Midwives in the United States: past and present

Abstract

The main focus of the present paper is to place the current occupation of certified nursemidwife (CNM) within the historical context of the decline of lay midwifery and the rise of the medical profession. The development and growth of nurse-midwifery is documented, as well as current problems facing the profession. The most salient contemporary issue is cancellation of malpractice insurance for 1400 CNMs in 1985. The consequences of this, and suggested policy changes, are explored. Midwives in the U.S.: past and presentIn colonial America the midwife's post was one of the most important in the community. Since it was beneath the dignity of male physicians to act as obstetricians, women had a virtual monopoly over the practice (Packard, 1963: 53). Our first midwives were European women who emigrated to the colonies. These women undoubtedly practiced in Europe and transported their skills to the New World (Thoms, 1961: 3). Yet, rigid role expectations for women of the period prevented extension of the practice of midwifery beyond simple deliveries, and if the bii:th was in any way atypical, midwives were blamed for the complications.In spite of the danger of blame and punishment for difficulties, deaths, or birth defects which were encountered at the time of delivery, midwives did deliver the majority of babies born at this time. Midwives were rather well thought of and prominent members of the community. Thorns (1960: 10) reports how the Widow Bradley in 1655 was furnished with a house and lot rent-free in New Haven as long as she continued her services as a midwife. Other midwives received houses, money in the form of a yearly stipend, tobacco, or other gifts as support and in exchange for their services. In general, midwives were greatly respected and had strong relationships with their patients. They frequently participated in baptisms or the burial of infants, and women with gynecological problems would tell midwives things they would be reluctant to tell a doctor. In addition, midwives testified in court cases involving bastardy, verified birth dates, and examined female prisoners who had pleaded pregnancy to escape punishment (Scholter, 1977: 440).

The Social Construction of Deviance, Conflict and the Criminalization of Midwives, New Orleans: 1940s and 1950s

“…The job of Certified Nurse-Midwife (CNM) evolved as the role of the lay midwife declined, but CNMs were unable to truly compete with physicians, in part because of a loss of malpractice insurance. Nearly 1,500 CNMs in the United States had their malpractice insurance cancelled in 1985 (Radosh 1986). That said, traditional midwives may have suffered more than CNMs, even in the 14 states where traditional midwifery was clearly legal as of the mid 1990s.…”

The History of Midwifery in the United States

“…5 Despite the lack of formal training, midwives could have extensive knowledge of herbal remedies and how to manage many pregnancy and non-pregnancy-related ailments. 5 In the colonized areas of what would become the United States, early midwifery was provided by practitioners that were trained in their respective home countries 6 and undoubtedly passed their trade on to new generations of midwives. While some localities required midwives to be licensed in the early 18th century, lack of physicians allowed midwifery to thrive.…”

“…However, in Europe, men entered the field of midwifery, which in turn brought man-midwives to the colonies. 6 In the mid-18th century, a physician opened the first midwifery school in the colonies, admitting both women and men. Just a few years later, the first medical school opened in the colonies as well, leading to an increase of available physicians-generally men.…”

“…Just a few years later, the first medical school opened in the colonies as well, leading to an increase of available physicians-generally men. 6 The medical schools claimed that physicians provided safe(r) care compared to midwives, leading to more affluent families seeking out physician over midwifery care, slowly drowning out midwifery. 6 And since a midwife's social status was dependent on the status of the community they served, 5 this also led to a decrease in midwifery's social standings.…”

“…Hence, starting in the 20th century midwives were depicted as untrained, dirty, and dangerous despite the fact that trained midwives objectively had better birth outcomes than many physicians. 6 Nevertheless, the promise of safer and maybe less painful birth pushed those that could afford it to follow physicians to hospitals. Midwifery continued to serve poor and rural populations that neither had the means nor access to hospitals.…”