Modern Midwifery: History, Politics & Activism, Research Paper Example

Introduction

Through love and hate, through sky and the ground, through war and political manner, women gave birth and healed. In the United State of America, especially in the South, women assisted one another with giving birth in the home lading up the 19th century. The time frame 1800-1900 marked the era of slavery. This era marked a huge shift in the country structure and the jurisdictions. The slaves were the healers bringing with them the skills to handle manual labor and the traditions of childbirth. Prior to the 1800, the healthcare and the medicine started moving toward a higher level of professionalism in medicine and advanced quality of care. Hospitals were being built and medical schools designed to train physicians. With an increase in mortality and infant mortality, midwives/ traditional birth attendants were claimed to be unsafe and incapable for safer birth. Thus the physicians were recognized as being a safer option to the midwife. This moved the birthplace and the attendants from home to hospital and from midwives to physicians. Few territories/ states freed their slaves, yet the majority sustained slavery and inequality, leading to civil war in 1861, which ended in 1965. During the time period between 1800 and 1900, midwifery as a practice developed and evolved in a variety of ways. It was shaped by the social prejudices and politics of the era. The following attempts to identify how these social and political forces most affected women, childbirth, and midwifery at the time.

Body

Racism in Midwifery

Physicians were becoming wealthier and being integrated into middle- and upper-class societies. Prejudice against the intelligence and capability of women, immigrants, black people and poor people was used to defame midwifery (Holmes, 1986). Midwives were not in a position of power; they made relatively little money, were not organized and did not see themselves as professionals. As Tunc (2010) notes in his study on the relationship between the mistress, the midwife, and the medical doctor, “evaluating such a complex collection of relationships entails breaking down numerous layers of social interactions, which include white and black mothers and their shared cultural experiences as beings that can reproduce” (Tunc, 2010). The author attributes the complexity of the relationship to the shared femininity between black and white women and the racial conflicts imposed on that relationship in the Antebellum South. Tunc notes that power played a significant role in this relationship between enslaved caretakers, slave?midwives, and the way white plantation births were handled. This was primarily due to developments that occurred within the “patriarchal, or antiquated, medical profession” (Tunc, 2010) and how it implemented barriers gradually to divide white women from their antebellum black midwives. Many of the childbirth and pregnancy conflicts that arose during the antebellum American South between 1800 and 1860 shaped the view of midwifery today and its view within the mainstream healthcare industry as a less viable option of care.

Midwifery between 1799 & 1860

Between 1799 and 1860, numerous developments occurred that influenced how midwifery would be positioned in America. In 1799, a class for midwives started in New York City. It was run by Dr. Valentine Seaman. However, Dr. William Shippen started a course in anatomy and midwifery in Philadelphia. It was standard during Colonial America for women to routinely provide most medical care in the home. After the War of 1812, medical institutions started using doctors instead of midwives and it became a common practice among the urban middle classes (Fett, 2002). The decline of women in the medical industry is largely attributed to social influences that emphasized women being married and domesticated. In 1817, an institution specifically for the training of midwives was proposed by Dr. Thomas Ewell of Washington, D.C. The school sought federal funding but it was denied.

During the 1830’s and 1840’s, the “Popular Health Movement” rose to prominence and sustained influence over the course of the century. This movement shaped the way health was regarded as each individual’s responsibility (Fett, 2002). In 1847, Elizabeth Blackwell gained acceptance into Geneva (New York) Medical College, and she eventually graduated at the top of her class. In 1848, three major developments occurred within the field drastically evolving childbirth and how it was viewed and handled within society. It started with The American Medical Association being founded, which enforced medical standards and practices, and then was followed up by Dr. Walter Channing of Boston using ether for humanitarian reasons to induce childbirth (Litoff, 1986). Finally, the discovery of Gold, at Sutter’s Mill on the American River, transformed San Francisco’s economy, establishing it as a major metropolitan area. The economic impact this had on the region would eventually develop medical standards and move child birth out of the home into the physician’s office (Fett, 2002). Much of the socioeconomic transition that occurred, 1840-1890 can be attributed to phase 1 of public health, which is most commonly referred to as a time when “empirical environmental sanitation” emerged (Litoff, 1986).

Midwifery, the Civil War, & Emancipation

The Civil War started in April 1861, the same year as the invention of the telegraph. In 1863, on January 1^st, the Emancipation Proclamation was drafted and issued. With the proclamation President Lincoln declared that slavery was to be abolished.  A year later, in 1864, Elizabeth and Emily Blackwell launched her own medical school specifically for women and it was associated with the infirmary. Other useful bacteriology occurred in surgery. The innovation of antiseptic surgery significantly reduced the mortality from injuries and operations and improved the range of surgical work (Litoff, 1978). Immigration was reduced during and after World War I, but this also limited the supply both of foreign-trained midwives. This group happens to be the most loyal clientele of midwives. This transition made physicians wealthier and introduced them to the middle- and upper-class societies. Prejudice towards the abilities and intelligence of women, specifically immigrants, poor people, and blacks, was used to degrade midwifery. Midwives had limited socioeconomic power. They also made little income. Much of this was attributed to the fact that they were not organized as a community which further enforced the idea they should not be viewed as professionals. Vaccines against typhoid and tetanus were developed. Doctors were among the first to purchase automobiles. Industrialization and urban life also brought an increase in the number of unattached individuals living alone in cities. Urban growth led to higher property values, forcing many families to abandon private homes for apartments in multi-family dwellings, which limited their ability to set aside rooms for the sick or those in childbirth.

Developments between 1850 and 1930

Near the end of the 1800’s leading into the early 1900’s, there were many milestones that occurred, which consolidated physician authority. There were also a variety of changing social beliefs and values that reinforced the mainstream medical industry’s claim to authority. The role American hospitals had in society grew to be dramatically more significant in the early 1900’s than they were in the previous century. The process of medical licensing to control education as a part of medical professionalization and the monopolization of the industry could first be seen in the 1870’s in a showdown regarding homeopathy, the American Medical Association no longer allowed physicians who were homeopaths to remain in orthodox societies. In 1870, Congress approved a charter for a homeopathic medical society in Washington, D.C., but in 1873, three training schools for nurses were established in New York. This furthered the push for professionalization of nursing and advanced tendencies toward order and cleanliness in medical practices. Between the 1870s and 1880s, a common support for the restoration of medical licensing was sought among all the competing groups. Then, between 1890 and the 1920’s, Phase 3 of hospitals was implemented when the advent and spread of profit-making hospitals took place. Operated by physicians singly or in partnership as well as by corporations, the hospitals’ large growth was due in part to the new potential for profit from surgery. The revenues produced by this shift created a monopoly within the industry compared to the market share held by homeopathic institutions.

Modern Barriers

Even though there have been a range of favorable laws passed in recent years to support midwifery, it is still very difficult for midwives to gain direct entry into the profession as it is still considered illegal in a large number of states. Current regulations and policies that enable midwives to have direct entry into the field include the new MEAC and NARM processes which are competency based apprenticeship neither requires completion of a specified number of years of formal professional education or requires an academic degree (Feldhusen, 2000). The problem is that Americans tend to associate an “apprenticeship,” like MEAC and the NARM, with the training required for a trade or a craft, as opposed to a profession. As the MEAC and NARM certifications, and accreditations that supports them, are new within the industry, they have not been met with a positive response. Feldhusen (2000) notes that, “there is very little reliable data about direct-entry midwives and their practice. It is impossible even to state with accuracy and confidence either the number of direct-entry midwives who are practicing or the number of births they attend” (Feldhusen, 2000). In the past 15 years this negative perception of midwives has only increased with greater criticism and isolation imposed on their positon within the mainstream healthcare industry. Such laws that attempted to provide further support to Midwives, like the 1994 The North American Registry of Midwives (NARM) which offered the very first ever written examination to test the knowledge needed for midwives to have safe entry into the practice, were circumvented by policies applied to Medicaid and managed care plans low income women were moved into hospitals. These are the main women who most benefit access to midwives and it resulted in the termination of many midwife programs today due to the fact that CNMs practice different laws from state to state. There are no set criteria or national mandates to enable entry into the practice on a federal level and licensing guidelines vary from state to state. All of this serves as a barrier to allowing skilled midwives from acquiring gainful employment. Meanwhile, “the United States provides the world’s most expensive maternity care but has worse pregnancy outcomes than almost every other industrialized country. Midwives are attending more births—5.5 percent in 1994, compared with 1.1 percent in 1980.The cesarean section rate is falling, from 25 percent in 1988 to 21 percent in 1995” (Feldhusen, 2000). These are daunting numbers and one might assume midwives would gain greater support considering the data, but past laws and prejudices that have limited their success and entry into the mainstream medical profession has made the political push for their place within the healthcare industry very one sided. More research needs to be drafted on the benefits of midwifery and the efficacy compared to the more modern child popular birth method of physician care.

Conclusion

In sum, around the turn of the century, economic changes made families less self-sufficient. Scientific discoveries and the development of more effective treatments led to increased public acceptance of medicine. Automobiles and smooth roads enabled people to have easier access to hospitals. Some city hospitals with enough capital opened prenatal clinics. As medical education and care improved, physicians organized to solidify their status and authority. Urban growth resulted in higher property values, which forced many families to abandon private homes and relocated to apartments. This reduced their capacity to house their sick relatives or those needing prenatal care. In the early 1900s, medical societies provided security against malpractice suits and doctors established alliances with each other, promising to testify on the other’s behalf. Doctors that did not belong to medical societies had difficulty finding insurance. By the early 1900’s, physicians were attending about half the nation’s births, including nearly all births to middle- and upper-class women. Midwives took care of women who could not afford a doctor, and during this period less than 5 percent of women gave birth in hospitals.

References

Feldhusen, A. E. (2000). The history of midwifery and childbirth in America: A time line. Midwifery Today, 27.

Fett, S. (2002). Working Cures: Healing, Health, and Power on Southern Slave Plantations. Chapel Hill: University of North Carolina Press.

Fraser, G.J. (1998). African American Midwifery in the South: Dialogues of Birth, Race, and Memory. Boston: Harvard University Press.

Holmes, L.J. (1986). Chapter 11: African American midwives in the south. In P. Eakins (Ed.) The American Way of Birth. Philadelphia: Temple University Press.

Kennedy, V.L. (2010). Born Southern: Childbirth, Motherhood, and Social Networks in the Old South. Baltimore: The Johns Hopkins University Press.

Litoff, J. (1986). The American Midwife Debate. New York: Greenwood Press.

Litoff, J. (1978). American Midwives: 1860 to the Present. New York: Greenwood Press.

Tunc, T.E. (2010). The mistress, the midwife, and the medical doctor: Pregnancy and childbirth on the plantations of the antebellum American South between 1800-1860.

Women’s History Review 19(3):395-419.