The practice of assisting women during childbirth, generally considered the province of
female midwives and a traditional art rather than a modern science. The earlier, primary
meaning of midwife is “a woman by whose means the delivery is effected” and later “a
woman who is with the mother at the birth” (Oxford English Dictionary [OED]). During
the transition from midwife-managed to physician-managed childbirth, male surgeons or
accoucheurs were sometimes known as men-midwives. Once persecuted as witches,
female midwives came to be demeaned by the male-dominated medical profession as
“old wives”—ignorant, superstitious, and incompetent folk practitioners who endangered
their “patients.” Midwifery’s decline in the United States dates from the 1920s, when the
majority of reported births began to be attended by doctors and increasingly took place in
a hospital rather than at home.
In preindustrial European society, female healer-mid-wives played a major role in
traditional health systems and a virtually exclusive one in childbirth. Both came under
ecclesiastical scrutiny as witchcraft based on alliance with the devil. The medieval
Catholic Church’s witch-hunting manual, Malleus Maleficarum (The Hammer of
Witches, first of many editions, 1486), devotes Question XI, Part I, to “witch midwives,”
who “in Various Ways Kill the Child Conceived in the Womb, and Procure an Abortion;
or…Offer New-Born Children to Devils,” and proclaims: “No one does more harm to the
Catholic Faith than midwives,” who are accused of a range of reproductive-system
crimes. In the 16th century, the Church began licensing midwives as part of its stand
against popular belief in magic and an effort both to improve medical practice and to
make money (Oakley 1976:26).
Until the late 1700s, childbirth in America was a social event attended by female
midwives, relatives, and friends; by the 1920s it had become generally a medical event
managed by male obstetricians. Trained in England to regard midwifery as part of
science, early American physicians imported “new obstetrics,” and after the American
Revolution, upper-class, urban American women and very gradually others turned to
male physicians for delivery. Throughout the 1800s, doctors characterized female
midwives as backward and worse, while the term “meddlesome midwifery” was used to
indicate excessive medical intervention. Midwives who once had enjoyed considerable
status came to be degraded as unskilled, domestic workers, although some still held high
social positions locally in the early 20th century, when physicians began active lobbying
to curtail or eliminate them while public-health officials argued for their regulation.
Greater centralization of maternity care in hospitals and increasing acceptance of
childbirth as a pathological process requiring obstetrical management rather than a
natural process with female attendants “standing by” meant that many states banned
midwifery or so regulated it that traditional practitioners could not meet the new
requirements.
Professional midwifery started in the United States during the 1920s. New York City’s
Maternity Center Association began in 1918, considered starting the flrst nurse midwifery training program in 1923, and established it in 1932. Kentucky native Mary
Breckinridge, a professional nurse and British-trained midwife, worked with granny
midwives in rural areas of her home state, where in 1925 she started the Frontier Nursing
Service to show the efficacy of trained nurse-midwives. In 1928 its staff launched the
Kentucky State Association of Midwives, later the American Association of NurseMidwives. The American College of Nurse-Midwives was founded in 1955, but the
College of Obstetricians and Gynecologists did not recognize certified nurse-midwives,
registered nurses with additional midwifery training, as primary childbirth attendants
until 1971.
Lay midwifery, sometimes also called “empirical” or “nonnurse,” encompasses both
licensed and unlicensed midwives who practice legally and illegally according to various
state’s laws. Margaret Reid (1989) traces contemporary lay midwifery in the United
States to the West Coast counterculture movement in the 1960s. Although differing from
traditional midwives who are more often rural, ethnic or religious minority women whose
children are grown, these predominantly White, middle-class women with young children
share with granny midwives, Hispanic parteras, and other folk practitioners the informal
training through apprenticeship, sense of “calling” or vocation, and greater reliance on
herbal remedies and noninstrumental techniques. They are also similar to traditional
midwives because they share cultural values and epistemological understandings about
childbirth with the women they attend.
Ethnographic and biographical accounts of midwives, their practice, and their clientele
need more systematic investigation to delineate fully the role of midwife. Recruitment
and training, status within their community and/or among its women, relationships with
other health-care practitioners, and the perception and evaluation of competence must be
considered as well as the social status and personal circumstance of those who choose or
are constrained to seek midwives’ services. Conceptual frameworks for the full range of
ritual and physical techniques employed should also be determined.
Contemporary American pregnancy and childbirth may be viewed as a yearlong rite of
passage involving a range of participants and “ritual specialists,” according to Robbie E.
Davis-Floyd. She distinguishes two contrasting models of childbirth: the technocratic and
the wholistic (1992:160–161). The former is male centered, objectified, and doctor
directed; the latter, female centered, integrative, organic, and relatively
noninterventionist. The midwife acts as nurturer, skillful guide, and assistant, while
responsibility for the birthing is the mother’s.
The performance of midwifery, the birth event itself, is seldom fully documented.
Brigitte Jordan gives an exemplary account of a Mayan midwife’s supervision of delivery
(1993:31–41). Everyone in the birth setting participates in “doing a birth,” assisting in
physical tasks and engaging in speech that ranges from everyday conversation to
“stories” about childbirth and death and “birth talk” specifically addressed to the
parturient woman. This complex of birth speech figures in an important meaning of
gossip or godsiblingship, the talk and interaction of all of those in attendance at
childbirth. Performed midwifery may thus be interpreted as a powerful language or
mythology.
Marta Weigle
References
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