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The Art and Practice of Midwifery

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The art and practice of midwifery, the attending of women in childbirth, is known to have been practiced in all ancient and early cultures, and one of the oldest formal professions. Almost exclusively a female realm, midwifery is clearly noted in the ear

The art and practice of midwifery, the attending of women in childbirth, is known to have been practiced in all ancient and early cultures, and is one of the oldest formal professions.

But while most cultures of the world have or continue to utilize women as birthing assistants, the term midwife is predominantly a designation applied to women of Europe and the United States, where this art has evolved into a licensed practice.

Almost exclusively of the female realm, midwifery is clearly acknowledged in the earliest books of the Old Testament, and was recognized as an important role within ancient Greek and Roman society

During the middle ages, however, the midwife’s function began to disappear when it became directly affected by rising superstition associated with an appalling rate of infant mortality and a harsh stigma attached to mothers who could not deliver their babies unaided.

During the 17th century, a slow and cautious reaffirming of midwifery began in Europe. 

Amidst the witch scares when midwives were highly suspect, most women still preferred to trust their labor to another woman rather than face the ordeal alone, and so usually opted for a practiced woman to attend.  Within a century, maternity hospitals began to be spring up in Europe’s larger cities, becoming formal training centers for midwife practices, but it wasn’t until the 19th century that their functioning began to receive formal sanctioning and recognition.

First the Netherlands, Scandinavia, Germany, and France passed laws certifying midwifery practices, with British Parliament following suit in 1902, passing England’s first Midwives Act.  This act set up a Central Midwives Board across Britain to regulate the training midwives received, standardizing how they would formally function. 

Similar acts were subsequently passed in both Scotland and Ireland in 1915 and 1918, respectively.  This reinstatement of midwifery status was greatly received in the British Isles as most births at this time took place at home with midwives in attendance. 

Beginning in the early 1930s, however, the trend toward hospital births took a major upturn, with institutional births rising from 40% in 1937 to 71% in 1965, with midwives continuing to be the primary baby deliverer.

While midwifery had, of course, arrived in America with the first settlers, for much of the 18th and 19th centuries, women of the South were routinely attended by Black women in their employ, while women of the North began to utilize formal maternity hospitals as early as 1751 when Benjamin Franklin founded Pennsylvania Hospital in Philadelphia, which had already begun to formalize the study of obstetrics and gynecology.

This trend continued into the later half of the 19th century, with the licensed position of nurse-midwife being established in the early 1920's as a response to the alarming rate of infant and maternal mortality in the US during this time.  In 1920, Massachusetts was the only state that didn’t afford midwives a legal status, but by 1965, ten other states had degraded the midwife position. 

Since that time, states have claimed the right to regulate midwifery at the state level, extending various educational and licensing criteria as they deem appropriate.

In the last decades of the 20th century, midwives have gained a new level of appreciation and authority, mainly due to the New Age movement that sees childbirth as a personal, spiritual experience, and not one intended for the cold and clinical atmosphere of a hospital. 

Many rooted in the counterculture communes of the 60s and 70s, today’s midwives and those mothers who choose this now “non-conventional” method of delivery, feel that the rights of women, the newborn, and the family during childbirth are among those human rights which must be reclaimed and retained.

Many women today feel that returning the major responsibility for normal childbirth to well-trained midwives rather than having it rest with the now traditional male, profit-oriented medical establishment, is an essential step in self-determination for women. They believe that the wisdom and compassion a woman can intuitively experience in the act of childbirth can make her a source of healing and understanding for other women, while creating a closer bond with all children.

Reflecting more than a trend, the number of midwife-attended births has risen nearly every year in the US since 1989 (which is the first year that midwife-attended birth statistics were reported). 

That year, midwives and certified nurse-midwives attended 132,286 births, or 3.2% of all US births.  In 2006, that number rose to 317,168 births--a record number--a 33% increase since 1996, representing 7.4% of all US births or 10.8% of all vaginal births.  These data should be considered lower estimates of the actual number of midwife-attended births due to underreporting of midwife-attended deliveries due to stimga, private deliveries, and circumstances where it is illegal.  Clearly, many feel that in this case the ancient ways are best.






Spiritual Midwifery, by Ina May Gaskin

Images via:



Birthing in chair image via medinfo.ufl.edu

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James R. Coffey

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