Part 1 ~ Historical and contemporary comments by physicians about midwives ~ 1820 to 2014

Easy-to-share link ~ https://tinyurl.com/y3fvpprb

The Midwife Problem:

Historical and contemporary quotes made by doctors about midwives over the last two centuries on a topic doctors called “the midwife problem“.

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Editor’s Note: Part two lists the specific comments by physicians about midwives, both negative (98%) and positive (2%) from 1820 to 2014, which is the year I first posted this historical material. 

If you want to go straight to the actual quotes, click HERE 

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The Problem with “Problems”

Historically, this use of the word “problem” is actually “dog whistle”, that is,  a phrase used by people who harbor a pervasive prejudice against another group of people, one so intense that the instigators of this hostility hope to eventually anilialat the “problem” — the idea that my life will be so much better after I get rid of YOU!   

Such “problem-solving” organizations routinely horass, insult and threaten to harm members of the denigrated group and, if possible, erase all traces of their historical roots. In the US, this prejudicial process gave us the Jewish problem, the American indian problem, the immigrant problem, the colored problem, the welfare problem, the women’s lib problem, the gay problem etc, etc.

Today, we describe the organized efforts of a group to get rid of individual members as a ‘hate crime’ and as ‘genocide’ when it is perpetrated on the entire ‘problematice’ group.

As you read these historical comments spanning more than 200 years, you can’t help but realize that the political imperative of the American obstetrical profession, in concert with organized medicine (the AMA), was to eradicate the practice of midwifery in all its forms — essentially the genocide of a woman’s profession. This was accompanied by relentless and frequently repeated insults and taunts designed to sew disrespect and distrust, such as the ubiquitous and endlessly repeated comment that: “midwives kill babies“. Legal harassment included having midwives arrested and charged with “practicing medicine without a license“.

So far as we know, American midwives were never physically burned at the stake, but the reputation and professional abilities of midwife were metaphorically stabbed in the heart by the astonishingly mean and denigrating comments that so easily came out of the mouths, and from the penmanship, of high respected and capable obstetricians!

Here is but one such example, regrettably by no less than the highly regarded Dr. DeLee, someone I’ve always thought of as one of the “good guys”. I liked and respected for devoting his professional life and economic resources to opening the Chicago Lying in facility that served poor and immigrant women who couldn’t afford obstetrical fees. He also Dr. Beatrice Tucker to attend home births for very poor mothers living in the tenement houses.

Unfortunately, when it came to midwives, Dr Delee was unbridled and malicious:

1915 ~ Dr. DeLee,The Teaching of Obstetrics“, American Association of Obstetrics and Gynecologists

The midwife has long been a drag on the progress of the science and art of obstetrics. Her existence stunts the one and degrades the other. For many centuries she perverted obstetrics from obtaining any standing at all among the science of medicine.

The midwife is a relic of barbarism. In civilized countries the midwife is wrong, has always been wrong. The greatest bar to human progress has been compromise, and the midwife demands a compromise between right and wrong.  All admit that the midwife is wrong. [TASPIM- 1915-C; .p. 114]

If the profession would realize that parturition [childbirth], viewed with modern eyes, is no longer a normal function, but that it has imposing pathologic dignity, the midwife would be impossible of mention.”[1915-C; p.117] 

This anti-midwife bias still alive and well in government agencies in 2022!

In those states that license professionally trained midwives, the state medical board and Board of Registered Nurses very often file charges against professionally-licensed midwives based on spurious charges made by obstetricians and then those same boards use obstetricians as “expert reviewers”, even though these doctors know nothing about the practice of midwifery in general and the provision of childbirth services in a non-medical setting such as the parents’ home or a free-standing birth center.

Crimes Against Humanity

But the truly unforgivable crime is what the influential leaders in American obstetrics did in 1910 when they branded normal childbirth as an inherently pathological aspect of female reproductive biology.

Obstetrical professors defined childbirth as a “nine-month disease” requiring a surgical “cure”, while describing maternal deaths associated with childbirth as similar to Mother Nature’s “plan” for salmon, which normally die after spawning.

Since 1910, the obstetrical profession has conducted well-financed political and economic campaigns to eliminate physiologically-based care for normal labor and birth in healthy women with normal term pregnancies and replace it with highly-medicalize protocols, medical interventions and invasive surgical procedures to the detriment of both mothers and babies.

This was originally accomplished  when leaders in the obstetrical profession propagated the unscientific notion that labor in healthy women with normal pregnancies was inevitably a medical emergency waiting to happen and thus required the pre-emptive strike of universal hospitalization of call childbearing women and the use of many drugs and other interventions.

In this highly medicalized model, we were told that our baby’s birth was only safe if labor was medicalized and the birth was conducted as a surgical procedure to be ‘performed’ by a physician-surgeon after the mother herself was rendered irrelevant — either unconscious under general anesthesia or numb from nipple to knees with spinal anesthesia and unable to push.  Then the physician-surgeon performed a ‘generous’ episiotomy and extracted the baby with forceps while the L&D nurse stood over the mother unconscious body on a stool and using all her body weight, provided a very forcible, dangerous and unnecessary form of “fundal pressure” on the woman’s uterus. This series of interventions can only be described as a “baby-ectomy“.

The error of using obstetrical interventions developed to treat complications in healthy low-risk women that don’t need or benefit from routine medicalization

In the 1960s, I was a young graduate nurse working nights in the L&D of a busy and racially-segregated southern hospital that was still deep in the “Dark Ages” of Twilight Sleep as originally practiced in 1910. Normal obstetrical protocols for the, all-white maternity ward on on 5th floor —  Five North — required us to give our newly admitted labor patients large doses of barbiturates (sleeping pills), followed by large and frequently repeated doses of narcotics and the hallucinogenic and amnesic drug scopolamine.

To keep laboring women from falling out of bed, we used leather wrist-restraints from the psychiatric unit to clamp the arms and legs of our laboring mothers to the four corners of their hospital bed. So-called ‘normal childbirth’ in our all-white L&D included the routine use of general anesthesia, episiotomy, forceful and unnecessary fundal pressure, forceps delivery, manual removal of the placenta and suturing of the episiotomy incision, which included the infamous “husband stitch“.

Again and again I saw respiratorically-depressed newborns of white mothers that never breathed, and the preventable deaths of these same new mothers from hemorrhagic shock and amniotic fluid embolisms. This was directly or indirectly caused by the multiple unnecessary interventions by doctors doing risky and dangerous things didn’t need to be done and often resulted in great harm.

This represents the most profound change in normal childbirth in the history of the human species. 

This was in stark contrast with the experience of black mothers in the segregated, all-black ward on One South in the hospital’s basement. Because of segregation and generations of racial prejudice, our doctors firmly believed that black mother were like farm animal and didn’t feel pain like middle and upper class women women, or that they believed that our black mother somehow ‘deserved to suffer’.

As a result, our black labor patients were not given any kind of pain medications and had no special nursing care during labor as they simply walked around their 4-bed room and sat themselves on the toilet when they began to feel “pushy”.  Since there were only 2 RNs and a couple of aids for the entire 40-patient general ward, these  black mothers frequently delivered without anesthesia, episiotomy or forceps,in the elevator on their way to the delivery room and since their mother had no narcotic drugs, their newborn babies that breathed spontaneously at birth.

The 200-year long war on normal childbirth ~ What doctors were saying about midwives

Within the medical community there were — and continues to be — a very wide difference of opinion on the value (vs. danger) of physiologic management of normal childbirth and proper role for midwives as independent practitioners who provide physiologic childbirth services to healthy women with normal pregnancies.

While physicians in the US fiercely debated the ‘midwife problem‘ over the last 2 centuries, midwives and the childbearing women who used their services, were unfortunately not included (or even consulted) in the vitally important discussions that would decide whether healthy women and their healthy babies would die.

To provide the context for the irrational behaviour of the American obstetrical profession, I gathered comments published in the scientific literature by doctors about midwives and normal or “physiological” labor and birth during the last two-plus centuries (early 1800 to contemporary times) in the following post.

I hope the dramatic, conflicting, and most often disparaging comments by members of the medical profession will provide a helpful perspective to better understand the historical political tension between obstetrical medicine and the midwifery profession as well as the on-going controversies in contemporary times.

I describe this historical topic as the last and most important UNTOLD story of the 20th century — how healthy laboring women were turned into the patients of a surgical speciality and normal childbirth became a surgical procedure to be “performed” by obstetrical surgeons.

As noted above, this represents the most profound change in normal childbirth in the history of the human species

We need a “Truth and Reconciliation Commission”

I am totally serious when i say the US, like South Africa, desperately needs a “Truth and Reconciliation Commission”  to repair the damage done to generations of childbearing women and independent profession of  midwifery by the American obstetrical community over the last hundred-plus years and to allow the US to include physiological childbirth practice and the care of professional midwives to once again be part of our mainstream healthcare system.


An Important Vocabulary Distinction ~ midwifery and obstetrics as historical and contemporary disciplines:

** Editor’s Note:  American doctors made an important distinction between the traditional discipline of “midwifery” and what they saw as the problem of midwives as “female practitioners”.
Doctors described themselves as practicing midwifery when they provided care to a healthy laboring woman and attended her normal spontaneous birth in the family’s home. However, these same doctors often had a very hostile relationship had with “midwives” who provided this same type of “midwifery” care.
For doctors, the historical topic of midwifery was politically and practically very different from their discussions of individual midwives as ‘female practitioners’ of midwifery. During the 18th, 19th and very early 20th century, doctors were NOT trying to eliminate midwifery, per se. In fact, a physician who attended normal births was known as a “man-midwife“.
However, influential obstetricians were extremely interested in eliminating midwives from the practice of midwifery.
From their perspective, care provided by midwives was an illegitimate encroachment on the entitlement of “regular” (i.e. allopathic) physicians. The goal of doctors as ‘man-midwives’  was to take over the provision childbirth services as an exclusive aspect of medical practice, a fact very well articulated in the 1820’s quote below ~”Remarks on the Employment of Females as Practitioners in Midwifery; Published Cummings & Hilliard – Boston, 1820
It’s possible to identify when doctors stopped describing their provision of normal childbirth services as “midwifery” and instead described what they were doing as “obstetrics”. The first annual meeting of a new organization known as the American Association for the Study and Preventions of Infant Mortality” was held in 1910 and one of the five major divisions or topic of study was “midwifery”. However, the discussions at both 1910 and 1911 meeting was on how best to “Eliminate the Midwife”. By 1912, that same division was now being called “Obstetrics”.

Link to Part 2 ~ Historical and contemporary quotes by doctors about midwives over the last 2 centuries on the topic they called “the midwife problem”

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Midwives are specialists in
childbirth, postpartum, and
well-woman health care.
They are educated and trained
to recognize the variations of
normal progress of labor and
deal with deviations from
normal to discern and intervene
in high risk situations.

Agnodice_engraving
A modern engraving of “Agnodice”, a midwife and obstetrician in Ancient Greece, who according to legend disguised herself as a man in order to practice as a doctor.
The term midwife is derived
from Middle English: mid = “with”
and Old English: wif = “woman”.
Midwifery is a health care
profession in which providers offer
care to childbearing women during
their pregnancy, labour and birth,
and during the postpartum period.

mid·wife

(mĭd′wīf′)

  1. pl. mid·wives (-wīvz′)
  2. A person,usually a woman, who is trained to assist women in childbirth.
  3. One who assists in or takes a part in bringing about a result“In the Renaissance, artists and writers start to serve as midwives of fame” (Carlin Romano).

transitive verb.  mid·wifedmid·wif·ingmid·wifes or mid·wived (-wīvd′) or mid·wiv·ing (-wī′vĭng) or mid·wives (-wīvz′)

  1. To assisting the birth of (a baby).
  2. To assisting bringing forth or about: “Washington’s efforts to midwife a Mideast settlement” (Newsweek).

Middle English midwife : probably mid, with (from Old English;
see me- in Indo-European roots) + wif, woman(from Old English wīf; see wife).

Word History: The word midwife was formed in Middle English from two elements, mid and wife. At first glance, the meaning of wife would would seem to be clear. However, wife often meant simply “woman” in general in Middle English, not specifically “female spouse” as it most often does in Modern English.

The other element in midwife, the prefix mid-, is probably the Middle English preposition and adverb mid, meaning”together with.” Thus a midwife was literally a “with-woman”—that is, “a woman who is with another woman and assists her in giving birth.”

The etymology of obstetric is even more descriptive of a midwife’s role. Its Latin source obstetrīx, “a midwife,” is formed from the verb obstāre, “to stand in front of,” and the feminine suffix -trīx; –> the obstetrīx would thus literally stand in front of the baby as it was being born.

American Heritage® Dictionary of the English Language, Fifth Edition.

Word origins of  “Midwife/midwifery” & “Obstetrix” as the Latin equivalent of “midwife”

The historical word ‘midwifery/midwife’ comes from Middle English and reflected the female gender of the care provider. During this time, the idea of ‘adult woman’ and ‘wife’ were often used interchangeably, since the principle occupation for adult women was to care for their family, neighbors and other members of the community.
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The word “midwife” originally focused more on the noun and its gender — female ‘midwives’ (wives/women), than the verbs/activity of providing childbirth services. Later on, the word ‘midwifery’ focused more on the verbs of providing childbirth services, as male physicians began to refer to themselves as ‘man-midwives‘.
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Historically the word ‘midwifery’ was also used in formal medical education to identify the instruction of medical students in normal childbirth practices. Medical textbooks used the word to indicate the study of normal childbirth as well as its possible pathologies, such as a 1832 medical textbook entitled “The Art of Midwifery and Churgery” (surgery). {a copy of this textbook is housed at Stanford’s Lane Library}
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As recently as 1955, an obstetrical textbook for doctors published in the UK was titled “The Modern Practice of Midwifery & Gynecological Surgery“.
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The Latin word for ‘midwife’ is ‘obstetrīx‘. It comes from the verb ‘obstāre-‘ or “to stand in front of,” and the feminine suffix ‘-trīx
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The “obstetrix” was one of three types of women-providers who traditionally assisted mothers-to-be during childbirth. Two of the woman-helpers stood on each side of the laboring woman, steadying her in an upright position or helping the mother squat while pushing.  As the baby was being born, the obstetrīx or midwife typically stood or crouched in front of the laboring woman, assisting the mother as she pushed, helping the baby if necessary and catching the baby as it was being born.

JAshford Egyptian tree mom MW
Midwife assisting a laboring woman in ancient Egypt

JAshford African Stand 3some
A native American couple, with husband holding his wife steady in an upright position as she pushes and the midwife receives the the baby

Part Two: the really good stuff, actual quotes of comments by “medical men” (i.e. doctors) about midwives click HERE