Questions of competence: The midwife debate in The Netherlands in the early twentieth century

Abstract

In the early decades of the twentieth century a "midwife debate" took place in the Netherlands, in a series of discussions on what the future role of the midwife would be and what tasks she should be allowed to perform. The word "debate" is carefully chosen, for while the exchange became vigorous at times, it never reached the proportions of a "problem" or a "controversy". The Dutch were not concerned with such fundamental issues as registration and control of the profession which dominated the often heated disputes preceding the Midwives Acts of 1902 and 1936 in England.1 Such questions had largely been settled, at least on paper. The Dutch debate was in stark contrast to the American "midwife problem", with its sombre consequences for the midwife, the undermining of her economic and professional position, fierce attacks on her abilities, and pressure to oust her from obstetric work.2 The importance of the Dutch midwife and her place in obstetric practice as attendant at normal births were not questioned. However, many of the issues raised in the Netherlands dealt directly with the right of the midwife to perform certain obstetric procedures, the division of labour between general practitioners (artsen) and midwives, and potential earning power. The debate was of great significance in consolidating the midwife profession and for the future of obstetric care.

An examination of the historical context of interprofessional collaboration in Dutch obstetrical care

“…In the nineteenth century, autonomous midwifery practice was heavily curtailed in several western countries, but the discussion in the Netherlands had a different focus (Marland, 1995). Here, the discussion was not about the continued existence of the midwife since the role of the midwife in ''normal'' deliveries was firmly entrenched due to the early introduction of legislation governing the obstetrical professions, the institutionalization of midwifery training and the low rate of hospital births (Lieburg, 1989), In contrast, the discussion centered on the role of the midwife in complicated childbirth.…”

“…Until 1955, the midwife and the GP were the main professions involved in the majority of obstetrical care and both professions struggled to make a living from obstetrical practice and openly competed for posts and clients (Marland, 1995). The third profession involved in obstetrical care, the obstetrician, had a monopoly over specialized care and clinical operative or medical intervention.…”

“…Nevertheless, the obstetrician was sometimes summoned to the house of the woman in labor for instrumental intervention. Given a lack of overlap of scope of practice, obstetricians did not feel threatened by midwifery practice and, in fact, played a significant role in enhancing the quality of midwifery training and often were allied with midwives in their competition with the GPs (Marland, 1995).…”

De rol van welvaartsstaten en professies in de Vlaams-Nederlandse verschillen in de organisatie van de zorg voor moeder en kind

“…In Nederland gaat de wetgeving die het takenpakket en de bevoegdheden van de verloskundige omschrijft, samen met de vroege inrichting van een opleiding voor verloskundigen, terug tot in de negentiende eeuw (Vanlieburg & Marland 1989). België 3 -dat toen deel uit maakte van de Nederlanden -stond onder hetzelfde bewind en kende dezelfde ontwikkelingen (Marland 1995).…”

“…De bevoegdheid van vroedvrouwen om autonoom normale bevallingen te begeleiden, zoals bepaald in de wet van 1818, werd bevestigd in de wet van 1885, na de onafhankelijkheid (Marland 1995). In de vroege 20ste eeuw deed zich in Nederland een debat voor over de competenties van de verloskundigen.…”