OPEM Topical Citations: Anti-midwife strategies by Organized Medicine in America ~ early 1900s  

by faithgibson on December 19, 2018

in Contemporary Childbirth Politics

Various strategies developed by organized medicine to make it impossible/illegal for midwives to provide midwifery care, while physicians 

Ø “In states where the midwife is practically unknown, it should be seen to that the Medical Practice Law excludes the possibility of midwives practicing within the limits of the state. 

In states where the midwives are not forbidden by law and are numerous, a well organized license and regulation system should control those in practice. Outline for them the minimum standard for their cases and enforce at least this standard by taking away the licenses of those who violate the law.

Renew the old licenses every year and issue NO NEW ONES. Thus the midwives will gradually be excluded from practice by their own incompetence and by the lapse of time.” [1911-C, p. 209] ^29

Ø “Have the license to practice be an annual affair based on the record for the previous years. Then by gradually raising the standard and providing dispensary care (free clinics and home delivery by medical students), .. the {midwife} problem in a few years would simply (solve) itself.” [1911-C, p. 210] ^30 

Ø “…the great danger lies in the possibility of attempting to educate the midwife and in licensing her to practice midwifery, giving her ...a legal status which cannot …be altered…”[1912-B, p.222 ] ^31

Ø “I believe that the midwife should be eliminated as rapidly as possible. She should, however, not be given a license but should be given a certificate, to be renewed from time to time or canceled as deemed advisable under the circumstances. Licensing her will not add to her knowledge, and will not make her more efficient but will place upon the state permanent responsibility for her work.” [1912-B, p.227] ^32

Law / legal commentary

“Licensure is the process by which an agency of the government grants permission to practice to individuals in certain professions or occupations. Generally the authorizing statute specifies certain minimal educational requirements and other qualifications. 

Licensure is the strongest form of legal regulation of an occupation because when it exists, it prohibits practice of that occupation without a license.” [JNM . Vol37, #2 March/April, p. 97] ^33 

Ø …regarding to legislation to abolish midwives: “But we know by experience that in America, legislation without public sentiment behind the law is absolutely futile.” [1911-C, p. 208]^34

Ø “From the legal standpoint the practice of midwifery may be regarded as on occupation, which, if not under proper regulation, may be dangerous either to the public health or to the public safetyIt is true that in this particular occupation this distinction is somewhat artificial.” 

As a general rule, however, the practice of midwifery {only} affects individuals or small groups of individuals, while the practice of medicine (with its public health function of reporting communicable diseases) and other professions licensed to handle infections diseases affects the general public as a whole.”[1911-E; PriceMD, p.223] ^35 ^36

Ø “It is  questionable whether the powers of the legislature in the several states would extend so far under theAmerican ConstitutionThere is no doubt that such a plan, if constitutional, would have much to commend it, for it is undoubtedly best for women in childbirth to be attended by a well-educated and trained physician.”[1911-E; PriceMD, p.224]

Assuming the legislature to have the power in any state to immediately abolish the practice of midwifery, what would be the practical results?

In the first place, the law could not require a parturient woman to provide herself with proper attendance [skilled or licensed caregiver], nor could it forbid her the assistance of friends and neighbors of our own sex.

The restriction of the law could necessarily apply only to midwives who are habitually engaged in the practice of the profession for hire. It would be necessary for the State to supply a sufficient number of trained physicians to replace the abolished profession, and even here there would be a great number of racial and personal prejudices to overcome. “ [1911-E; PriceMD, p.224] ^37 ^38

Ø “Moreover, it is a hard matter to obtain the proper evidence to convict such persons, and we have never had an instance in a year and 4 months of (the) execution of the Midwifery Law of an accusation being brought against midwives by either a patient or a physician, (except a health officer).” [1911-F, p. 223] ^39

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