THE MIDWIFE PROBLEM ~ New York State Journal of Medicine, Vol. 15, No. 8, August 1915

by faithgibson on September 21, 2012

New York State Journal of Medicine, Vol. 15, No. 8, August 1915
Vol. 15, No. 8, August, 1915; page 291

The One Hundred and Eighth Annual Meeting of The Medical Society of the State of New York, held in New York City April 28, 1914, I presented the following resolutions to the House of Delegates:

WHEREAS, The demand for better obstetric care has directed increased attention to the practice of midwives, and
WHEREAS, Necessity demands that the supervision and training of midwives should be undertaken by the State, and
WHEREAS, At the present time there does not exist in New York State any such supervision and regulation, therefore be it

Resolved, That the President of The Medical Society of the State of New York appoint a committee of five members who shall immediately after their organization begin a study of the subject as it presents itself in this State, and file their report with the House of Delegates of the State Society at the meeting in 1915.
In pursuance of this resolution, the president, Dr. Grover W. Wende, appointed the following committee:
John Van Doren Young, M.D., New York
City, Chairman.
O. Paul Humpstone, M.D., Brooklyn.
John A. Sampson, M.D., Albany.
Frederic W. Sears, M.D., Syracuse.
Peter van Peyma, M.D., Buffalo.

During the summer Dr. Sampson, of Albany, resigned and Dr. George W. Kosmak, of New York City, was appointed. The committee felt that while they were sorry to lose Dr. Sampson, they were exceedingly fortunate in securing the co-operation of one so well informed upon the subject as Dr. Kosmak.

From the outset of the work we have realized the bigness of the problem and the difficulties confronting an investigation, and the still greater difficulties of any committee in offering a substitute for the midwives other than simply to say dogmatically, “eliminate the midwife.” For practical purposes the question may be considered under two heads, the midwife in the City of New York, and the remainder of the state.

The ethical question is the same whether in New York City, Rochester, Buffalo, or the outlying districts of the state, but the practical question is quite different. Let us consider for the moment the question in New York City. Six years ago there were approximately 3,000 known midwives in the city; today there are 1,448 registered, whose work is supervised by a special bureau of the Board of Health, and whose ranks are recruited from the graduates of one recognized school for midwives in the city, the Bellevue Hospital School for Midwives. It is a startling fact, nevertheless true, that this body of 1,448 midwives deliver approximately 53,000 babies per year; that all the lying-in hospitals in New York City can care for is 11,000. There are 5,427 practicing physicians in New York City. If the midwives were abolished this would give to all physicians registered in New York City about nine confinements to look after per year. If you eliminate the various specialists who do not do obstetrical work and throw this enormous volume of work upon those who actually do the obstetrics of the city, it would probably mean from 20 to 25 cases per year to each physician.

Is there any ethical reason in the light of the foregoing figures, why the state, and especially the medical profession, should allow about l,700 violators of the law to do an enormous amount of work affecting in New York City alone over 100,000 lives per year? When you realize that this, in ten years, affects the life and health of half a million babies and the future health and welfare of not less than 350,000 to 400,000 women, the enormity of the problem is at once apparent to you. Whether in a small outlying district of a manufacturing town one or two midwives ply their vocation, known to every practitioner in her neighborhood, and whom she feels she can call upon in the slightest trouble, will do proportionately as much harm as the 1,400 midwives in a large city is a question hard to answer.

On the other hand, one is face to face with the question, should you eliminate the midwife, what will you substitute ? The answer to this question is the reason for this discussion. It is an admitted fact that the problem is so complex that the immediate elimination of the midwife is an economic impossibility. I feel sure that eventually the midwife will be a relic of the barbaric past, and that this field of medicine will be in the hands of those qualified as physicians to give such service as the pregnant and parturient woman has a right to demand.

The whole problem is summed up in the right of the expectant mother to the best possible obstetric care, and this paper is a plea for better obstetrics, for a realization by all practitioners of medicine, in or out of the cities, that there is no more noble work or no work more worthy of their best endeavor than the study and care of the obstetric case. Surely nothing can be more important to the health of the nation than the care given to its mothers, who are the fountain-head of the future generation. The excuse has been frequently offered for the existence of the midwife by the statement that she is not hurried, that she gives to the

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