The following article was written by Jennifer Stover, current president and founding member of the Birth and Baby Resource Network, for the Women's Press. The original online published version can be found here. The history of American midwifery is a long one. Please take a moment to read on, and learn a little about the road our midwives have traveled.
Midwifery; a David
and Goliath Tale
By Jennifer Stover
The
story of midwifery in America is a classic power struggle for women’s rights,
respect and choice; a tale of the clash of women’s culture and values with the
male dominated spheres of science, medicine and finance. It is an ugly story
laced with racism and class war fare. This struggle continues to walk the halls
of political power and sits in insurance industry board rooms today.
It
began as the eighteenth century was drawing to a close and the science of
medicine was on the rise. Men for the first time began to move deeply into the
privacy of the birth room, a place that in most cultures around the world is
traditionally populated almost exclusively by women. This slow and determined
encroachment into what had previously always been a woman’s world began the
battle.
Before
men became involved American midwives had always held a place of respect within
their communities. Their skill at helping women during the birth process was of
vital importance to all in the community. Women were encouraged to stay mobile
as long as possible during the birth, the pain of the process was recognized
but not believed to be insurmountable, the passage of time was noted but there
were no standardized graphs labors had to abide by, and women utilized up-right
physiologically sound positions for pushing a baby out.
When
male doctors took over this all changed. Pain relieving drugs were used as an
inducement to have doctors attend women’s births. These medications changed the
balance of power forever; stripping the woman’s innate abilities. She became an
object to practice medicine upon; someone who needed her baby delivered to her
like a pizza instead of using her own physical power to bring her baby forth.
Soon untested scientific “theories” blended with necessities created by using
pain medications and women were routinely being cut and babies were being
pulled out with forceps.
As
the prestige of the medical profession rose, so did their power. In the end it
came down to dollars and cents. In order to corner the market doctors began a
campaign to stamp out midwifery. First they created a belief that birth was a
medical event which could only be safe if attended by a physician. Doctors
traveled in the upper circles of society. They convinced bankers, lawyers and
other prominent society men to avail themselves of the best that the science of
modern medicine could offer for their wives by using a physician. Men
controlled the medical schools and women were not allowed to attend so female
care providers slowly began to die out. In the early twentieth century not
satisfied yet, they convinced the government to begin a propaganda campaign
slandering midwives as dirty, illiterate, and ignorant. Eventually only
poor women or newly arrived immigrants were still turning to midwives for care.
Meanwhile
another huge shift in health care in our country was taking place. Hospitals
were on the rise, with their bureaucracies, standardizations, schedules and
sanitization of birth. Women were told it was best when labor began to leave
their homes, where they had some control, and travel to a hospital, where they
had no control. Hospitals lead to the
immediate separation of the newborn from its mother and scheduled feedings.
These disruptions in the process along with the drugs created babies who could
not suck effectively, needing to be force fed from bottles. Soon the women of America
thought their bodies were so defective they couldn’t even breastfeed their own
children. Meanwhile the practice of midwifery was outlawed in most states.
But
it’s hard to hold good women down. It is hard to stop women from answering the
call to serve women; especially women in need. In the 1920’s nurses began to
step forward to get additional training in the skills required to help low
income women, the rural and urban poor. These were women who couldn’t pay
doctors and hospitals, therefore providing them care did not threaten the
medical establishment’s monopoly. They eventually founded specialized nurse
midwifery schools and associations. From this branch was born the certified
nurse midwife. In the 1960’s couples living on communes had turned their backs
on many forms of the “establishment”. These female rebels began to birth their
babies at home with the help of other women in their communities. The daring
women who answered this call eventually became highly trained homebirth
midwives. It took courage to be a midwife, to practice midwifery without a
license. Not only could you lose everything, your home and your practice, you
could be thrown in jail. In our county one traditional midwife was brought up
on charges of second degree murder in 1978. Over time this branch of midwifery also
adopted standards for training, created associations and worked hard to become
legal once again. In California
the legal battle culminated in 1993 in the creation of a system to license out
of hospital midwives but it took 4 more years for the first group of midwives
to be licensed by the state medical board.
All
midwives are still fighting for the right to work as autonomous, respected
members of the birth provider community. Whether they are CNMs who have made
the choice to work in a doctor’s practice under his supervision because even if
they could find a company willing to cover them medical malpractice insurance
is prohibitive, or the LMs who can’t get insurance company’s to reimburse their
clients for basic care the struggle continues. The California Medical Board is
currently reviewing whether to change the language in the regulations governing
LMs to allow them to order the life saving medications and tools they need to
attend birthing women. And so the struggle continues.
To learn more about the history of midwifery:
A Midwife’s Tale; Martha Ballard her Diary by Laurel Thatcher Ulrich
Motherwit: an Alabama Midwife’s Story by Onnie Lee Logan
Listen to Me Good: the Life Story of an Alabama Midwife by Margaret Charles Smith
Birth Matters: a Midwife’s Manifesta by Ina May Gaskin
A Short History of Midwifery: http://midwifeinfo.com/articles/a-short-history-of-midwifery.
I am a Midwife, a movie by the Midwives Alliance of North America: http://www.youtube.com/watch?v=iIl6VnjQjJ8
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