The History of
Midwifery in the
United States
Throughout history women
have always assisted other women in childbirth. Harvard
historian Laurel Thatcher-Ulrich researched diaries of sea captains voyaging to the
“new land” and found records of midwives assisting women in labor on ships
sailing from England to the United States in the 1600’s. Martha Ballard, a midwife living in Hallowell,
Maine, was one of the few women who kept a diary in the late 1700’s and early
1800’s. In recording her practice of 27
years, she gives a clear picture of a midwife’s duties, which included assisting
women in travail, as well as attending to sick women, children, and less often men. She had knowledge of herbs, and cultivated and
harvested herbs for her practice. There were few medical doctors at this time and most of
them were located in larger cities, such as Boston. The
midwife was the one called in times of family illness. Her diary has countless entries
allowing the reader to see that it was the travel to the birth by horse back, sled, or
canoe that was much more difficult and life threatening that the birth itself.
It wasn’t until 1789
that written records documented the appearance of “man midwives” and the
practice of “scientific obstetrics”, a time where we see doctors settling in
more rural areas. During this time, doctors
attended births only as observers and as a support person for the family. The midwives and neighboring women assisted the
women in labor and provided all of their care. Doctors
felt that if they showed compassion during the time of childbirth, they would become
familiar to families and later called to assist people during times of illness. Not long afterward, these men came to feel they
should assist the women in labor rather than be present as observers. Martha
referred to these few men as “bunglers” and saw that their use of opium in
childbirth did little but slow the labor and delay the birth process. It became “fashionable” to use
medications for the relief of labor pains and then to use forceps to speed the birth
process and shorten the women’s time of discomfort.
By the early 1900’s, fifty percent of women in childbirth were assisted by
midwives and fifty percent were assisted by doctors.
At the turn of the century the use of ether was coming into vogue and doctors had
begun to use so many instruments to assist manual deliveries of babies, they felt it would
be easier for them if women came to hospitals to give birth. Birth was moved to the hospitals for convenience and not
for reasons of maternal or infant safety.
It is important to mention that
Martha Ballard’s home birth statistics for infant mortality in the 1700's parallel
the hospital statistics of 1942, 5 deaths/1000births.
Despite the modern technological changes in birth in America, there had been no
improvement in infant mortality during childbirth and including the first year of life. Today we are seeing that the United States spends
the most money of any other nation for obstetric care, although we are far from the
leaders in normal, safe, uneventful vaginal birth (6.76 infant deaths/1000 births in 2001
and rated 24th when compared with 30 other countries).
Today we are seeing that one medical intervention leads to another in a downward
spiral leading to mechanical or operative delivery in most hospitals today. Women are given medication for “pain”
rather than good labor support. Women are
“on the clock” to birth their babies in a specified amount of time, or they are
pressured with pitocin, epidural anesthesia, and cesarean delivery. What is missing is skilled midwifery: care of
woman to woman from early pregnancy and through the postpartum period. Unlike almost every other nation in the world
today, in the United States only about ten percent of women in childbirth are assisted by
midwives.
Andrea Mietkiewicz, CPM, RN, Midwife
Elektra Nancy Duncan, CNM, FNP, CLNC
28 Abbott Street
Old Town, ME 04468-2102
Office: 207-827-8871
Fax: 207-827-8871
Email: midwives@clearlightholisticmidwifery.com
