Historial Document Archive

by faithgibson on March 8, 2016

Directory to historical documents published in the 18th, 19th and early 20th century

Link to–> contemporary politics of normal childbirth (1970 to present)

Link to PDFs


I. HISTORY: Medicine & Midwifery in 3 parts:

Editor’s prologue: Background on historical vocabulary, peculiarities of the period and backstory of the 19th & early 20th century practice of medicine relative to childbirth practices and services as provided by MDs:

The use of the word “midwifery”  in the following historical material does NOT (in most instances) refer to midwives as birth attendants, but to a medicalized form of  childbirth services provided by MDs. As a regular part of a general practitioner’s medical services, midwifery (as non-surgical and physiologically-based), was what normal care during pregnancy and childbirth was called. 

Medical textbooks on the biology, physiology, and medical care of childbearing women published during this era used the word “Midwifery” in their title; medical schools likewise provided courses in ‘midwifery’ as it would be provided by doctors. In this context, the word ‘midwifery’ did not refer to the training or practice of midwives as professional birth attendants.

Prior to the early the 20th century, doctors who provided normal physiological (i.e. non-surgical) birth services were referred to as ‘man-midwives’ by both public and medical profession.

A doctor’s ‘private’ (paying) midwifery patients were generally cared for in the family home, which was considered to be a far better, safer choice than hospitals. Before antibiotic drugs were became available in the early 1940s, hospitals were bio-hazardous places associated with the death of many patients from untreatable infections, with 33% of all maternal deaths in hospitals attributed to puerperal sepsis (childbirth fever).

Historically, hospitals were places of last resort that were only used by the poorest of the poor, the homeless and the mentally-ill. During the thoudands of years before medicine became modern science (particularly the discovery of antibiotic drugs) hospitals were charity institutions specifically developed to serve indigent and/or incarcerated populations.

People with financial or family resources avoided hosptial at all costs, which were seen as dirty, diseased-ridden places where poor people went to die.  For the rest of society medical care was always provided in the patient’s own home, with other family members feeding and taking care of them, or being cared for by someone hired to cook and provide nursing care in the home.

This avoidance of hospitals also applied to childbirth, which also was expected to take place in one’s own home, surrounded by family and friends and with the help of someone knowledgable in midwifery — either a midwife or the family doctor.   

For poor or unmarried women who were homeless (i.e. did not have a home in which to have a home birth), or couldn’t afford to pay a birth attendant to come to their home,  the necessary hospital childbirth was a no-frills, no-privacy experience, with an extremely high likelihood of acquiring a nosocomial (hosptial-based) infection and in far too many instances, dying from ‘childbed fever’, a virulent form of septicemia.

Indigent midwifery patients were housed in the lying-in wards of charity hospitals during the last weeks of pregnancy and for several additional weeks after the baby was born. This is the origin of the term “lying-in”, as women about to give birth and newly delivered mothers spent several weeks lying around in bed while waiting to go into labor, or caring for their newborns afterwards.  

These charity institutions were staffed by religious orders or supported by the tax base of local governments or the largess of  charitable foundations. Free ‘midwifery’ services were provided by medical students as a part of their clinical training, or by local doctors who received payment from government or charity for each mother they delivered.

A. Midwifery vs. Midwives: what American doctors in the early 1900s called ‘the midwife problem’

During the last decades of the 19th century the topic of  ’midwifery’ presented the medical profession with a confusing public relations dichotomy. Doctors had long noted that providing care during childbirth was the key to building a busy and economically successful medical practice.

As a result they had long ago defined the medicalized discipline of midwifery to be an important part of their general practice of medicine. The gratitude of the new mother for being “tenderly and safely” cared for during childbirth was expected to generate loyalty to her doctor, which in turn would create many opportunities to provide other kinds of medical care to her family and nearby neighbors.

Here is how the issue was described by a physician in 1820 in an article published in a medical journal:

Women seldom forget a practitioner who has conducted them tenderly and safely through parturition…  

It is principally on this account that the practice of midwifery becomes desirable to physicians.  It is this which ensures to them the permanency and security of all their other business.” [1]

 Read more…..

II. Medicalized Midwifery Morphs into the surgical speciality of the “New Obstetrics”

A central tenet of organized medicine’s plan was the idea that ‘modern’ obstetrics was no longer a general practice of medicine but was instead  a new surgical discipline.  Referred to as ‘the new obstetrics’, it’s proponents identified childbirth in all its forms and circumstances its proper scope of practice. This included healthy women with normal pregnancies, as well those suffering from the complications of pregnancy and childbirth. The issue here was surgical training, something that doctors only had. For example, a Dr. Holms in 1920 stated that:

“Only the properly trained physician who has acquired surgical techniques with specialty training in obstetric physiology and pathology is competent to circumvent the many ills of childbirth.”

Read more ……

Part III – (under construction) 

With a few exceptions, documents are in chronological order

1. The Great Debate: the historical conflict between medicine & midwifery in the United States ~ an overview of the historical clash btw doctors and midwives in the US during the first three decades the 20th century

This compilation of quotes and excerpts was complied by Faith Gibson from material originally published by Neal Devitt, MD in 1974 as an academic thesis of the same name, and many of historical documents included in the bibliography of his thesis. 

The Official Plan to Eliminate the Midwife: 1910-1935

2. “On the systematic use of antiseptics in midwifery practice” ~ Edinburgh Obstetrical Society Session 1880-1881~

Edinburgh OB society 1880

This treatise is a published report on the efforts of physicians to reduce maternal mortality from sepsis in the lying-in wards of charity hospitals in Scotland and was written before the “germ theory” of infection and contagion was generally understood or accepted by the medical profession. Until the end of the 19th century, infection was though to be the effect of “poisons” or “noxious material”.  Even after the work of Semmelweis, Koch and Pasteur, doctors continued to be skeptical and there was a lot of disagreement over these new ideas.  As a result, the words ‘bacteria’ and ‘germs’ occur only once, at the very end of the paper.

Scientifically establishing that microscopic bacteria and other pathogens were the sole cause of  infection was the life’s work of the French chemist Louis Pasteur. He presented this radical explanation at a meeting of the medical society in France in 1881 by drawing a picture of the rod-like streptococcus on a chalk board. Pointing to what looked like a line of tanker cars on a railroad track, he very famously said: “This Gentlemen is the cause of childbed fever”.

3. Edinburgh Obstetrical Society Inaugural Address by Dr. Ballantyne, 1906.

This is extraordinary, MUST-READ  document in many ways — the speaker uses of a ‘science-fiction’ narrative to communicate his extraordinary vision. The amazing accuracy of his technological predictions make this a very positive  and interesting read.

“Inaugural Address on the Future of Obstetrics”

4.  Supervision of Midwives ~ Journal of the American Medical Association ~ Jan-June 1907

5. Bio & Background on Abraham Flexner 1866-1950 ~ co-author of the Flexner Report complied from various sources

5-b The Amazing Logistics of Flexner’s Fieldwork ~  Mark D. Hiatt, MD, MBA 

Originally published in Medical Sentinel 2000;5(5):167-168. Association of American Physicians and Surgeons (AAPS).

6.  A Review of the Midwife Situation ~ Boston Medical & Surgical Journal ~ 1911

7.  Section on Midwifery ~ Am Assoc. for the Study & Prevention of Infant Mortality ~ 1912

8.  The Elimination of the Midwife ~ 1912 ~posted in 3 parts

American Association for Study and Prevention of Infant Mortality

Transactions of the Third Annual Meeting  October, 2-5, 1912 —
pages 222-237

9. Has the Trained and Supervised Midwife
Made Good?
1912 ~ posted in 3 parts

By Emmons, 2nd, M. D.,
and
Huntington, M. D., Boston, Mass.

American Association for Study and Prevention of Infant Mortality
Transactions of the First Annual Meeting
Johns Hopkins University, Baltimore, November 9-11, 1910
pp. 199-213

10.  The Midwife Problem ~ New York State Journal of Medicine, Vol. 15, No. 8, August 1915

11.  Twilight Sleep: Simple Discoveries in Painless Childbirth ~ 1914 ~ Dr. H. Smith Williams & Dr. J. Whitridge Williams

Obstetrician Dr. JW William lays out his new ‘business plan’ to create and finance a national system of general  hospitals for by convincing healthy  maternity patients to give birth in community hospital lying-in wards. He recognized this as an effective and logical way to generate flow of revenue that regular and dependable and could then be used to finance the departments of surgery, X-ray, laboratory service of a general hospitals all accross the US that would be as ubiquitious as schools and libraries.

12. A  Further Study of the Use of Chloroform in Labor ~ 1917 ~ Dr. I. L. HILL, M. D.;
New York

13. TIME Magazine article on the 1936  AMA convention and a controversy over the use drugs and anesthesia for normal childbirth

Medicine & Childbirth: Nature v. Drugs 

14.  Vanishing Midwives ~ 1947 ~ Newsweek, Volume 30

15. “How Normal Childbirth Got Trapped on the Wrong Side of History:

The Last and Most Important UNTOLD Story of the 20th Century –> how healthy women became the patients of a surgical speciality and normal birth became a surgical procedure”  

Draft of a work-in-progress by Faith Gibson, LM:

16. Influence of state-regulated midwives on reducing childbirth-related mortality from the mid-17oo’s to early 20th century: 

The Decline in Maternal Mortality in Sweden: The Role of Community Midwifery ~ 2004 ~ by Ulf Högberg, MD, PhD

Click here to access the archive on contemporary political and scientific Issues ~ obstetrical management of normal childbirth, contemporary midwifery issues, and the physiological management of normal childbirth in all setting and by all types of birth attendants