Midwives, Nurses, & OBGYN's (Oh My!)

A history of the over-medicalization of birth and the female body.  

Society often paints midwives as spiritual, non-academic women, who are ill-equipped for the real dangers of childbirth. From sitcoms, to celebrity reporting, having a midwife or doula present for your birth can be seen as ‘woo woo.’ With the rise of western medicine, midwifery received the reputation of being unsafe for mothers, unsafe for baby, and something only elite women take part in. You should want to see a doctor, instead of seeing a woman who carries on a tradition of guiding women through their births, right? I’m going to walk you through the history of midwifery and why societal preferences for doctors above midwives can be misguided.  You’ll learn how, over generations, midwifery in the U.S. turned from a practical practice, to a discredited one with the development of modern medicine and rampant sexism resulting in the overmedicalization of the female body. 

During colonial times, midwives solely performed deliveries for all women. They brought this tradition over from England, where midwifery is still widely respected. In fact, in countries like Japan, Sweden, and the United Kingdom, midwives attend most births and outnumber obstetricians. In the 1700s, society viewed childbirth as a social rite performed by women for women. They respected a woman’s natural process of giving birth, and trusted midwives to guide this process. However, in 1751, a large push for professionalism in medicine led to sexist views on the profession of the midwife. Women were deemed too emotional and incapable of learning new obstetric methods. With these attitudes being spread, wealthy women didn’t want midwives attending their births, but physicians instead. Midwifery soon became the best access to healthcare that lower class women and women of color could afford for their births.

Social influence slowly pushed women out of the medical field, claiming that once married, women should only have domestic roles. Even as Midwife training programs appeared across the country, the primary students were men. In the late 1800s, the American College of Obstetrics and Gynecology was formed, and doctors became more integrated into the middle and upper classes. With the downfall of Midwifery in America, came the rise of gynecology and obstetrics.  

19th century American Gynecologist J. Marion Sims is widely known as the father of modern gynecology. Lesser known is that he performed his first experiments on slave women without anesthesia. Anesthesia being difficult to obtain during the time was Sims excuse for foregoing it. He also carried a cruel and racist belief that black women have a higher pain tolerance than white women. With this being the basis of modern gynecology, it's no surprise that obstetrics and gynecology carry a long history of mistreating women, especially black women. By 1900, physicians were present at half the births in the nation, Midwives still making up for the other half while taking care of lower-class women and women of color. In 1914 the invention of “twilight sleep” allowed women to not feel the pain of childbirth. In fact, they didn’t feel it at all. Women would seemingly go to sleep and wake up with no recollection of the birth. “Twilight sleep” was viewed as a sign of medical progress even though mothers were completely removed from the birth experience and often the anesthesia negatively affected the newborns. However, the serious problems associated with “twilight sleep” were ignored for years and the practice continued into the 1970s. 

After the invention of twilight sleep, in 1915 Dr. Joseph DeLee described birth as a pathological process, one that wasn’t a normal function for women, and therefore, midwives had no business in it. 

Sit with that one a minute. Can you imagine telling a modern mother that her birth is a ‘pathological process’?!  

It’s astounding to see the lying propaganda peddled in the medical community and blindly accepted as truth.  Obviously, a woman’s body has evolved for the process of pregnancy, birth, and post-partum, and yet false theories to the contrary would persist until the 1950s.  

In 1952 the midwifery section of the National organization for Public Health Nursing affirmed that pregnancy was in fact a natural process, and a family centered event (gee really? Thanks!) With this attitude change, more women began entering the medical field as nurses, midwives, and OBGYNs. By the 1970s women accounted for only 9 percent of medical students, but this would jump to 25 percent by the end of the decade. During this time, women’s groups began learning how to care for their own vulvas, and shortly after these groups called for medical care to be demystified and for the female body to be de-medicalized. They argued that since birth was a natural process, there wasn’t a need for births to take place in hospitals over the constant supervision of obstetricians. Furthermore, in the 1980s, the medical community came under fire, while women’s groups demanded the same access to medical care for all women. The disparity in medical care started becoming obvious to women of color, who were far more likely to have limited access to effective care. With this in mind, midwifery started to be viewed as a profession again, and one that should be standardized and regulated. In 1994 the North American Registry of Midwives offered its first written examination to certify midwives. Sadly however, midwifery is still illegal in many states as of 2020, and regulations on what’s required to become a certified midwife varies from state to state.  

Today, the majority of births still occur in a hospital. Even with midwives and doulas becoming more widely accepted, there’s still a mistrust of the profession. But when you look at the history, it’s clear to see midwifery decreased in popularity because of sexist, racist, and classist views. Midwives were discredited by the medical community for being women, lower-class, and women of color, even though they carried on long-standing and effective traditions.  

As a vagina superhero, I believe medical birth practices and midwifery can come together, each with the unique and vital value they provide. In fact, the word obstetrics, is actually the Latin word for midwife, and is taken from the root word obstare, meaning to stand before, because attendants stood in front of the mother to “catch” the baby.

The two professions don’t have to be at odds with each other, they can agree to be on a shared mission, to help mother’s deliver their babies to the world. For example, training programs at UCSF now place both midwife students and OBGYN residents together during a vital part of their learning, in order to build a foundation of respect between the two professions.

UCSF charges forward with this new initiative in the wake of covid-19 causing shut-downs of maternal wards, especially in low-income and rural communities. Integrating midwives into maternal healthcare is necessary to ensure every mother gets the best care.

The history of these two professions should be examined while noting that quality medical access is still less accessible to women of color and lower-class women. In turn, midwives, even today, can help fill that gap in healthcare.

While I am hopeful to see institutions like UCSF work hard to create an understanding between these two professions, there is no doubt that the U.S. overall needs to step up in providing equal care across the board which should include more readily available and highly trained midwives.

Integrating advocates for mothers into the medical system that inherently trusts in the female body’s process can be part of much needed reform and a movement towards healthy birth opportunities for all women.