for the birthing mother. But thousands of traditional societies, and the vast majority of industrialized societies, do have a specific category of career that translates into English as midwife. Broadly speaking, a midwife is defined as a skilled practitioner who cares for the mother during pregnancy, birth, and the postpartum period and is recognized by her government or her community as such. In traditional societies midwives often serve additional roles as community healers, and in industrialized societies as specialists in primary health care, gynecological well-woman care, and sometimes also in complementary therapies such as homeopathy, herbalism, and nutrition.
According to the International Definition of a Midwife endorsed by the International Confederation of Midwives (ICM) and various development agencies, the midwife’s sphere of practice generally includes supervision, care, and advice to the pregnant woman; attending births on her own responsibility; caring for the newborn and mother after birth; identifying risks or abnormalities; taking preventive measures; procuring medical assistance when necessary; and dealing with emergencies in the absence of medical help. She also takes an active role in counseling and education not only for women but also for families and communities. She may practice in hospitals, clinics, health units, freestanding birth centers, homes, or any place her services are needed. Her government, her community, insurance companies, or individuals may pay for her services; traditional midwives often barter for their care, accepting whatever the family might offer.
OBSTETRICS AND MIDWIFERY
Throughout the world, during the nineteenth and twentieth centuries, biomedical obstetrics took over much of the care and “management” of pregnancy and birth. Biomedical personnel tend to attribute the dramatic decline in maternal and infant mortality of the twentieth century, especially in developed countries, to medical and technological advances. Yet public health experts insist that much of this decline is due to public health measures such as improvements in sanitation and hygiene, better nutrition, higher education, and better working conditions for women. They note that in the developing world, clean water would do far more to promote maternal health than the expensive high-tech hospital. Nevertheless, biomedicalization equates to modernization, so such hospitals continue to be built in modernizing countries, and governments continue to encourage or insist that women give birth in them.
One direct result is that the rates of obstetrical intervention in birth are rising worldwide. For example, national cesarean rates in Taiwan, China, Brazil, Argentina, Chile, Mexico, and Puerto Rico are between 40 and 50 percent. In the United States, the cesarean rate has risen since the early 2000s from 23 percent to 29.1 percent; most European countries, Canada, and Australia have cesarean rates in the mid-20 percent range. Although professional midwives attend the majority of births in some of these countries, they are biomedically socialized and often overworked, and have been unable to stem the rising cesarean tide, which is largely obstetrician-driven. The exceptions include the Scandinavian/Nordic countries and Japan, where cesarean rates range from 12 to 17 percent; in those countries, both midwives and obstetricians have worked hard to preserve normal vaginal delivery.
Obstetrical dominance over birthing represents not a neutral substitution of one care provider by another, but rather a fundamentally different and opposing philosophical approach to birthing care—one that takes a mechanistic approach to birth, treating the laboring body as a dysfunctional machine unable to work properly without technological intervention. The high rates of unnecessary intervention in birth and the resultant iatrogenic damage to mother and child have spurred professional midwives around the world to develop, articulate, and practice a “midwifery model of care”—a woman-centered, humanistic, and physiological approach to birth based on respect and compassion for the woman, and on the large body of scientific evidence that demonstrates the much better outcomes that result when the woman is encouraged to birth in the place of her choice, to move about freely, eat and drink at will during labor, and give birth in upright positions. Application of this model has been shown in multiple studies to result in far less technological intervention in birth, greater maternal satisfaction, higher rates of breast-feeding after birth, and low rates of cesarean section and perinatal mortality.
In Europe and Australia, midwives have always been and continue to be the primary attendants at the majority of births, yet during the 1900s their education became heavily medicalized and their practices moved almost entirely into the hospital. In Canada and the United States, the obstetrical takeover of birth in the early 1900s resulted in the near-elimination of midwifery. In all these countries, home birth has become rare (around 1% of all births) in spite of much evidence demonstrating planned, midwife-attended home birth to be as safe as, or safer than, hospital birth for women without serious complications. Many professional midwives are engaged in a process of self-examination, attempting to reclaim the autonomy they lost with the obstetrical takeover of birth in the nineteenth and twentieth centuries, to return to attending out-of-hospital births at homes and in birth centers, and to work in nonhierarchical collaborative relationships with obstetricians.
NURSE- AND DIRECT-ENTRY MIDWIFERY
The early British combination of nursing and midwifery has long been the model for the profession of nurse-midwifery in many developed and developing nations, but many have come to critique this model because education in nursing first tends to heavily socialize midwives into the hierarchical, interventionist biomedical model of birth. Such critics have worked to generate or regenerate direct-entry midwifery, in which midwives are not first educated in nursing, but instead are educationally grounded in the midwifery model of care. The best-known example of this kind of midwifery comes from the Netherlands, where for centuries midwives have been trained in their own midwifery schools and have enjoyed full integration into the health care system as autonomous practitioners, maintaining in the 2000s a 30 percent home birth rate in their country. Since the 1970s midwives in Canada, the United States, Australia, New Zealand, Mexico, and other countries, inspired in part by the Dutch model, have developed new models of direct-entry education and autonomous practice for midwives based on the midwifery model of care. This reclaiming and revitalization of midwifery has resulted from alliances between activist consumers, mid-wives, public health officials, and many others working to humanize birth.
TRADITIONAL AND PROFESSIONAL MIDWIVES
There is a sharp distinction made in international literature and discourse between professional midwives and traditional birth attendants (TBAs). The definition created by the professional midwives of the ICM stresses the completion of prescribed course(s) of studies in midwifery and registration and/or legal licensing to practice midwifery.
Professional midwives who meet these criteria, including both nurse- and direct-entry midwives, are usually fully incorporated into health care systems. Traditional midwives, who still attend the majority of births in many developing countries, have no such formal education; they suffer multiple forms of discrimination within biomedical systems. The World Health Organization (WHO) does not recognize the traditional midwife as a midwife, but rather as a TBA—“the term TBA refers only to traditional, independent (of the health system), non-formally trained and community-based providers of care during pregnancy, childbirth, and the postnatal period” (WHO 2004, p. 8). WHO suggests that TBAs are stopgap measures until more “qualified” personnel are available (and indeed, traditional midwives have been largely eliminated or greatly reduced in number and scope of practice in, for example, Thailand, Costa Rica, Venezuela, Argentina, Chile, and Brazil, with the exception of the Amazon region). Health authorities tend to accept this distinction, while social scientists reject or contest it, examining the social roles of definitions as tools of power to determine insiders and outsiders, and studying and documenting the vital roles traditional midwives still play in many societies.
Since the mid-twentieth century nongovernmental organizations, multilaterals, and bilaterals have invested heavily in professional midwife and TBA training in their efforts to reduce maternal and perinatal mortality in the third world. The social science of midwifery grew out of this trend, and reflects social scientists’ roles in analyzing training programs for development organizations and the impact of new models on both quality of care and health outcomes. Social scientists find that women trained as professional midwives are usually young and have borne no children themselves. In developing countries, they are educated in an urban environment, usually in two-year programs, then sent out to serve in a rural village, where they wear the white coat and expect respect from the townspeople for their professional, educated status. They usually work in underfunded and understaffed government-built clinics, but for an extra sum of money will sometimes attend a home birth if they are called. Workloads and stress levels in such clinics are high, often resulting in maltreatment of women and early burnout on the part of the professional midwife.
Thus even though the governments of almost all developing countries have embarked on massive programs to bring birth into the clinics and hospitals under the care of professional midwives and obstetricians, many rural women resist because of inadequate and impersonal care. For example, women are forced to birth flat on their backs in very exposed positions, usually receiving an episiotomy to widen the vaginal outlet and speed the birth. To the apparent bewilderment of governments and biomedical personnel, many women in developing countries prefer the more nurturing and culturally appropriate care provided by the local traditional midwife/TBA, usually an older woman who has given birth several times and has earned the respect and trust of her community through years of midwifery practice.
Training courses intended to educate TBAs in how to identify risks and to improve their prenatal and maternity care have been strongly criticized. Designed by biomedical personnel, course content is often inappropriate to local circumstances and realities. Courses often assume access to material resources that are lacking locally, are taught in a style inappropriate to the literacy skills and learning styles of midwives, and fail to provide TBAs a respected and effective place within an integrated system of medicine. Additionally, TBA trainings emphasize transporting the woman to a hospital for a large number of risk factors, in places where transport is often unavailable and hospital care is inadequate. Traditional midwives take such courses to seek additional skills to cope with emergencies; in many countries, traditional midwives are very aware that their community-based care is the only viable alternative to an unnecessary cesarean and an unpleasant hospital experience.
In some places, professional midwives and physicians scorn and denigrate TBAs, treating them and their clients disrespectfully when they transport to a hospital or clinic. But sometimes professional midwives make a sincere effort to learn about and honor local customs and traditions, approach local people with an attitude of respect, and cooperate with traditional midwives; in such situations of mutual accommodation between the biomedical and traditional systems, TBAs and their clients are more willing to transport to the hospital in case of need, and birth outcomes improve.
It is important not to romanticize or demonize professional or traditional midwives. Both work under discriminatory biomedical systems and both usually try to give skilled and considerate care and remain, in many parts of the world, the only viable option for millions of women. Social scientists question the wisdom of dividing professional midwives and TBAs in a hierarchical manner that allows government agencies and development planners to support one group while trying to exterminate the other, suggesting that a “real midwife” may be recognized either by her government or her community as such, and that all midwives should have access to adequate, scientifically based, and culturally appropriate training.
Changes in midwifery in the developing world are intimately linked to debates over midwifery in the developed world, where professional midwives provide care for the majority of pregnant women. Their education is generally university-based and often postgraduate, giving them skills in research and publication unavailable to midwives in the developing world. They practice in hospitals that are usually well staffed, well funded, and replete with medical technologies. Their major dilemmas are ideological: they struggle both in thought and in practice with the tension between what they themselves call the “medical” and the “midwifery” models of care. Many professional midwives are working to support and sustain traditional midwifery and its future development. Many weave elements of traditional midwifery knowledge, such as the use of herbs for aiding labor or stopping a postpartum hemorrhage, manual techniques for turning breech babies and facilitating the delivery of “stuck” babies, and upright positions for birth, into their practices.
In general, midwives spend more time than physicians with women during pregnancy, answering their questions and providing emotional reassurance, and know more about how to facilitate normal labor and birth without drugs or surgery than obstetricians. The vast body of epidemiological evidence demonstrating the benefits of midwifery care in many countries will prove key to mid-wives’ maintenance of their roles and their identities as being “with women” in the new millennium.
SEE ALSO Medicine; Natural Childbirth
Davis-Floyd, Robbie E., and Carolyn Sargent. 1997. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Berkeley: University of California Press.
Davis-Floyd, Robbie, Stacy Leigh Pigg, and Sheila Cosminsky, eds. 2001. Daughters of Time: The Shifting Identities of Contemporary Midwives. Spec. issue, Medical Anthropology 20 (2–4).
DeVries, Raymond, Edwin van Teijlingen, Sirpa Wrede, and Cecilia Benoit, eds. 2001. Birth by Design: Pregnancy, Maternity Care and Midwifery in North America and Europe. New York: Routledge.
Jordan, Brigitte.  1993. Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland, Sweden, and the United States. 4th ed. Prospect Heights, IL: Waveland.
Kitzinger, Sheila, ed. 1991. The Midwife Challenge. London: Pandora.
Lefeber, Yvonne. 1994. Midwives without Training: Practices and Beliefs of Traditional Birth Attendants in Africa, Asia and Latin-America. Assen, The Netherlands: Van Gorcum.
Luckere, Vicki, and Margaret Jolly, eds. 2002. Birthing in the Pacific: Beyond Tradition and Modernity? Honolulu: University of Hawaii Press.
World Health Organization. 2004. Making Pregnancy Safer: The Critical Role of the Skilled Birth Attendant—A Joint Statement by WHO, ICM, and FIGO. Geneva: WHO. www.who.int/reproductive-health/publications/2004/skilled_attendant.pdf.
Robbie E. Davis-Floyd
Gwynne L. Jenkins
Midwives cared for women during and after childbirth and provided advice on other problems related to female reproduction, including breast-feeding and infant care. They also served as general medical advisers and practitioners.
the work of midwives
The most common and well-known work of midwives was delivering babies. A woman in labor called the midwife when she entered what modern physicians call "active labor," the early stage of childbirth when the contractions become regular and strong. Usually the midwife would encourage the woman to remain active as long as she could at this stage, believing that activity such as walking made labor shorter. Midwives rarely used medicines, allowing nature to take its course.
In the system of "social childbirth" that dominated this period, births were attended not just by a midwife but by a group of female neighbors and relatives. At some point—usually when the birth seemed imminent—the woman or her husband would "call the women." The women took an active role in assisting the midwife. Often a woman gave birth supported on either side by other women; some accounts describe women delivering babies while seated on another woman's lap. Midwives sometimes used birthing stools, a horseshoe-shaped raised chair on which a woman could sit while giving birth, but even then the birthing woman would be held or supported by other women. The midwife's job was to catch the infant, cut the umbilical cord, and deliver the afterbirth.
After the birth and the delivery of the placenta, the midwife would wrap the mother's abdomen and legs with linen bands, a practice thought to prevent postpartum complications. Mothers would then "lie in" for a week or so to recover from the birth, but midwives rarely cared for their patients during this
time unless complications arose; instead, new mothers were attended by an "after-nurse," who could be a paid caregiver or an unpaid relative.
In addition to attending childbirth, midwives provided advice and remedies on breast-feeding and postpartum complications. Midwives supplied medicines to increase the flow of breast milk, made ointments for sore nipples, and sometimes even lanced breast abscesses. If childbed fever set in, as it sometimes did, midwives nursed the invalid and provided what medicines they could until the woman either recovered or died.
Although midwives were primarily birth attendants, their responsibilities often went further. Many midwives acted as general practitioners, making medicines, nursing the sick, and even setting broken bones. At a time when physicians were sometimes in short supply or beyond the purses of many patients, midwives filled the gaps in available medical care.
A midwife was typically a married or widowed woman past menopause who had borne children herself. Most often, she was of middling rank or class, although elite women also became midwives. All of these characteristics were considered crucial for midwifery. The midwife must be respectable and well-thought of by her neighbors, or they would not trust her; she must be past childbearing herself, or her own pregnancies and the care of young children would interfere with her duties; and she must have given birth in order to properly empathize with her patients.
Most midwives did not have formal education or training. Instead, they served informal apprenticeships with older midwives. Often this apprenticeship was as simple as merely attending many births as one of "the women," learning from the midwife, and gradually taking on more and more responsibility. Women also learned home remedies and herbal medicines from their older female neighbors and relatives, especially mothers and grandmothers. Such knowledge was passed down through families along with other household practices and family remedies.
midwives in non-european communities
Enslaved African American women also served as midwives. Like their European American counterparts, African American midwives provided general health care as well as obstetrical services. Slave midwives took care of their own families, their fellow slaves, and sometimes the white family as well, using herbal remedies and homemade medicines. They relied on oral traditions to learn their skills, although occasionally a master provided more formal training. On large plantations, masters often built specialized slave hospitals or infirmaries, with slave midwives and nurses in attendance.
Midwifery was one of the few specialized skills reserved for female slaves. As such, it sometimes conferred unusual privileges. Some slave midwives were called not just to their fellow slaves but to neighboring white families as well. As a result, they had unusual freedom of movement. Such mobility enabled midwives to see friends and relatives on other plantations and to act as messenger or go-between for other slaves. Midwifery could also be a source of outside income for an enslaved woman if her master allowed her to keep some of her fees. Because of their skill and their privileges, slave midwives were deeply respected in their communities. Their fellow slaves looked to them for wisdom as well as healing.
Less is known about Native American midwives. Research on Native American childbirth customs suggests that they, like other cultural practices, varied considerably from culture to culture. In general, Native American women were attended by other women, often kin, who assisted and supported the mother during childbirth. If a birth was complicated, a traditional healer or shaman might be called in, and in some tribes these healers were women. Shamanistic healers used sweat baths, herbs, roots, and prayer to ease the birth.
changes between 1750 and 1820
The years from 1750 to 1820 were a critical period in the history of midwifery. Shortly after the Revolution, male physicians trained in Europe began attending the births of wealthy urban women. Male physicians could offer services that midwives could not, specifically the use of forceps and painkillers such as opium. Patients felt these techniques made childbirth safer and less painful, and women who could afford to do so chose male physicians over midwives.
As time passed, physician-attended birth became more and more common, even in rural areas and among the middle class. At times, a woman called both a midwife and a physician to attend her. Midwives and physicians thus negotiated a delicate balance between traditional childbirth and the new physician obstetrics. What did not change, however, was the female domination and control of childbirth. As long as births remained in a woman's home, as they would until the early twentieth century, women remained in charge of their own birth experiences, and the tradition of social childbirth continued. Midwives themselves continued to practice throughout the nineteenth and twentieth centuries, although their practice became more and more marginal, often limited to remote rural areas, new immigrants, and the poor.
See alsoMedicine .
Fett, Sharla. Working Cures: Healing, Health and Power on Southern Slave Plantations. Chapel Hill: University of North Carolina Press, 2002.
Leavitt, Judith Walzer. Brought to Bed: Childbearing in America, 1750–1950. New York: Oxford University Press, 1986.
Marie Plane, Ann. "Childbirth Practices among Native American Women of New England and Canada, 1600-1800" in Peter Benes, Ed. Medicine and Healing, Annual Proceedings of the Dublin Seminar for New England. Folk-life 15 (1990): 13-24.
Tannenbaum, Rebecca J. The Healer's Calling: Women and Medicine in Early New England. Ithaca, N.Y.: Cornell University Press, 2002.
Ulrich, Laurel Thatcher. A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812. New York: Knopf, 1990.
Rebecca J. Tannenbaum
MIDWIVES. Almost every baby born in early modern Europe was delivered by a midwife. Childbirth was a female ritual into which men entered only in emergencies. An expectant mother invited female friends, relatives, and neighbors to attend her in childbirth. During the long hours of labor, these "gossips" supported the mother emotionally and physically, propping her up as directed by the midwife. They prayed and prepared special foods, kept the fire stoked, and performed all other necessary tasks. Historians have pointed out, however, that single or poor women may have experienced the attendance of gossips as discipline rather than encouragement. In the eighteenth century some well-to-do women began to choose male midwives, but such remained a minute fraction of all births.
Midwives ranged greatly in training, styles of practice, and expertise. Some women delivered a few babies based upon their experiences as gossips, never considering midwifery as their primary roles. Others were very skilled. Sarah Stone (c. 1730), for example, a midwife who practiced in the west of England in the early eighteenth century, functioned as a consultant midwife. She was called into a number of births when a midwife was having trouble, and her complaints about the ignorance of country midwives sound much like those of some of her male surgical colleagues.
The regulation of midwifery varied considerably across Europe. Informally all midwives were regulated by local reputation. Louise Bourgeois (1564–1636), midwife to the queen of France in the early seventeenth century, counseled her midwife daughter never to permit women to deliver in her home lest people think she was encouraging vice by allowing unwed mothers to give birth clandestinely. In England, where midwifery practice was only lightly regulated, a midwife might choose to take out a bishop's license. To obtain such she needed testimony from local respectable matrons about her skills and moral worth. Midwives' religious practices were closely policed. If a baby were born who might not survive, the midwife was often empowered to perform an emergency baptism. Many men feared the magical connotations of reproduction and childbirth, and midwives were sometimes thought to provide abortifacients and to practice magic, another reason for governing midwives' orthodoxy.
Civic authorities were also keen to regulate midwives, since midwives provided evidence in cases of rape or suspicious pregnancy and asked unwed mothers in labor about the identities of the fathers. In 1452 the German city of Regensburg set up the first system of municipal regulation of midwives. These women had to satisfy the authorities about their religious orthodoxy and pass an exam set by a panel of physicians, surgeons, and midwives. It was assumed by the authorities that these women were literate and skilled.
The history of midwifery has echoed other concerns. Early histories of midwifery, often written by obstetricians, discussed the bad old days before the advent of the modern specialty and portrayed midwives as ignorant and superstitious. Women's historians have begun to consider a more balanced view of midwives, outlining their variety and integrating their practices into larger frameworks of gender relations and women's work.
See also Motherhood and Childbearing ; Obstetrics and Gynecology .
Schrader, C. G. Mother and Child Were Saved: The Memoirs (1693–1740) of the Frisian Midwife Catharina Schrader. Translated by Hilary Marland. Amsterdam, 1987.
Gelbart, Nina Rattner. The King's Midwife: A History and Mystery of Madame du Coudray. Berkeley, 1998.
Marland, Hilary, ed. The Art of Midwifery: Early Modern Midwives in Europe. London, 1993.
Wilson, Adrian. "The Ceremony of Childbirth and Its Interpretation." In Women as Mothers in Pre-Industrial England, edited by Valerie Fildes, pp. 68–107. London, 1990.
Mary E. Fissell
The evocation of the word midwifery calls up two images. The first is a medically trained nurse who specializes in obstetrics and gynecology and is licensed to attend childbirths in the hospital and, less frequently, in freestanding birthing centers or the homes of clients. The second and older image is the tradition of social childbirth, in which women gave birth at home in the presence of other women and with the guidance of a skilled folk practitioner. Due to a number of economic, cultural, and political factors, social childbirth declined in significance for native-born northern white women relatively early. By the late 1760s, they had already begun to rely on male physicians to deliver their children. Traditional midwifery, however, continued to flourish among European immigrants who settled in the cities along the northeastern seaboard from the late nineteenth through the early twentieth century.
In the South, the midwifery tradition has been for the most part an African-American one, with the midwife mediating the reproductive experiences of both black and white women, especially in the region's rural communities, from the early seventeenth to the closing decades of the twentieth century. By the 1940s, social childbirth had been largely replaced by scientific childbirth in the hospital, but a few surviving traditional African-American midwives continued to offer their services in the late 1980s, as reported by Debra Susie (1988) in Florida and by Linda Holmes (1986) and Annie Logan (1989) in Alabama.
Throughout the slaveholding South, African-American midwives had the responsibility for managing pregnancy and childbirth. Often, these women were slaves practicing not only on the plantations where they resided, but also attending births on neighboring plantations, for which their owners collected a fee. In the rural areas of the South, slave midwives also delivered the children of white women. Powerful in their knowledge of the physiological, medicinal, and spiritual aspects of childbirth, slave midwives inhabited an intensely ambiguous role. They wielded an expertise that allowed them to compete successfully with "scientifically" trained white male physicians of the period while they remained classified as property, rarely receiving remuneration, and subject to sanctions should the infant or mother die. Given the close association of childbirth with other aspects of bodily functioning, slave midwives were also generally recognized as healers, and they attended the sick as part of their practice. The medical historian Todd Savitt notes that free black women also marketed their skills as birth attendants to a white clientele, while at the same time offering their services to neighbors and kin in their own communities (Savitt, 1978, p. 182).
In the African-American community, across historical periods, women who became midwives did so either through apprenticeship to another midwife (often a family member), or through the experience of having given birth themselves. Whatever the practical route of transmission, the emphasis in the articulation of an identity as a midwife was on the spiritual nature of the practice. Women were said to be "called" to become midwives in the same manner that a person is called to religious ministry; the decision was not under the control of the individual practitioner. So too were prayer and divine guidance crucial to the midwife's success in delivering babies and nurturing the mother back to health.
Childbirth, in this framework, did not end with the physical emergence of the infant. The midwife was also responsible for postpartum care, ensuring that both mother and child—spiritually as well as physically vulnerable—were protected from harm. Though the length of time varied, new mothers were expected to refrain from normal activities, avoid eating certain foods, and keep close to home for up to a month after birth, under the guidance of their midwives.
The dual nature of midwifery as skilled craft and as spiritual service to others was intrinsic to its emergence during the slave period, and it continued as an essential feature through the end of the twentieth century. It is important to recognize, then, that African-American midwives historically viewed themselves as socially embedded in the cultural and religious belief systems of their own communities, as well as having control of a set of skills that allowed them a measure of independence and authority in the broader society.
See also Nursing
Holmes, Linda J. "African-American Midwives in the South." In The American Way of Birth, edited by Pamela S. Eakins. Philadelphia: Temple University Press, 1986, pp. 273–291.
Logan, Annie Lee, as told to Katherine Clark. Motherwit: An Alabama Midwife's Story. New York: Dutton, 1989.
Savitt, Todd. Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia. Urbana: University of Illinois Press, 1978.
Susie, Debra A. In the Way of Our Grandmothers: A Cultural View of Twentieth-Century Midwifery in Florida. Athens: University of Georgia Press, 1988.
gertrude j. fraser (1996)
A midwife is a person, usually a woman, who assists other women in giving birth. Typically, this assistance extends throughout pregnancy, labor, delivery, and the newborn period. Midwives focus on delivering healthy babies in as natural a manner as possible; they also provide health counseling to mothers and families. Although obstetricians and midwives have much knowledge and experience in common, they occupy different professions. While both are concerned with a healthy pregnancy and delivery, obstetrations are prepared to deal medically with complications. It is not uncommon for midwives and obstetricians to collaborate.
Since the 1970s, a small but growing proportion of North American women have chosen midwives to attend their births. Many of these midwives are registered nurses with formal midwifery training and certification by the American College of Nurse Midwives. There are also "lay" or "direct-entry" midwives, who have not been trained as nurses. Midwife deliveries may take place in hospitals, birth centers, or homes.
See also:BIRTH; NATURAL CHILDBIRTH; PREGNANCY; PRENATAL CARE
Leféber, Yvonne, and Henk W. A. Voorhoeve. Indigenous Customs in Childbirth and Child Care. Assen, The Netherlands: Van Gorcum, 1998.
Rooks, Judith P. Midwifery and Childbirth in America. Philadelphia:Temple University Press, 1997.