The History of Midwives and Midwifery

It is unknown exactly when midwifery emerged as a profession but it can be assumed that midwives have been part of the human experience since the emergence of the human race.

Traditionally birth has been the domain of women. The ancient Jews called her the wise woman, just as she is known in France as the sage-femme, and in germany, the weise frau and also Hebamme or mother’s adviser, helper, or friend. The English term midwife, the Latin term cum-mater, and the Spanish and Portuguese term comadre all have the same meaning: with woman.

The midwife is mentioned in the book of Genesis, 35:17. “And when she (Rachel) was in her hard labor, the midwife said to her, ‘Fear not, for now you will have another son.” the book of Exodus, 1:20 states, “Therefore God dealt well with the midwives: and the people multiplied, and waxed very mighty.”

The midwife had knowledge and skill in an area of life that was a mystery to most people. Since women had no access to formal education, it was widely assumed that the midwife’s power must come from supernatural sources. Midwives were healers, they were called “wise woman” by the people, witches or charlatans by the authorities. Hence, the midwife was sometimes revered, sometimes feared, sometimes
acknowledged as a leader of the society, sometimes tortured and killed.

The age of witch-hunting spanned more than four centuries, from the 14th to the 17th century, in it’s sweep from Germany to England. The witch hunts were well organized campaigns, initiated, financed, and carried out by the church and the state. Witches were considered a political, religious, and sexual threat to the Protestant and Catholic churches, as well as to the state.

The extent of the witch-craze is starting, the total number killed is estimated to be in the millions. Woman made up some 85 percent of those executed, many were midwives and healers.

Witch hunts did not eliminate the lower class woman healer, but she was forever branded as superstitious and possibly malevolent. As a result she was thoroughly discredited among the emerging middle class, in Europe. It was now possible for male practitioners,  who claimed themselves to be technically superior to the lay midwife, to enter the birth room. In the hands of these new nonprofessional male practitioners obstetrics, among the middle class, was quickly transformed from a neighborly service into a lucrative business.

By the early 1800’s there were a growing number of formally trained doctors entering the business of Obstetrics. These formally trained practitioners, or regular doctors as they called themselves were exclusively male, and usually middle class,. Female midwives and women in general were denied medical education, and the use of technologies forbidding them from practicing medicine.

The professionalization of obstetrics is one of the leading factors in the demise of midwifery. As doctors sought to improve their status by proving midwives uneducated, it also became fashionable for the upper and middle class to employ male, regular doctors for obstetrical care. women were losing their ancient occupation to men.

In terms of medical skills and theory the regular doctors had nothing over the lay practitioner. Medical programs varied in length from a few months to two years, most had no clinical facilities, and there was no body of medical science to be trained in. The regular doctors were taught to treat most ills by heroic measures, most often these cures were either fatal or more injurious than the original disease being treated.

In the United States the removal of woman from their traditional role as midwife began much later than in Europe but ultimately went much further. Midwifery is still a thriving occupation in Scandinavia, the Untied Kingdom, the Netherlands, etc., where here in the Untied States midwifery was nearly wiped out completely.

Medical historians have called the years before 1750 “the age of the midwife.” Doctors were few and the first men of this period to attend births simply called themselves “male midwives.” It wasn't until the first American men began to return from medical schools in Europe with new knowledge and skills to aid women in birth that midwifery began it’s inclusion within the medical practice of men.

By the early nineteenth century with the entrance of educated physicians into the field of obstetrics the middle class midwife was being driven from her practice. Only traditional midwives who attended ethnic immigrants, the poor, isolated whites, and blacks continued to work. Following along the lines of what took place in Europe several years prior upper class women were choosing to employ male physicians for obstetrical care.

As medicine gained legitimacy and power toward to end of the nineteenth century, it called for the abolition of midwifery and home birth, a goal that it nearly accomplished. Physicians trained in the specialty of obstetrics and gynecology declared themselves to be the proper caregivers for childbearing women, and the hospital was deemed to be be the proper setting for that care. Birth increasingly began to be viewed as medical problem to be managed by a physician and birth evolved from a physiological event into a medical procedure.

Midwifery was declared to be illegal in most jurisdictions and as the old “granny midwives” died out, the profession almost died with them. Midwifery never completely succumbed to the campaign waged against its practitioners by the medical profession and it’s during these darkest times the seeds of the the future of midwifery were being sowed. Although they were slow to grow, they proved to be enduring. Today midwifery is a professionally regulated field. Midwives are trained professionals with expertise in normal, low-risk birth. Currently in the United States there are two main categories of midwives, Certified Nurse Midwives (CNM’s), and Direct Entry Midwives (DEM’s). Direct Entry Midwives may be further broken down into subcategories reflective of the varying legal status in different states, including Certified Professional Midwives (CPM’s) and Licensed Midwives (LM’s).