Supervision of Midwives ~ Journal of the American Medical Association ~ Jan-June 1907

The Journal of the American Medical Association
Volume XLVIII  January-June 1907
Edited by George H. Simmons, M.D.

Miscellany

Supervision of Midwives

In February, 1906, an investigation of midwifery practices both abroad and in this country was undertaken in New York City by a body of representative men and women. The results of this investigation are given by Miss F. E. Crowell, assistant secretary of the New York state branch of the Public Health Defense League, in Charities and the Commons, Jan. 12, 1907. Miss Crowell begins her article by a brief review of the history of midwifery, which she states is as old as the human race. During thousands of years the care of parturient women was practically in the hands of midwives. If an unusual or dangerous complication arose a physician was called to assist in the delivery, but the process of labor was considered a natural, normal occurrence, requiring no interference or aid except that to be obtained from women experienced in this work.

Gradually as medical science developed and the art of obstetrics was taken up by physicians, the midwife, while she did not actually retrogress, at least stood still. Universities were closed to her and opportunities for improvement were denied, with the inevitable result that midwifery ceased to be regarded as a profession and there was a lowering of the standards which had hitherto prevailed among women who had devoted themselves to this calling. The introduction of the forceps gave physicians an advantage, and in the seventeenth century, in France, it became fashionable to employ a physician instead of a midwife. The women of the masses, however, have continued to demand aid from their sister women, and economic conditions have kept alive the calling of the midwife till to-day.

Early in the nineteenth century Europe seems to have accepted the fact that midwives constituted an inherent part of the social order—a force to be guided and controlled, rather than ignored and opposed. As a result, many European countries provided for the examination and licensing of these women; England alone refused to enact legislation affecting midwives till 1902. To-day the training and duties of midwives are practically the same in all European countries. They are admitted to lying-in asylums for poor women and are taught cleanliness and the physiology of labor theoretically as well as practically. The European midwife is under supervision during her entire lifetime. Her equipment is inspected, she is prosecuted in case of neglect, and for neglect her license may be revoked.

In this country little supervision is exercised over these women; in some states they are compelled to take an examination. In New York, Miss Crowell states that the majority of midwives are ignorant, untrained women who find in the natural needs and prejudices of the parturient women of their race a lucrative means of livelihood.

In the investigation 500 women were visited, and of this number 51 were unable to read or write, while 30 per cent. were unable to speak English. Two hundred and one held foreign diplomas. This means that 40 per cent. of the number had been properly trained and had given evidence of certain required standards of proficiency. Forty-three per cent. held diplomas from so-called schools of midwifery in this country, or certificates from physicians, who, says Miss Crowell, for reasons best known to themselves, have in many instances seen fit to certify to the proficiency of ignorant, incompetent women.

Of the 500 women visited Miss Crowell states that less than 10 per cent. could be considered capable, reliable women. In some cases Miss Crowell found that the diplomas from American schools had been given to women who could neither read nor write, but who had the price—$66. There are four such schools in New York City, she states. Midwives holding these diplomas told Miss Crowell of being sent to their first case alone, of having to conduct the entire labor as best they could, and of their fear that they might, on their return, find the patient dead. The bags and equipment of the majority of these women, Miss Crowell says, would make fit decorations for a chamber of horrors. Rusty scissors, dirty string, a bit of cotton, a few corrosive tablets, old rags and papers, some ergot and vaselin, and a gum catheter, wired, were the usual contents.

Many of the women had complete portable sterilizers which they had been compelled by law to use in Europe, and when asked why they did not use them here, replied: “It is not necessary; nobody cares what we use; the bag is handier, and everyone uses it here.”

Some women who had no bags carried string in their pockets and scissors attached to their belts, or would depend on whatever they chanced to find at the patient’s home. Of the entire 500 visited, Miss Crowell states that less than 10 per cent. could be qualified as competent midwives. A few women were found who washed the child’s eyes with boracic acid, and a still more limited number who used the silver nitrate prescribed by the board of health.

Miss Crowell also calls attention to the evils of allowing a midwife to sign a death certificate in the case of a stillborn child. It is impossible to estimate, she says, how many of these cases are actually stillbirths and how many the result of criminal interference with pregnancy [i.e., abortion]. Nearly all the midwives visited carried wired catheters, showing that they were in the habit of interrupting pregnancy, while some carried uterine curettes, dilators, pessaries, etc.

In New York state there is special legislation regulating the practice of midwifery applying to Erie, Monroe, Niagara and Chautauqua counties, but Miss Crowell found that while this law has operated toward raising the standard of efficiency among midwives in those sections of the state, the enforcement of the limitations under which the licenses are granted is entirely neglected. In proof of this statement Miss Crowell relates interviews with some Buffalo midwives, whose obstetric bags were quite as dirty as that of the average New York midwife.

The Journal of the American Medical Association
Volume XLVIII  January-June 1907
Edited by George H. Simmons, M.D.