III. OPEM -> Medical Education and its Relationship with the Campaign to Abolish Physiologic Childbirth & the Midwife
III. Medical Education and its Relationship with the Campaign to Abolish the Midwife
Only with the knowledge of the status of obstetrical science in the United States in the early 1900’s can one reasonably evaluate the obstetricians’ campaign to eliminate the midwife. Obstetrical education in the early 1900s in United States was not based on clinical training — that is actual hand-on practice, but rather textbook learning, lectures by professors and “observation” of care rendered by others.
~ “In 1850, Dr. James P. White, introduced into this country clinical methods of instruction in obstetrics. Yet, during the following 62 years … our medical schools have not succeeded in training their graduates to be safe practitioners of obstetrics.” 1911-B; WilliamsMD
~ “After 18 years of experience in teaching what is probably the best body of medical students every collected in the country — the student body at the Johns Hopkins Medical School for the years 1911-1912 …. — I would unhesitatingly state that my own students are absolutely unfit upon gradation to practice obstetrics in its broad sense, and are scarcely prepared to handle the ordinary cases.” [1911-B; WilliamsMD p. 178]
~ “In 1911, the great American obstetrician, J. Whitridge Williams, (original author of “Williams Obstetrics”), completed a survey of obstetrical education in United States medical schools. Williams found that more than one-third of the professors of obstetrics were general practitioners. ‘Several accepted the professorship merely because it was offered to them but had no special training or liking for it.’ 13 had seen less than 500 cases of labor, 5 had seen less then 100 cases and one professor had never seen a woman deliver before assuming his professorship. Several professors of obstetrics were not able to perform a Cesarean section. [DeVitt, MD, 1975] {*}
Before a (medical) student was licensed to practice, Dr. Williams reported that :
~ “the actual figures show that in 25 schools, each student see 3 (deliveries) or less, in 9 schools, 4-5 cases and in 8 others, 5 or more cases, while in some of the smaller hospitals this is possible only by having 4-6 (medical students) examine the each patient…”
Dr. Whitridge Williams, the original author of “Williams Obstetrics” was highly critical of this situation:
~ “The generally accepted motto for the guidance of the physician is ‘primum non nocere’ (in the first place, do no harm), and yet more than 3/4 of the professors of obstetrics in all parts of the country, in reply to my questionnaire, stated that incompetent doctors kill more women each year by improperly performed operations than the … midwife….” 1911-B; WilliamsMD p.180
~ “A priori, the replies seem to indicate that women in labor are safer in the hands of admittedly ignorant midwives that in those of poorly trained medical men. Such conclusion however, is contrary to reason, as it would postulate the restriction of obstetrical practice to the former (midwives) and the abolition of medical practitioners, which would be a manifest absurdity.” [1911-B; WilliamsMD]
Birth Attendant: Midwife Physician Total Births (%): 52% 48% Stillbirth: 10% 90% Neonatal Deaths: 35% 65%
[Van Ingen(in Baker, MD; 1913, for NYC]
~ “Baker [1913] reported that for New York City as a whole, midwives attend 40% of all births but had only 22% of the maternal deaths from puerperal sepsis while physicians, with 60% of the births, had 69% of the deaths from sepsis in their practice. In these surveys the death was attributed to midwife practice if she was ever present at the labor even if she turned the case over to a physician or hospital” [DeVitt, MD; 1975] {author’s note: these figures actually reflect three categories, the last of which has some overlap — midwife/home, physician/home and hospital/medical student-doctor, which accounts for the missing percentage points}
Levy examined birth-related mortality in Newark, NJ for 1921 and found a similar relationship to that of Van Ingen’s survey of Manhattan.
Birth Attendant: Midwife/Home Phys/Home Hospital Birth percentage 38% 30% 31% Puerperal Deaths: 13% 34% 52% Neonatal MR/1000 32% 40% 34%
~ “With these results of the midwifery surveys and of Williams’ survey of obstetrical education, the debate over the future of the midwife began. Against the midwife were obstetricians who favored immediate abolition of the midwife no matter what the consequences [most were from Boston – Noyes, 1912], or who favored gradual abolition through stricter regulation [Williams, 1912; Ziegler, 1913]. For the midwife, were public health officers and Southern obstetricians who realized that the midwife could not be eliminated immediately and thus wished to train her [Nicholson, 1917; Hardin, 1925], and a few physicians [most notably Abraham Jacobi, 1912] who wished to establish midwifery schools in the United States to make the midwife a permanent institution in the US as it already was in Europe.” [DeVitt, MD, 1975]
http://collegeofmidwives.org/collegeofmidwives.org/safety_issues01/rosenbt2.htm
