What Happened to Midwifery in America? Part 1

                                          Tom Podmore

                           unsplash-image

Historical Midwifery

Throughout history midwives have been ever-present, often in the background, but always with us.  They have been women in the community other women have turned to for support with women’s unique physical and emotional issues. Most people know the word, midwife; early English for “with woman”.   The French word for midwife, “sage femme” (wise woman) dates back thousands of years, along with the Danish word, “Jordmor” (earth mother). The book of Exodus describes midwives who disobeyed the command of Pharaoh to kill all sons born to Hebrew mothers.  When summoned by the king of Egypt for not obeying his command, the midwives explained that they never attended Hebrew births because the women were healthy and always gave birth before the midwife arrived.[1]  In the seventeenth century, accounts of the childbirth practices of Native Americans were provided by European male explorers who described solitary, painless birth without the presence of female supporters.  Since men were not allowed to witness births in these times, descriptions may be considered inaccurate. 

                                             Midwifery/Birth Support existed in Native American Births.

                       Boston Public Library

Midwifery in Early America

Despite accounts of solitary birthing by Native American women, other reporting exists that midwives or close family members were usually involved.[2] Midwifery in Europe long predated the discovery of America but when Europeans began to migrate to the new world, midwives were part of this exodus.

            We know that childbirth in early America was attended by midwives. The majority of practitioners acquired their skills in the European countries from where they immigrated.  From earliest historical accounts, childbirth was characterized as a social event, attended by women friends, neighbors, and relatives of the laboring woman.  These birthing boosters gathered in the appointed labor areas of the home, offering advice, moral support, comfort and empathy while taking part in the deliveries of early American infants. Only during the most challenging and dysfunctional deliveries was a “physician” summoned to assist. The value of his contribution was physical strength and, occasionally, crude instrumentation to force a baby from its mother’s womb.[3]

European Men Interfere With Traditional Midwifery           

In the 1750’s, European men with medical training were immigrating to America, bringing along instruments of intervention for various medical situations that might arise.  The first Colonial medical school was established in 1765 and by 1810, midwifery was on the curriculum and prospective midwives were being taught at five American medical schools. Midwifery’s role in childbirth was recognized and well-accepted until attending birth became an economic transaction.[4] During this time, interference and instrumentation in childbirth culminated in the creation of a new medical specialty, “Obstetrick Art”. 

                                Crude instrumentation intrudes on medieval birthing

                  unsplash-image

Physicians in England and America Transform Childbirth          

Physicians in England and America were successfully transforming childbirth from a family event into a lonely and male-dominated one. Coincident with the forming of this novel specialty, many early American doctors were satisfied to leave normal deliveries to midwives.  A small number of interested physicians even offered training opportunities in obstetrick art to midwives desiring more knowledge.[5] Unfortunately, this intra-professional cooperation was short-lived, ceasing to exist by 1820.

Rennaissance Barber/Surgeons Forge Birthing Tools           

Much earlier, during the Renaissance in Western Europe, barbers and surgeons came together in an unholy and lucrative alliance.  Noting that the respective tools of their trades were eerily similar, these seemingly disparate professions conspired to exchange secrets and eventually merged to explore the mysterious, uncharted, and previously female-dominated universe of childbirth. It is necessary to explain that midwives of these times occasionally had to turn to these barber-surgeons when the events of a normal childbirth became desperately complicated (think: baby is stuck and must be removed by force).  By 1588, barber-surgeons were inventing and perfecting metallic, mechanical tools for use in difficult situations of labor and delivery.  One particularly innovative and imaginative barber-surgeon, Peter Chamberlain, invented the crude instrument which was later known as obstetrical forceps.[6]

                Contemporary version: McLean-Tucker-Luikart Obstetrical Forceps.

                                                       Courtesy of : Michael L. Hall MD

Forceps 101           

While forceps have been modified over time, the primitive version was found to be quite expedient in extracting a baby, dead or alive, from the female pelvis.  While shortening the birth process, crude forceps deliveries tended to wreak havoc on an infant’s head, face, or buttocks, not to mention gross and irreparable damage to delicate maternal tissues.  If mother and baby survived a traumatic forceps delivery, any expertise of the barber-surgeon did not extend to repairing the likely perineal mutilation created during the process. Lacerations and jagged tearing of the female perineum, vagina, and rectum inevitably resulted in bladder or rectal-vaginal fistula formations.  The unlucky recipients of traumatic forceps deliveries subsequently suffered persistent leakage of urine, stool, or both from their vaginas; injuries that would have persisted for the remainder of their lives.

Chamberlains’ Lucrative Secret           

Nonetheless, Chamberlain’s forceps were so popular and successful, mechanically and financially, that other Chamberlain men joined in the expedited-birth business.  Fortunately for the Chamberlain finances, forceps and accompanying techniques, were preserved as intellectual property, remaining a well-guarded family secret for three generations.

            Although the Renaissance was a time of unparalleled discovery and invention, the development of maternal forceps introduced a time of unbridled interference with female reproductive functioning; assaults on normal birth processes that only rarely required  force, much less metallic intrusions into the female pelvis.[7]  At some point between the 17th and 18th centuries, other enterprising tool smiths began to focus on the economic opportunities associated with the use of forceps. In 1760’s America, the colonists’ circulation of fake news touted the growing popularity of medical men and their magical instruments.  Concurrent with these exciting innovations, anything that resembled normal childbirth was condemned and advertised as a “perilous” event.  Midwives were portrayed as outdated, unscientific, and incompetent. Early American media succeeded in convincing women that safe childbearing required the superior skills of medical men and their birthing tools.[8

[1] Exodus 1:15-22

[2] Native American Customs of Childbirth. Teachinghistory.org/history-content/ask-a-historian/24097

[3] Suarez, SH. Midwifery is Not the Practice of Medicine. 1992. Yale Journal of Law and Feminism. 5(2):6. Available at: https://digitalcommons.law.yale.edu/yilf/Vol5/Iss2

[4] Supra note at 325.

[5] Suarez at 326.

[6] Bridsky, PL. Where Have All the Midwives Gone? 2008. JournalPerinatal Educ. 17(4): 48-51.

[7] Whether the Chamberlains’ instruments were quality-tested (on livestock, perhaps?) prior to use or just random, laboring women has not been recorded in historical materials. mmh

[8] Suarez at 326.

http://midwivesontrial.com