Part 1 Untitled synopsis of obstetricalized childbirth and elimination of midwives from 1820 to early 1900s
Untitled synopsis of obstetricalized childbirth
and elimination of midwives from 1820 to early 1900s
Part 1 ~ 8 pages 2725 words
By Faith Gibson
California Licensed Midwife 041
February 2025
Part 1 ~ word count: 2758
The history of the word “midwifery”
The word “midwifery” comes from Middle English about 1500s and simply meant “with-woman” in relation to childbearing. In the narrowest sense, any woman who stays with and helps another woman during the childbearing process of labor and birth is providing midwifery care.
Midwifery is formally defined as “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pregnancy, birth, postpartum and the early weeks of life.
The term “man-midwife” usually refer to male doctors who regularly attended “case of childbirth.
hg
Between 1820 and 1920, a long list of the most influential obstetricians in America, assisted by the American Medical Association (AMA), waged a relentless campaign to get state laws passed that would define childbirth as surgical procedure “performed” by the medical profession. This made it illegal (therefore a crime) for any person (including midwives) who had not graduated from medical school to attend “cases of normal childbirth”.
For the obstetrical profession of the very early 1900s, simply defining the practice of midwifery to be crime did not go far enough. These doctors were highly offended by the sheer arrogance of these “female practitioners”.
These women who had not spent a single day in medical school, much less having graduated, and yet they pretended to know how to deliver a baby safely, and be able to deal with potential problems as well a doctor who’d graduated from medical school and had a diploma on the wall of his office conferring on him the elevated title of: “Doctor of Medicine”.
The idea that highly educated MDs and uneducated female practitioners of midwifery would have comparable roles in society in such a critical area of life as childbirth was just too absurd for words!
But much more to the point was the negative economic impact that midwives had on obstetrical profession. There just was no way to get around the obvious facts – midwives were the obstetrical profession’s direct economic competition. They attended between 40% and 60% of all births in the northeast area of the country, particularly the highly populated areas around New York City, Boston and Baltimore.
However, every time an uneducated midwife attended a birth, the doctor who lived and worked in that same neighborhood was cheated out of his rightful fee for having delivered that baby! This profound gender prejudice and dislike of midwives by physicians has been a well-documented theme in the United States for several hundred years.
“Remarks on the Employment of Females as Practitioners in Midwifery“, 1820
One of the very earliest and best records of this gender bias was a treatise by a physician entitled “Remarks on the Employment of Females as Practitioners in Midwifery” published in Boston by Cummings and Hilliard in 1820.
Its physician-author was addressing other physicians in regard to the practice of midwifery by midwives. He expressed his objections to the female gender in general but was particularly offended by the practice of midwifery “by female practitioners” i.e. apprentice-trained midwives.
This physician’s remarks obviously echoed the objections of other MDs, who in 1820 were all male. The medical profession was horrified by the thought that they might have to compete economically with females that were defined by these “medical men” (the moniker doctors preferred) as the “weaker sex”.
This rejection of women as “female practitioners of midwifery” was based on a series of erroneous ideas about our homo-sapiens species that included a built-in gender bias that resulted in the male of our species seeing himself as physically and intellectually superior to “the weaker sex”.
This physician-author went on to describe women as “intellectually incapable of being educated” as practitioners, postulating that the emotional nature of women made them incapable of being able to respond rationally in an emergency, and even if it was possible to sufficiently educate women, the indelicate nature of medical knowledge would corrupt their morals.
In regard to the practice of midwifery by these “female practitioners”, this early 19th century physician-author stated that while labor and birth were of themselves “simple”, the potential for systemic complications made childbirth a medical event which should only be attended fully “qualified” physicians.
Then he expressed his concern that midwives, if they were to become formally trained and educated as women practitioners, would be preferred by “the better classes of women” who’d happy to pay the lower fee for the services of a midwife and would consider that it was “indelicate and vulgar to suffer the attendance of a (male) physician”
However, the real argument for having doctors, and not midwives, be the standard provider of maternity care was that childbirth services by doctors was the key to a successful general medical practice! The process of promoting the doctor’s medical practice began with the new mother’s gratitude to the doctor who delivered her baby and resulted in a great loyalty to the doctor for having provided this important and intimate service to the childbearing woman and her family.
The new mother, high on the beta endorphins and oxytocin hormones of associated with giving birth and breastfeeding, would “naturally” want to brag to all her family members, relatives and neighbors that the doctor who just delivered her charming newborn was just so wonderful, and obviously would be the very best choice for anyone who needed “doctoring”. This would predictably generate “return business” and assure him a very profitable medical practice for decades to come!
The physician-author of this 1820s publication identified this “truism” thusly:
“Women seldom forget a practitioner who has conducted them tenderly and safely through parturition. . .”
He went on to say:
“It is principally on this account that the practice of midwifery becomes desirable to physicians.
It is this which ensures to them the permanency and security of all their other business.”
The physician-author ends by congratulating “distinguished individuals” in the medical profession for being so successful in excluding midwives from the practice of midwifery.
“It is one of the first and happiest fruits of improved medical education in America, that they (i.e. midwives) were excluded from practice; and it was only by the united and persevering exertions of some of the most distinguished individuals our profession has been able to boast that this was effected.”
Connecting up the same dots just 90 years later
and still leaving both mothers and midwives “out in the cold”
Influential members of the obstetrical profession all agreed that, they had find way to permanently stop midwives from practicing. midwives were not only their economic competition, but the very bane of their existence! They must rid themselves and the unsuspecting American public from these uneducated (thus dangerous) “female practitioners” by tearing them out by the roots, never to be hear from again!
The result was a coordinated his public-relations campaign organized by between the obstetrical profession and the AMA that was specifically developed to permanently destroy the reputation of midwives by describing them as ignorant, drunk, with dirty hands and even dirtier fingernails; they didn’t they know what they were doing, and were only interested in collecting their fee.
This was a near-perfect match to the late 18th century generally repugnant cartoon character of Sarah Gamp from a Charles Dickenson novel. Her employment status was as a “monthly nurse”, living with the family for the first month after the baby was born, and taking care of the baby at night so its mother could sleep.
For generations, the cartoon depiction of Sarah Gamp, who was not and had never been a midwife, was referred to the all-male obstetrical profession as the classic example of just how dirty and unkempt midwives were, that their only talent was in collecting a fee they hadn’t earned and didn’t deserve!
Nonetheless, the fictitious persona of Sarah Gamp fit perfectly with the American obstetrical profession’s “final solution” to what they described as “the midwifery problem”. From their perspective the answer to the “midwifery problem” was to ridicule, belittle, insult and ultimately rid the country of midwives, once and for all time!
I see this so-called “midwifery problem” as the problem doctors were having in their effort to get rid of midwives!
When all else fails, call your adversary a murderer
by insisting that “Midwives Kill Babies”
Influential obstetricians knew these claims weren’t true, but they weren’t nearly as interested in truth as in achieving their number one goal — getting rid of the economic and sociological threat that midwives posed. As long as 40% to 60% of all childbearing in the country were being delivered by midwives, the care provide by obstetrical surgeons would be negatively compared to the much more sociologically-satisfying and hands-on personal care provided that is the heart of midwifery. It was, as they say, a “no brainer”.
Midwives were physically present in the mother’s home during the many hours of labor that preceded the birth. They encouraged mothers to remain upright, move and walk around because labor pains are ever so much more painful when the laboring woman is lying down.
Being upright and moving around is also Nature’s way to keep the baby moving downward in the mother’s pelvis. When she started to feel “pushy”, the midwife would help her into an upright position that made “right use of gravity” so she could push more effectively. When the baby’s head began to be born, the midwife “caught” the baby as it slid out of its mother’s body and immediately handed the newborn baby up to its mother.
Note: This is the obverse of being admitted to a hospital labor room and spending many hours of labor lying in the hospital bed in the middle of the room sounded by the IV poles, blood pressure cuff, and the tangle of cords from the continuous electronic fetal monitor (EFM) that sits at your bedside and snakes over and encircles twice around your pregnant belly!
After the birth, the midwife would give the baby’s its first bath, help the mother breastfeed for the first time, made sure the family was providing sufficient food and drink to the new mother, kept track of her immediate postpartum bleeding, help her to the bathroom, and then make house calls every afternoon for several day to be sure that mother and baby were OK.
How could male surgeons possibly compete with that?
More to the point, all these doctors had forked over a lot of money to pay their tuition for two years of medical school, and surely didn’t do that so they could do the work of a “mere” nurse or nanny! Social status is as social status does!
An even more important issue was obstetricians having total control over their own profession. Unfortunately, the obstetrical profession’s maternal mortality rates were terrible — many times higher than those in comparable European countries. It comes as no surprise that they would be compared to the much lower mortality rate of midwives, who easily bested them by a country mile. It wasn’t a “good look” for a profession that claimed to be the heroes that rushed in to save childbearing women from Mother Nature’s Biggest Mistake Ever – vaginal birth!
But the obstetrical profession was stuck in an untenable position, something a “Saturday Night Live” comedian would describe as “can’t get no respect!”. Here are just some of the good numbers for midwives, not-so-good numbers for doctors that made grown men-obstetricians cry!
1913 ~ Drs. Van Ingen and Dr. Josephine Baker, MD; New York City
| Type of birth attendant: | Physician | Midwife | |
| Percent of births attended | 48% | 52% attended over half of all birth | |
| Stillbirth: | 90% | 10% 80% fewer stillbirths | |
| Neonatal Deaths: | 65% | 35% 65% fewer neonatal deaths |
1917 ~ Dr. Levy, MD, in reference to mortality statistics published by Dr. Van Ingen and Dr Josephine Baker for NYC, noted that:
“These figures strongly refute the charge of high mortality among the infants whose mothers are attended by midwives; ….
… (this) presents the unexpected problem of explaining the fact that the maternal and infant mortality for the cases attended by midwives is lower than those attended by physicians and hospitals.” [ref: 1917-B; p. 44]
No less an imposing figure than Dr. J. Whitridge Williams, former Chief of Obstetrics at Johns Hopkins University Hospital and current Dean of the prestigious Johns Hopkins School of Medicine, readily conceded that midwives had much better morbidity and mortality outcomes than doctors. But these facts didn’t change Dr. JWW’s mind or his intention to get rid of the “competition”, which meant eliminating the sociological role of “midwife”.
He could have chosen to promote and expand the proven system of safer care being provided by midwives, but instead focused solely on the training and abilities of doctors. His goal was to make the obstetrical services provided by doctors so much better than anything a midwife could do that all midwives would be seen for what they really were – inadequately-trained scam-artists and dangerous “want-a-be doctors” – and instantly vanish from the face of the earth, never to be seen again!
In Dr. JWW’s imagination, the magnitude of all these deficiencies would relegate midwives and midwifery to the dustbin of history, never ever to be heard from again. In twenty years, no one would even be able to pronounce the word “midwifery” correctly (mid-wiff-er-ree), but instead would say “mid-wife-er-ree”.
In my mind’s eye, I imagine Dr. JWW and his colleagues singing three verses of the Star Spangled Banner in anticipatory celebration of such a major coup!
In 1911, Dr. Williams gave a public presentation that included these statements:
….. the ideal obstetrician is not a man-midwife, but a broad scientific man, with a surgical training, who is prepared to cope with the most serious clinical responsibilities, and at the same time is interested in extending our field of knowledge.
No longer would we hear physicians say that they cannot understand how an intelligent man can take up obstetrics, which they regard as about as serious an occupation as a terrier dog sitting before a rat hole waiting for the rat to escape.
{citation 1911-B“ “The Midwife Problem and Medical Education in the US”)
In 1912 these comments by Dr. Williams were published in the Transactions of the AASPIM:
“The question in my mind is not “what shall we do with the midwife?”
We are totally indifferent as to what will become of her…[1912-B, p.225]
No attempt should be made to establish schools for midwives, since, in my opinion, they are to be endured in ever-decreasing numbers while substitutes are being created to displace them. [1912-B; p.227]
Another very pertinent objection to the midwife is that she has charge of 50 percent of all the obstetrical material [teaching cases] of the country, without contributing anything to our knowledge of the subject.
As we shall point out, a large percentage of the cases are indispensable to the proper training of physicians and nurses in this important branch of medicine…” [1912-B, p.224]
Dr JWW’s valid criticisms of American medical schools and their poorly-trained graduates:
In all but a few medical schools, the students deliver no cases in a hospital under supervision, receive but little even in the way of demonstrations on women in labor and are sent into out-patient departments to deliver, at most, but a half dozen cases.
In reference to the professional training of midwives in Europe, he said:
“When we recall that abroad the midwives are required to deliver in a hospital at least 20 cases under the most careful supervision and instruction before being allowed to practice, it is evident that the training of medical students in obstetrics in this country is a farce and a disgrace.
It is perfectly plain that the midwife cases … are necessary for the proper training of medical students. If for no other reason, this one alone is sufficient to justify the elimination of a large number of midwives, since the standard of obstetrical teaching and practice can never be raised without giving better training to physicians.” [1912-B, p.226]
However, there were a few physicians of that era who were genuinely distressed by the organized campaign to eliminate the practice of midwives, and their joking reference that:
“the only good midwife is a dead midwife”.
Part 2, which begins on {LINK} the next page.
Coming soon to a theater near you!
The long and winding story of Dr. J. Whitridge Williams and his opinions about childbirth
as recorded the 1914 book “Twilight Sleep: Simple Discoveries in Painless Childbirth”
