Day 11: Historical & contemporary comments by physicians about midwives ~ 1820 to 2014

by faithgibson on April 11, 2016

in Contemporary Childbirth Politics, Historical Childbirth Politics 1820-1980

A 30-day series of quotes spanning two hundred years ~ click here to begin with Day 1

You can also read the entire series as a single post

Day 11 ~ 1966 to 1985

 1966 ~ Dr. J. Rovinsky, MD; foreword of Davis Obstetrics:

“There is no alibi for not knowing what is known

1971 ~ Dr. Levy, et al ~ Published report on a California  nurse-midwife pilot program at Madera County Hospital from July 1960 to June 1963 that served mainly poor agricultural workers.

During the three-year program, prenatal care increased and prematurity and neonatal mortality rate decreased at the county hospital.

After it was discontinued by the California Medical Association, the neonatal mortality rate increased even among those women who had received no prenatal care.

This suggests that the intrapartum care delivered by nurse-midwives may have been far more skillful than that delivered by physicians. Prenatal care decreased while prematurity rose from 6.6 to 9.8% and neonatal mortality rose from 10.3 to 32.1 per 1,000 live births.

It was concluded that the discontinuation of the nurse-midwives’ services was the major factor in these changes.

1975New York Times Magazine

In the United States … in the early part of this century, the medical establishment forced midwives — who were then largely old-fashioned untrained “grannies” — out of the childbirth business. Maternal and infant mortality was appallingly high in those days…

As the developing specialty of obstetrics attached the problem, women were persuaded to have their babies in hospitals, and to be delivered by physicians …. Today it is rare for a woman to die in childbirth and infant mortality is (low) … [Steinmann, 1975]

1977 ~ Letter from Dr. Heinrichs, MD., Ph.D., August 1, 1977, Stanford University Medical Center to the State Legislature, strongly opposing AB 1896, the first of 6 failed direct-entry (non-nurse) midwifery licensing bill:

If we want an increase in cerebral palsy, mental retardation, extended hospitalizations for mothers undergoing infections, fistulas, hemorrhages, and other severe and disabling results of neglected childbirth, only then could one endorse bill AB 1896. 

1985 ~ Drs. Feldman and Friedman: Prophylactic Cesarean Section at Term?”

This peer-reviewed paper in the NEJM proposed that the prophylactic use of Cesarean section become new standard of care for all childbearing women, claiming that pre-labor Cesarean surgery would 36 to 360 for every “extra” woman dying from complications of their surgery .

p. 1266 ….the number of extra women dying as a result of a complete shift to a prophylactic cesarean section at term would be 5.3 per 100,000….

This may be the proper moment to recall that the number of fetuses expected to suffer a disaster after reaching lung maturity is between 1 in 50 to 1 in 500. … if it could save even a fraction of the babies at risk, these calculations would seem to raise the possibility that a shift toward prophylactic cesarean section at term might save a substantial number of potentially healthy infants at a relatively low cost of excess maternal mortality.

We probably would not vary our procedures if the cost of saving the baby’s life were the loss of the mother’s. But what if it were a question of 2 babies saved per mother lost, or 5 or 10 or (as our calculations roughly suggest) as many as 36 or 360? …. Is there some ratio of fetal gain to maternal loss that would unequivocally justify a wider application of this procedure?

p. 1267….is it tenable for us to continue to fail to inform patients explicitly of the very real risks associated with the passive anticipation of vaginal delivery after fetal lung maturity has been reached?

If a patient considers the procedure and decides against it, must she then be required to sign a consent form for the attempted vaginal delivery?

“Prophylactic Cesarean Section at Term?”; Feldman GB, Friedman JA;
New England Journal of Medicine 1985;312:1264-1276

Day 12 ~ 1992 to 2006

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