Nicole Yingling
CPM, LM

"I know midwives were a thing 'in-the-olden-days,' but it's different now..."

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From ancient and Biblical times, women have served other women during birth. Although the written histories are limited, it is widely recognized that this knowledge was passed down generationally. Each continent and people group developed their own style of birth attendant. From birth until the moment of death, these women would serve their community through awareness of the human body, knowledge of plant and herbal remedies, and general health. This is who one would visit when their child had a fever, for broken bones, diseases and wounds. In the West, these women became known as "midwives." To explore a complete timeline, click here.

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​In Europe, especially in the Middle Ages, science, medicine, and faith were considered in conflict with each other. Eventually, the simplest of human conditions were seen as "a curse": moles, baldness, birthmarks, and abnormalities. And, due to the nature of birth - it was thought midwives may have something to do with various body differences. It didn't take long for midwives to be seen as the cause for all other childbirth related misfortunes. Miscarriages, pre-eclampsia, stillbirths, bleeding, and early childhood death were seen as curses placed on individuals or families by those present at the time of birth. Superstition was rampant. At this time, ensuring royal bloodlines was critical to European monarchy.  In 1486, German Catholic clergyman wrote "Malleus Maleficarum" - a sort of handbook for understanding the handiwork of demons and anyone who may be partnered with them. Midwives were listed as suspect. This led to an eruption of persecution against midwives. And, is likely the reason why some define midwives as witches still today. Doctors during this time were required to be males and rarely attended births. So, they were allowed to develop skill, prestige, and were not targeted. Not so for the midwives. For the next several hundred years, midwives teetered between being adored by her community or scorned by royals and the priesthood. By the time Europe expanded into the Americas and the world, midwives were being regulated by the government and the Church under the supervision of their male counterparts. This power dynamic remained fairly contained in Europe. However, in colonies, the dynamics made an even darker turn for the worse. ​

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Colonial America's relationship with midwives was a mixed bag. It is understood that a midwife served at three births upon the Mayflower's sail. On one hand, some were held in high esteem and found local communities appreciated their skill. On the other hand, due to European opinions and Puritanical perceptions, others were considered a necessary evil. By the rime of the American Revolution, black and white, free and slave midwives were usually compensated, even by Washington. Ethnic backgrounds from Africa and other continents being brought into the colonies, as well as Native Americans, still maintained their own midwifery practices and traditions. For the most part, birth among these people groups was secure in the role of their midwives. Soon, it became convenient to assign the role of midwife to slaves, especially in the Southern states. Midwifery work requires inconvenient work hours, it can be a sweaty and gritty process. This environment wasn't considered proper for wives of prominence and means. Slaves, however, were considered of more value should they be taught the profession. ​​During the 18th century, male doctors in the States began pressing those in political power to create restrictive regulations against midwives. Unlike the Americas, Europe created avenues to incorporate midwives into the wider circle of community health. Interestingly, in the late 1800's this led to better birth outcomes for continental Europe. By the time the Civil War had ended, midwifery work was reserved for slaves, the Natives, the very poor, or the newest of immigrants. This social construct developed into a symbol of status - those higher in status were served by obstetricians, and lower status by midwives. The only exception to this were a budding group of nurse-midwives. Nursing is a needed profession in times of war; and America had seen its fair share. Historically, men had served as nurses in American wars. This changed during the Civil War era. Female nurses were able to gain respect from the larger medical community. Eventually, this lead to the start of midwifery nurse-led schools and practice. Emancipation meant previously enslaved midwives were able to serve the local community at less cost than local physicians. The decades between the Civil War and the 1950's witnessed a steady growth in the numbers of midwives. In the South, thousands throughout each state served all communities and races. That is, until regulatory agencies and newly organized physicians joined forces. ​

 

Ellis Island welcomed wave-after-wave of immigrants who eagerly embraced all things industrial, modern, and American. America's industrial age was in full swing. Factories, productivity, efficiency - each important concepts to the industrial age were praised. These concepts were embraced by the medical and hospital establishments of the early 19th century. Yet, birth is not (always) efficient. It cannot produce at factory speed and with "cookie-cutter" precision. As far as modern obstetrics was concerned, it was worth a shot! More surgical procedures, tools, and protocols were developed forming a birth industry mirroring the new age. Hospitals in large cities were struggling to meet the demands of booming populations. Not to mention the rise in viruses and disease. The larger medical community, including obstetrics, needed support nation-wide in order to raise funds and backing to produce larger and more efficient hospitals. It was no longer efficient to send health care into a home. No. It was far more efficient to build large facilities for large cities. Before long, birth itself was seen as inefficient.

"Twilight Sleep" a cocktail of medications used to put women under in labor, was developed in 1914. The early woman's liberation movement saw this as benefit to women - no need to suffer in pain! Yet, due to the reaction to medication women weren't able to push their own babies out. Forceps deliveries became the norm. Along with that, there was not to be an eating in labor (one could vomit when using these gasses), and babies couldn't be held after the birth by a mother who was recovering from such drugs. The answer? The nursery. Hospitals in the United States developed protocols requiring mother-baby separation in hospitals.

Initially, in the late 19th century, American hospitals saw an increase in maternal and infant mortality. In the next century, major advancements in medicine improved mother and infant death rates from 1900-1980. These included, "maternal and infant welfare services, including prenatal, natal, and postpartum home visits by health-care providers,...prenatal-care programs to educate, monitor, and care for pregnant women... use of antimicrobial agents (e.g., sulfonamide in 1937 and penicillin in the 1940s) and the development of fluid and electrolyte replacement therapy and safe blood transfusions accelerated the declines in infant mortality; from 1930 through 1949, mortality rates declined 52% ." In the later part of the 20th century, improvements concerning prematurity continued to improve infant mortality. Initially, "home visits" included midwives. However, with time, the medical system turned to large hospitals to take care of these services and midwives were pushed out of the circle. Instead, by 1950, the American College of Nurse Midwives together with hospital administrators championed the development of childbirth education.  ​Midwives were not welcomed by such an efficiency driven system.

Due to the status and social constructs in place, the medical community, media, and state regulating and legislating agencies rallied together to suppress and eliminate midwifery practice. As early as 1906, newspapers labeled midwives as "uneducated, dirty, and incompetent." Regulations increased by unobtainable leaps and bounds. Often, midwives were made aware of changes to regulations only after charges were placed against them. And, those reporting midwives were hospitals and obstetricians seeking their elimination. Modern medicine was the American answer to all the woes of childbirth. In 1900, less than 5% of American women gave birth in hospitals. By 1980, 80% of babies were born in a hospital in America. That same year, midwives attended 1% of all American births. The American industrial age had changed American birth. And the midwives of the South, the immigrants, and those who managed to still serve their communities? They were regulated, made to pay increasing costs, they faced new laws and restrictions. prosecution and jail time. By the 1960's only a few dozen of midwives remained. (https://www.midwiferytoday.com/web-article/history-midwifery-childbirth-america-time-line/) ​

 

 

The 1960's and 70's brought a deep questioning of many systems in American culture. Eventually, families began to question birth practices - "why can't the father attend? do I really need to be drugged?" along with a resurgence of confidence in the body's natural ability. Birth classes were created to rekindle awareness regarding how normal a process birth could be when supported by education and practical techniques. During these years, midwives emerged from the hippie movement (like those at The Farm in Summertown Tennessee) and, eventually, merged with nurse-midwives as well as traditional midwives throughout the United States. These groups of informed and motivated midwives collaborated and created the organizations which were foundational to establishing modern midwifery programs in the United States. These include Midwives Alliance of North America, North American Registry of Midwives, and American College of North Midwives. American Association for Birth Centers. A new awareness and intrigue was born. And, families wanted to reclaim their place in welcoming the newborn. The medical community was of mixed opinion. While the benefits of unmedicated birth were plain to see, the mindsets and protocols in place are hard to change and those systems largely remain in place today.

 

Today, midwives and home birth, has resurged with growing numbers of Certified Professional Midwives attending most births. Nurse midwives are found in every state and also attend home births. As of 2022, 12% of babies born in the United States will be born at home. ​ ​​