Holding for part 2 Final and Fatal Blow ~ Eliminating midwifery in the US for three-quarters of century
Part 2 ~ Final and Fatal Blow ~ Eliminating midwifery in the US for three-quarters of century
Nonetheless, these highly educated and respected doctors did not hesitate to deliver the “fatal blow” that eliminated midwives as practitioners and midwifery as a non-interventive form of non-institutionalized maternity care for the rest of the 20th century and a quarter of a century into the next century.
This was achieved by repeating the claim every chance they got to authoritatively announce unbidden that “midwives kill babies”. Nearly a century later, when a professional midwifery licensing bill was introduced in the California Legislature in 1993, the descendants of those early 20th obstetricians happily testified before our State Legislature that “midwives kill babies”.
Between 1910 and 1920, the identified goal for the American obstetrical profession was to make the mere memory of midwifery irredeemably repugnant, so much so that everything about midwifery care would be resoundingly rejected by the public. The next step was convincing the American people that when it came to the serious of childbirth, the motto was
“always a physician, never a midwife”
To that end, a PR campaign by influential obstetricians included pro-doctor, anti-midwife articles written by obstetricians to be published in newspapers and women’s magazines, but their simple message was the same:
“always a physician, never a midwife”.
In the 10 years between 1910 and 1920, the rate of midwife-attended births plummeted like a boulder, going down from a high of 60% of all births to just 13%. All that was left of midwifery in America were the black granny midwives in the segregated South who attended the births of all black mothers and very poor white women.
In the early 1900s, 850 new mothers died as a direct result of childbirth out of every 100,000 women who gave birth in Unites States, while at this same time, only 230 Swedish mothers died of childbirth-related causes per 100,000.
News Flash – It’s not much better today! Since the early 1900s, the US has had the very highest maternal mortality rate of all the wealthy industrialized countries in the world and that is till true today, right this very minute! How could this happen? Why did “We the People” let this happen to us?
It easy to see this as a sign that things are hopeless for midwives and childbearing women in the US. However, but I see this turned around 180 degrees from the perspective of hopeless.
Nearly all the countries in Western Europe have robust maternity care systems in which thousands of professional trained midwives provide personal, hands-on, low-tech maternity care in homes and hospitals to millions of childbearing women every year. These are some of the best statistics in the world for good outcomes for both mothers and babies.
Historically, European midwives have always had mutually cooperative relationships with physicians. Instead of being competitors, GPs were on the same team and provided backup when small problems arose that could be taken care of at home and arranging a hospital transfer for a new mother or neonate when appropriate. GPs are themselves backed up by a comprehensive healthcare system that is able and willing to provide whatever the midwives needed or the medical services required by the childbearing mother or her infant.
All this is in very high contrast to the United States, where members of the obstetrical profession and organized medicine have had an ax to grind in relation to “female practitioners of midwifery” for at least a hundred years.
What they do best is to get their undies in a big bunch and demand that their state’s medical board arrest midwives and charge them the illegal of medicine, which is what happens in many places in the US.
We decide whether or not the “Truth” will make us free as healthy childbearing women and their midwives – it’s all about action vs. inaction
As a midwife, you can counter all this negativity about midwifery by pointing to a mountain of published statistics – historical as well as contemporary (references available later) that ranked the care provided by midwives as safest, with private physicians in second place, and the very highest mortality rate being associated with teaching hospitals. One of the most compelling elements of this historical saga in the persistence of professional midwifery care through time and around the world.
That is a story worth telling both for the vision achieved more than two centuries ago when the very first state-supported professional midwifery training programs began in Sweden, the Netherlands, England, Germany and elsewhere. This story of midwifery in Europe also reveals just how perpetually ill-willed nature of the obstetrical profession, with its eternal efforts to lord over all “non-obstetrician” practitioners – i.e. professional midwives, family practice physicians and general practitioners.
The more things change the more they stay the same! However, that leaves is with the question of: “Does any of this still matter? Maybe “yes”, maybe “no”.
“Maybe I’m a dreamer, but I’m not the only one” Beatle John Lennon, 1972
I confess, I have always been a “dreamer” and that many of my dreams have come true – a family and three great (now adult) children, a bird’s eye view of the under belly of a dysfunctional obstetrical system that deludes itself into thinking that it’s the doctor (not the mother!) who “delivers the baby”.
As a community-based professional midwife I’ve had the privilege of attended literally hundreds of nice normal home births. Notice I didn’t talk about “delivering” or “catching” babies. When normal childbirth is taken out of the hospital’s obstetrical department, childbearing women are in their own bedroom, they just reach down, “catch” their own baby, and warmly welcome their newborn into their own hands and then into their waiting arms. Also ,this gave fathers a chance to get to “catch” (and dare I say “bond) with their newborns.
But in the 1960s when I was pregnant with my first baby, there were no midwives and hospital L&D wards were only a very short step away from a prison camp. Draconian hospital obstetrical protocols during labor mandated the routine use of the amnesic-hallucinogenic drug scopolamine.
In this obstetrician-centric system, women no long “gave birth” as a normal spontaneous biological process in which they pushed their babies out under their own steam and got to take credit for all their hard work! In an obstetricalized system, babies are “delivered” by the doctor (i.e. not the mother), and was a process that began by “putting the mother to sleep” under a general anesthetic.
Beam me up Scotty, think I landed on the wrong planet!
Bottom line for me was simple — I wanted absolutely nothing to do with this bizarre and inhuman process, which, if doctors didn’t have medical licenses, would have been consider to be a crime against Nature!
But luckily for me, I’d trained as a student nurse in this very same hospital — Orange Memorial Hospital, now Orlando Regional in Orlando, Florida. But in 1964 OMH was still a racially segregated facility. It had been my good fortune as a nursing student to be assigned to the all-black ward in the basement of the hospital for several weeks. Known as “1South” it was where all black patients of all ages, all genders, all stages of life, all diseases, all kinds of injuries were admitted. However, there was no labor ward or delivery room, so a black labor patient was admitted to an all-female 4-bed ward.
Another side-effect of racial discrimination was a bare-bones staff with only two nurses, a ward clerk and a nurse’s aide for 40 patients. That meant no nurse stayed in the room to monitor the patient’s labor. Instead, one of the nurses came into the room, assigned the soon-to-be-new mother to her bed, checked her temperature and blood pressures and said:
“Come get me or the other nurse when you start pushing. We’ll get a stretcher and take you upstairs to the (all-white) delivery room on 5 North.
As a segregated southern hospital in 1962, the was all the care provided to a black woman in labor.
Yes, it was racist, discriminatory, not fair, would be illegal today, but for black childbearing women in a segregated ward on 1 South in 1962 it was a Godsend! Magically, none of the standard obstetrical interventions and invasive procedures of the all-white 5 North L& D unit applied to them.
Unlike their heavily drugged white counterpart upstairs, this black mom would not handcuffed to a delivery table, or have her legs strapped into metal stirrups, no episiotomy, forceps delivery, no manual removal of the placenta, no need for stitches afterwards. Their good fortune was that none of the painful and invasive interventions that had been routinely forced on all white labor patient with religious zeal since 1910 applied to black labor patients.
When this black labor patient started to have to have pushing urges, one of the other women patients went to tell the nurse. The nurse brought a stretcher to the room and helped the about-to-be mother move from bed to the stretcher. After throwing a sheet over her for modesty’s sake, the floor nurse steered the stretcher into the hall. I grabbed the other end of the stretcher and we moved rapidly down the middle of the ward and into the 1st floor back elevator that went up to 5North.
As a student nurse, I’d already seen my first Cesarean delivery as well as the precipitous birth of “grand multip” – obstetrical jargon for woman who’d had given birth many times a was therefore likely to give birth very rapidly. I remembered them both fondly. I was particularly amazed during the Cesarean delivery when the surgeon reached to the incision in the mother’s uterus and brought out a fully-formed, exquisitely made and beautiful baby girl who immediately took her first breath and cried lustily for the next 20 minutes.
All this was unforgettable on its own merits, but also because my parents never talked about where babies came from or fessed up to any of the other “facts of life”. As a student nurse our textbooks described the childbearing process, but there were no photographs of exactly how that happened. Also, it was still early my nurses’ training, so I had not yet seen a normal birth. Obviously, Cesarean surgery was not the same as a spontaneous birth. Nonetheless it was an extraordinary thing to watch, as the doctor lifted the perfect newborn infant up in his hand and briefly paused, as if this was a religious rite and he was holding the infant aloft to be blessed by the gods. Can’t help but note that this gift of human life is a wonderful thing.
The perpetual question of youth, especially of teenage girls: “How does that great big thing (i.e. a human baby) get out of that tiny little place?”
Believe it or not, witnessing my first spontaneous birth was even more exciting and memorial than the Cesarean surgery.
They provided a up close and personal “front row seat on the dependable biology of normal childbirth. These healthy women consistently “bring forth” babies with enviable ease. These births where just so dramatically different than what happens the anesthetized labor patients on 5 North where the “delivery” conducted as a series of surgical procedures.
This was in such sharp contrast to the extremely interventive obstetrical practices of 20th century that were being routinely used in the all-white 5North labor ward. The protocols for those births – actually doctor-deliveries – always introduce unnecessary and unnatural dangers into the biology of normal childbearing also demonstrated. As a result, I learned more about the fundamental nature of childbearing than I ever did from obstetrical textbooks or my nursing instructors.
and as the elevator climbed up from the basement to 5North 5North.
On this occasion
street nd the nurse and .
The reason was simple enough — the obstetrical interventions and interruptions in the normal biology of spontaneous childbirth used upstairs on the all-white wards were conspicuously (thankfully) absent in these unscripted elevator births. Stuck in a elevator with a mother who suddenly started pushing meant the nurse had no other option than to temporarily become the midwife and “catch” the baby as it slid out between the mother’s legs. As would be the norm for midwifery care, the baby was handed, umbilical cord intact and pulsing, into the mother’s waiting arms as the baby took it first breathe and began to cry.
One of the many things that were dramatically different from the typical doctor-managed birth of that era was that the nurse-acting-as-midwife handed the mother’s baby to the mother (instead of a delivery room nurse) and allowed the baby’s umbilical cord to remain intact.
But I was particularly fascinated with two specific and instructive aspects of the spontaneous elevator births that I witnessed. These factors fully captured my attention at the time, and have remained pristinely and stubbornly in my mind ever since.
