Midwifery in the United States and other developed nations
Childbirth is an event traditionally attended by other women, especially those close to the birthing
mother who have experience in giving birth as well as assisting others. However, in the early 20th
century, midwife involvement dropped to 50% of births (Dawley, 2003). This was a time when doctors
were emerging into the medical field and began placing the blame on midwives for America’s high
mortality rate. However, later studies showed that mortality rate among physicians were much higher
than that of midwives (Dawley, 2003). There were also factors that were overlooked while condemning
these women. The lack of knowledge about bacteria and germs had detrimental effects. One of the
leading causes in death in 1900 was childbed fever, in which infection was spread in hospitals when
doctors would treat sick individuals before tending to women in labor without washing their hands
(Block, 2007). Traditional midwives were typically immigrants or African Americans. Doctors planted fear
in the minds of many people, by stigmatizing these women as dangerous, dirty, barbaric, and ignorant and
racism was employed as the strong belief in eugenics aided in this widespread fear (Dawley, 2003; Harper, 2005).
Around this time, many nurses wanted to be educated in childbirth but were put down by male doctors.
Mary Breckinridge founded the first nurse-midwifery, and nurses were eventually allowed to practice, though
their work was overseen by physicians (Dawley, 2003). This was a huge blow to the practice of traditional midwives.
Healthcare increased during WWII, as well as an increase in hospitals and the education of nurse-midwives.
The maternal mortality rate also decreased and it was attributed to the increase in hospitalization, though this
was also when the importance of sanitization emerged(. Medicalization emerged through the increase of technology.
Forceps were invented and chloroform was introduced. Men used tools, which were only to be used by men at
the time, and drugs to maintain a sense of authority, as midwives had to rely on male specialists for difficult births.
Twilight sleep, first used in Germany and popularized in America during the 1940s, was a combination of morphine
and scopolamine given so women would not remember their birth, with serious side effects such as hallucinations
(Harper, 2005). The conditions in which these women gave birth seem so horrid that it would make one wonder why
any woman would choose these options. Women used to be told by the Church that their womanly suffering was
punishment for the sins of Eve and when these pain relievers came out, suffragists took this as an opportunity to
exercise their independence and rallied for choice (Harper, 2005). Demerol, Stadol, and Pitocin are just a few of the
drugs that replaced previous pain relievers. According to statistics in the 1990s, epidurals are used in 80% in hospital
births and episiotomy in over 90%, while currently, the U.S. holds one of the highest cesarean rates at 33% (Davis-Floyd, 2009).
These conveniences were created mainly for doctors. Drugs are used to speed up birthing as there are time limits for
hospital rooms. The lithotomy position makes it easier for doctors but much more difficult for the mother and baby.
Due to these changes in childbirth, women feel a strong sense of fear to have a baby, their sense of control is transferred
from herself to her doctor, and she comes to accept that her body is not normal.
Midwives now attend 10-12% of births, 95% of who are certified nurse midwives (CNMs), who are accepted by ACOG and
usually work in a hospital setting(Harper, 2005; Rooks and Ernst, 1999). Certified professional midwives (CPMs) are
prohibited in 11 states and can be criminalized for practicing (Block, 2007). The slow emergence of midwifery in Canada,
recent supportive legislation in New Zealand, restrictive government reforms of Australia, and birthing model of the
Netherlands show the dire importance of support for choice.
Some reasons why women are starting to choose midwives and homebirths include the idea that it is woman-centered
and are given choices and control over the decisions of their birthing experience (Parry, 2008). Midwives strive to care
for the mother’s well-being before, during and after pregnancy with the assumption that childbirth is normal with interventions
only being used if it is necessary. Also, the family is included and encouraged to participate in the experience. Midwives
screen their clients and “high-risk” women are referred to obstetricians who are trained for complications. However, most
women are “low-risk” and unnecessary interventions on the natural process of childbirth disregards a woman’s sense of
empowerment, which can be enormous when given this control over their bodies and should not be.
References
Block, J. (2007). Pushed. Cambridge, MA: Da Capo Press.
Buitendijk, S. (2011). Gender Issues in Determining the Service and Research Agenda for Pregnancy and Birth Care:
the Case of Home Birth in the Netherlands. Interdisciplinary Science Reviews. 36(2): 193--202.
Davis-Floyd, R. E. 2009. Gender and ritual: giving birth the American way. In: Gender in Cross-Cultural Perspective,
5th edition. Brettell CB and Sargent CF, editors. Pearson/Prentice-Hall
Davisa, D. and Walker, K. (2010). The corporeal, the social and space/place: exploring intersections from a midwifery
perspective in New Zealand. Gender, Place and Culture. 17(3):377--391.
Dawley, K. (2003). Origins of Nurse-Midwifery in the United States and its Expansion in the 1940s. Journal of Midwifery & Women’s Health. 48(2): 86-95.
Demand for homebirth increases as Government abandons women and babies - Media Release. (2011, Oct 26).
Homebirth Australia. Retrieved from http://homebirthaustralia.org/
Harper, B. (2005). Gentle Birth Choices. Rochester, VT: Healing Arts Press.
Kline, K. N. (2010). Poking fun at midwifery. Women and Language. 33 (1): 53-71.
Parry, D. C. (2008). “We Wanted a Birth Experience, not a Medical Experience”: Exploring Canadian Women’s Use
of Midwifery. Health Care for Women International. 29:784--806
Rooks, J. P. and Ernst, E. K. M. (1999). The Future of Midwifery. International Journal of Childbirth Education. 14 (4): 16-21.
Childbirth is an event traditionally attended by other women, especially those close to the birthing
mother who have experience in giving birth as well as assisting others. However, in the early 20th
century, midwife involvement dropped to 50% of births (Dawley, 2003). This was a time when doctors
were emerging into the medical field and began placing the blame on midwives for America’s high
mortality rate. However, later studies showed that mortality rate among physicians were much higher
than that of midwives (Dawley, 2003). There were also factors that were overlooked while condemning
these women. The lack of knowledge about bacteria and germs had detrimental effects. One of the
leading causes in death in 1900 was childbed fever, in which infection was spread in hospitals when
doctors would treat sick individuals before tending to women in labor without washing their hands
(Block, 2007). Traditional midwives were typically immigrants or African Americans. Doctors planted fear
in the minds of many people, by stigmatizing these women as dangerous, dirty, barbaric, and ignorant and
racism was employed as the strong belief in eugenics aided in this widespread fear (Dawley, 2003; Harper, 2005).
Around this time, many nurses wanted to be educated in childbirth but were put down by male doctors.
Mary Breckinridge founded the first nurse-midwifery, and nurses were eventually allowed to practice, though
their work was overseen by physicians (Dawley, 2003). This was a huge blow to the practice of traditional midwives.
Healthcare increased during WWII, as well as an increase in hospitals and the education of nurse-midwives.
The maternal mortality rate also decreased and it was attributed to the increase in hospitalization, though this
was also when the importance of sanitization emerged(. Medicalization emerged through the increase of technology.
Forceps were invented and chloroform was introduced. Men used tools, which were only to be used by men at
the time, and drugs to maintain a sense of authority, as midwives had to rely on male specialists for difficult births.
Twilight sleep, first used in Germany and popularized in America during the 1940s, was a combination of morphine
and scopolamine given so women would not remember their birth, with serious side effects such as hallucinations
(Harper, 2005). The conditions in which these women gave birth seem so horrid that it would make one wonder why
any woman would choose these options. Women used to be told by the Church that their womanly suffering was
punishment for the sins of Eve and when these pain relievers came out, suffragists took this as an opportunity to
exercise their independence and rallied for choice (Harper, 2005). Demerol, Stadol, and Pitocin are just a few of the
drugs that replaced previous pain relievers. According to statistics in the 1990s, epidurals are used in 80% in hospital
births and episiotomy in over 90%, while currently, the U.S. holds one of the highest cesarean rates at 33% (Davis-Floyd, 2009).
These conveniences were created mainly for doctors. Drugs are used to speed up birthing as there are time limits for
hospital rooms. The lithotomy position makes it easier for doctors but much more difficult for the mother and baby.
Due to these changes in childbirth, women feel a strong sense of fear to have a baby, their sense of control is transferred
from herself to her doctor, and she comes to accept that her body is not normal.
Midwives now attend 10-12% of births, 95% of who are certified nurse midwives (CNMs), who are accepted by ACOG and
usually work in a hospital setting(Harper, 2005; Rooks and Ernst, 1999). Certified professional midwives (CPMs) are
prohibited in 11 states and can be criminalized for practicing (Block, 2007). The slow emergence of midwifery in Canada,
recent supportive legislation in New Zealand, restrictive government reforms of Australia, and birthing model of the
Netherlands show the dire importance of support for choice.
Some reasons why women are starting to choose midwives and homebirths include the idea that it is woman-centered
and are given choices and control over the decisions of their birthing experience (Parry, 2008). Midwives strive to care
for the mother’s well-being before, during and after pregnancy with the assumption that childbirth is normal with interventions
only being used if it is necessary. Also, the family is included and encouraged to participate in the experience. Midwives
screen their clients and “high-risk” women are referred to obstetricians who are trained for complications. However, most
women are “low-risk” and unnecessary interventions on the natural process of childbirth disregards a woman’s sense of
empowerment, which can be enormous when given this control over their bodies and should not be.
References
Block, J. (2007). Pushed. Cambridge, MA: Da Capo Press.
Buitendijk, S. (2011). Gender Issues in Determining the Service and Research Agenda for Pregnancy and Birth Care:
the Case of Home Birth in the Netherlands. Interdisciplinary Science Reviews. 36(2): 193--202.
Davis-Floyd, R. E. 2009. Gender and ritual: giving birth the American way. In: Gender in Cross-Cultural Perspective,
5th edition. Brettell CB and Sargent CF, editors. Pearson/Prentice-Hall
Davisa, D. and Walker, K. (2010). The corporeal, the social and space/place: exploring intersections from a midwifery
perspective in New Zealand. Gender, Place and Culture. 17(3):377--391.
Dawley, K. (2003). Origins of Nurse-Midwifery in the United States and its Expansion in the 1940s. Journal of Midwifery
& Women’s Health. 48(2): 86-95.
Demand for homebirth increases as Government abandons women and babies - Media Release. (2011, Oct 26).
Homebirth Australia. Retrieved from http://homebirthaustralia.org/
Harper, B. (2005). Gentle Birth Choices. Rochester, VT: Healing Arts Press.
Kline, K. N. (2010). Poking fun at midwifery. Women and Language. 33 (1): 53-71.
Parry, D. C. (2008). “We Wanted a Birth Experience, not a Medical Experience”: Exploring Canadian Women’s Use
of Midwifery. Health Care for Women International. 29:784--806
Rooks, J. P. and Ernst, E. K. M. (1999). The Future of Midwifery. International Journal of Childbirth Education. 14 (4): 16-21.