{"id":6068,"date":"2020-01-16T07:32:44","date_gmt":"2020-01-16T07:32:44","guid":{"rendered":"http:\/\/beautifulbirthsmidwifery.com\/?p=6068"},"modified":"2020-01-27T20:52:59","modified_gmt":"2020-01-27T20:52:59","slug":"the-history-of-midwifery-in-the-united-states","status":"publish","type":"post","link":"https:\/\/beautifulbirthsmidwifery.com\/2020\/01\/16\/the-history-of-midwifery-in-the-united-states\/","title":{"rendered":"THE HISTORY OF MIDWIFERY IN THE UNITED STATES"},"content":{"rendered":"\n\n[et_pb_section fb_built=”1″ _builder_version=”4.1″ custom_margin=”30px||||false|false” custom_padding=”3px|||||”][et_pb_row _builder_version=”4.1″][et_pb_column type=”4_4″ _builder_version=”4.1″][et_pb_text _builder_version=”4.1″ custom_margin=”-25px|||||” hover_enabled=”0″ text_font_size=”16px” text_line_height=”2em” text_font=”Muli||||||||”]

In Colonial America, there were no hospitals and no obstetricians.\u00a0 All births occurred in the home.\u00a0 Midwives were not only the normal care providers for pregnant women, as it was considered indecent for a man to attend a birth, but they also provided the majority of medical care to the entire family[1,2].\u00a0Midwives were considered such a vital part of the community that they were often provided houses rent-free [3,4]. \u00a0In 1716 New York City began requiring the licensure of midwives, which placed the midwife in the role of \u201ckeeper of social and civil order\u201d [2].\u00a0 It wasn\u2019t until 1752 that the first permanent general hospital was built to care for the sick.

<\/p>\n

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Physicians in Colonial times were largely uneducated.\u00a0 In 1765 the first medical school was chartered, but the number of medical schools did not begin to multiply until after the War of 1812 [2].\u00a0 Also in 1765, Dr. William Shippen opened the first midwifery school. However, many women at that time were illiterate and could not afford formal education, so Shippen\u2019s lectures were soon limited to male students [2,5].\u00a0 Following the War of 1812, the nascent medical schools were largely for-profit institutions that began churning out poorly prepared graduates [6].\u00a0 There were few opportunities available for higher education to women of that period.\u00a0 Women were considered less intelligent and less capable of learning than men, and societal beliefs stated that once a woman married, she should bother simply with domestic matters [2,6]. \u00a0Furthermore, attempts to start midwifery schools were denied federal funding [2].\u00a0 As a result, midwives were unable to keep up even with the inadequate education available to physicians, and they instead were required to continue relying on wisdom passed down through apprenticeships and learning from their own experiences, with only herbs and home remedies as the resources available to them [3].\u00a0 The misguided belief that men were more equipped to safely deliver a woman through labor and delivery began to proliferate [1].<\/p>\n

However, this misguided belief was not the only motivating factor causing women to discard centuries of tradition with midwives.\u00a0 The other very powerful driving force was the advent of anesthetics in the mid 1800s for use during labor and childbirth.\u00a0 Toward the end of the 1800s, there were great advances in the field of medicine as well as in the availability of anesthetics during labor and delivery [2,7].\u00a0 As anesthetics were only available in a hospital setting under a physician\u2019s care, more woman began to desire hospital births.\u00a0 Hence, as hospitals began to proliferate, midwifery care became reserved for only those women who were unable to pay for a physician.\u00a0 However, midwives continued to attend the majority of births in the U.S. until the early 20th century [8].\u00a0 At that time, physicians were commanding more and more control over all medical fields, and wanted to eliminate all competition [1,9,3].\u00a0 As a result, the number of midwife attended births began to quickly decline.<\/p>\n

In addition to lack of educational opportunities and lack of access to medical advances, the absence of organization within the midwifery community, as well as racial and gender bias, was devastating to the midwifery profession [1].\u00a0 This was in stark contrast with the growing organization and power of the medical community.\u00a0 The medical community began to target the midwife as they realized that there was money to be made in caring for the pregnant woman [1].\u00a0 \u201cAs the presence of medicine became highly competitive, physicians and medical students were advised that their presence at a delivery would insure the entire family as grateful patients thereafter\u201d [3]. \u00a0As a symbol of the power they were amassing, the American Medical Association was formed in 1848 to \u201cenforce standards on medicine as well as its practice\u201d [2].\u00a0 With their new organization and rising power, the medical community began their full onslaught of midwifery, dubbing it \u201cthe midwifery problem,\u201d and painted midwives as \u201cslovenly, immoral, drunken, promiscuous, and perverse\u201d [1].<\/p>\n

The medical community itself began to come under fire in the early 1900s, however.\u00a0 The Carnegie Foundation was awarded an endowment that was to be used \u201cfor the benefit of teachers in the colleges and universities of the United States, Canada, and Newfoundland,\u201d [10].\u00a0 The Carnegie Foundation appointed a board of trustees who performed a brief review of colleges and universities and discovered that, \u201cthere was little unity of purpose or of standards,\u201d [10] among the schools.\u00a0 Before they bestowed the endowment on any schools, the board felt it was necessary for an impartial party to inspect the current colleges and universities to ensure they offered quality education.\u00a0 They hired Abraham Flexner, a former headmaster of a private Kentucky high school, who visited each of the 155 medical schools in North America.\u00a0 Using Johns Hopkins University as his exemplar, Flexner scrutinized the quality of the education that each school offered[6].\u00a0 The result of his effort is now known as the Flexner Report.\u00a0 In his report to the Carnegie Foundation, Flexner stated that there was \u201can enormous over-production of uneducated and ill trained medical practitioners,\u201d which he went on to say was \u201cin absolute disregard of the public welfare and without any serious thought of the interests of the public\u201d [10].\u00a0 He felt the schools were more about profit than education.\u00a0 The Flexner Report spurred a transformation of medical education in North America.\u00a0 Within a decade medical education become more demanding and scientifically founded, and approximately one-third of the medical schools had closed or merged with other schools [6].\u00a0 Unfortunately, most of the remaining medical schools still did not offer education to women [6].\u00a0 As a result of the unremitting lack of opportunity, midwifery education was unable to keep up with the improvements in medical education.<\/p>\n

The continued suppression of the midwife by the now very powerful medical community began to really take its toll.\u00a0 In the year 1900, physicians attended roughly half of all births, but less than 5% occurred in the hospital. \u00a0By the early 1920s up to 50% of births occurred in hospitals [2].\u00a0 Birth was no longer considered natural, but was now viewed as a medical event in need of management by a physician.<\/p>\n

“[In 1920] Dr. Joseph DeLee, author of the most frequently used obstetric textbook of the time, argued that childbirth is a pathologic process from which few escape “damage.” He proposed a program of active control over labor and delivery, attempting to prevent problems through a routine of interventions. DeLee proposed a sequence of medical interventions designed to save women from the “evils” that are “natural to labor.” Specialist obstetricians should sedate women at the onset of labor, allow the cervix to dilate, give ether during the second stage of labor, cut an episiotomy, deliver the baby with forceps, extract the placenta, give medications for the uterus to contract and repair the episiotomy. His article was published in the first issue of the American Journal of Obstetrics and Gynecology. All of the interventions that DeLee prescribed did become routine.” [2]<\/p>\n

By 1935, physicians were attending the gross majority of births. While physician care and hospital birth became the norm, the number of perinatal deaths increased by 40-50% between 1915 and 1930 [2].\u00a0 By 1945 midwife attended births had dropped to 5%, and by 1975 less than 1% of births in the U.S. were attended by midwives[8]. \u00a0As the government tried to eradicate midwifery, midwives, who were often illegal and practicing underground, continued to serve lower class women who were unable to afford medical care and would have otherwise gone without care[9].\u00a0 Oftentimes these midwives were untrained immigrants or the so-called Granny midwives of the deep south who were descended from slaves, and their lack of knowledge about hygiene and modern medical discoveries added fuel to the fire that midwives were uneducated and dangerous as care providers [9].\u00a0 Additionally, during and following World War I, immigration into the United States was limited.\u00a0 This not only limited the number of experienced midwives coming into the country, but also limited the primary source of people seeking midwifery care [2].<\/p>\n

The tide began to slowly change in the late 1960s when a grassroots movement, spurred by increasing numbers of surgical births and interventions, had begun to move back toward natural birth and away from the over medicalization and lack of choice that was all too common in the hospital [2,9]. \u00a0Birth in the hospital also began to change somewhat during this time as women wanted more from their birthing experience.\u00a0 Fathers began to be allowed in the delivery room, and women were left conscious during the delivery.\u00a0 However, a rise in lawsuits continued to influence doctors and encouraged them to continue managing the birth as a medical event, a continued driving force in the hospital to this day [9].<\/p>\n

In the 1970s, the American College of Nurse-Midwives, which was formed in 1955, devised national standards for the education and certification of the Certified Nurse Midwife (CNM), much like the transformation exacted following the Flexner report.\u00a0 In 1971 ACNM issued a statement against out-of-hospital birth, which they rescinded in 1980 [2]. \u00a0CNMs began to gain numbers, growing to approximately 1000 CNMs nationwide by the end of the decade [8]. \u00a0CNMs are now recognized as primary healthcare providers by federal law and are licensed with prescriptive authority in all 50 states [11].<\/p>\n

The reprofessionalization of the direct-entry midwife (DEM) did not begin until 1982 with the founding of the Midwives Alliance of North America (MANA) [12].\u00a0 MANA established a board to develop a written exam based on the MANA Core Competencies.\u00a0 This board evolved into the North American Registry of Midwives (NARM), and the exam was the beginning of the CPM credential [8].\u00a0 In 1994 the first CPM credential was awarded, and by 2014 over 2454 CPM certifications had been issued [13].\u00a0 Currently, the number of women choosing homebirth is also increasing [14,15]. \u00a0To date, direct-entry midwifery continues to be unregulated in 21 states and is illegal in 10 of the 21 unregulated states [18].\u00a0 After hitting a low of approximately 1% In 1980, the number of babies being caught by midwives in the U.S. is now increasing [2,14].<\/p>\n

Even though, CPMs are still far from being endorsed by the medical community, attitudes about birth choices and care providers are beginning to change.\u00a0 In recent months the American College of Obstetricians and Gynecologists (ACOG) began to loosen its stance against CPMs and out-of-hospital births.\u00a0 In February of 2015, ACOG released a statement acknowledging that birth centers attended by CPMs were viable options for low-risk women [16]. \u00a0ACOG\u2019s latest statement concerning CPMs and homebirth was issued in August of 2016.\u00a0 The Committee on Obstetric Practice [17] issued a report that acknowledges that women have the right to choose the location of their birth, but advises that women make informed decisions about their choice of care provider and states that \u201cappropriate\u201d care providers are physicians practicing obstetrics, CNMs, Certified Midwives (CMs), or midwives \u201cwhose education and licensure meet International Confederation of Midwives\u2019 Global Standards for Midwifery Education\u201d.<\/p>\n

Midwifery has had a long, hard road in the U.S.\u00a0 With the continued acceptance of the mainstream medical community, and the continued demand of the consumer for care following the Midwives Model of Care\u2122, we are hopefully on a road that will end with more babies being born into the hands of midwives.<\/p>\n

 <\/p>\n<\/div>\n

References<\/span><\/h2>\n
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    \n
  1. Davis, E. (2004). Heart & hands (4th ed.). Berkeley: Celestial Arts.<\/span><\/li>\n
  2. Feldhusen, A. E. (2000). The history of midwifery and childbirth in America: A time line. Midwifery Today. Retrieved from http:\/\/www.midwiferytoday.com\/articles\/timeline.asp<\/span><\/li>\n
  3. Varney, H., Kriebs, J. M., & Gegor, C. L. (2004). Varney’s midwifery (4th ed.). Sudbury: Jones and Bartlett Publishers.<\/span><\/li>\n
  4. Wertz, R. W., & Wertz, D. C. (1977). Lying-In: A history of childbirth in America (Expanded ed.). New Haven: Yale University Press.<\/span><\/li>\n
  5. Leavitt, J. W. (1986). Brought to bed: Childbearing in America, 1750-1950. New York: Oxford University Press.<\/span><\/li>\n
  6. Irby, D. M., Cooke, M., & O’Brien, B. C. (2010). Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Academic Medicine, 85(2), 220-227. doi:10.1097\/ACM.0b013e3181c88449<\/span><\/li>\n
  7. Frye, A. (2008). Holistic midwifery: A comprehensive textbook for midwives in homebirth practice (Vol. I: Care during pregnancy). Portland: Labrys Press.<\/span><\/li>\n
  8. National Association of Certified Professional Midwives [NACPM]. (2014a). History of Certified Professional Midwifery and NACPM. Retrieved from http:\/\/nacpm.org\/about-nacpm\/history\/<\/span><\/li>\n
  9. Martin, K. (n.d.). Short history of midwifery. Retrieved from Gentle Delivery Childbirth Services: https:\/\/gentlemidwife.wordpress.com\/a-short-history-of-midwifery\/<\/span><\/li>\n
  10. Flexner, A. (1910). Medical education in the United States and Canada. New York City: Carnegie Foundation for the Advancement of Teaching. Retrieved from http:\/\/archive.carnegiefoundation.org\/pdfs\/elibrary\/Carnegie_Flexner_Report.pdf<\/span><\/li>\n
  11. American College of Nurse-Midwives [ACNM]. (2016, February). Essential facts about midwives. Retrieved from http:\/\/www.midwife.org\/Essential-Facts-about-Midwives<\/span><\/li>\n
  12. Midwives Alliance North America [MANA]. (n.d.). What is a midwife? Retrieved July 30, 2016, from http:\/\/mana.org\/about-midwives\/what-is-a-midwife<\/span><\/li>\n
  13. National Association of Certified Professional Midwives [NACPM]. (2014b). Who are CPMs. Retrieved August 1, 2016, from http:\/\/nacpm.org\/about-cpms\/who-are-cpms\/<\/span><\/li>\n
  14. Cheyney, M., Everson, C., & Burcher, P. (2014). Homebirth transfers in the United States: Narratives of risk, fear, and mutual accommodation. Qualitative Health Research, 24(4), pp. 443-456. doi:10.1177\/1049732314524028<\/span><\/li>\n
  15. MacDorman, M. F., & Declercq, E. (2016). Trends and characteristics of United States out-of-hospital births 2004-2015: New information on risk status and access to care. Birth, 43(2), 116-124. doi:10.1111\/birt.12228<\/span><\/li>\n
  16. The American College of Obstericians and Gynecologists [ACOG], & Society for Maternal-Fetal Medicine [SMFM]. (2015). Obstetric care concensus. Retrieved from http:\/\/www.acog.org\/Resources-And-Publications\/Obstetric-Care-Consensus-Series\/Levels-of-Maternal-Care<\/span><\/li>\n
  17. Committee on Obstetric Practice. (2016). Committee opinion No. 669. The American College of Obstetricians and Gynecologists [ACOG]. Retrieved from https:\/\/www.acog.org\/-\/media\/Committee-Opinions\/Committee-on-Obstetric-Practice\/co669.pdf?dmc=1&ts=20160725T1919187348<\/span><\/li>\n
  18. North American Registry of Midwives [NARM]. (2016). Advocacy<\/em>. Retrieved from http:\/\/ narm.org \/advocacy<\/span><\/li>\n<\/ol>\n<\/div>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n\n","protected":false},"excerpt":{"rendered":"

    In Colonial America, there were no hospitals and no obstetricians.\u00a0 All births occurred in the home.\u00a0 Midwives were not only the normal care providers for pregnant women, as it was considered indecent for a man to attend a birth, but they also provided the majority of medical care to the entire family[1,2].\u00a0Midwives were considered such […]<\/p>\n","protected":false},"author":1,"featured_media":6630,"comment_status":"closed","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"793","footnotes":""},"categories":[10],"tags":[],"class_list":["post-6068","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-midwifery"],"yoast_head":"\nTHE HISTORY OF MIDWIFERY IN THE UNITED STATES - Beautiful Births<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/beautifulbirthsmidwifery.com\/2020\/01\/16\/the-history-of-midwifery-in-the-united-states\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"THE HISTORY OF MIDWIFERY IN THE UNITED STATES - 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