Truth About Birth: Brief History of the American Midwife
“After a very hard delivery, the midwife finally exclaimed, ‘Don’t be afraid – you have another son!’ ”
Since the beginning of birth, women have offered themselves up for the soul work of midwifery: of holding their sisters and daughters in the darkest moments of the night, in tents and fields, in palaces, homes, and shanty towns. Generation after generation of new souls have entered the world into the hands of midwives whose role was honored and irreplaceable until the 20th century. Midwifery is a ubiquitous tradition; every tribe and culture have a version of the midwife. Traditional midwives are almost always women with unique gifts and skills learned through experience, who feel a sense of calling to their role, directed by God to serve the women in their community. The midwife was just one among a larger group of women who supported birth in the community setting. The women came together to the mother’s home and cared for her every need: seeing to her children and husband’s needs, managing the house and other responsibilities so the mother could focus on her birth and new child. In this way, it really did “take a village” to raise a child – these mothers didn’t have to face the early days of parenthood alone. It was in these community birth settings that midwives would be identified by their natural passion and skill in assisting childbirth. Once their abilities were noticed, the younger birth attendant would begin an apprenticeship (sometimes formal and sometimes not) with the more experienced midwife. In this way, women’s wisdom was passed down from the hands of one midwife to the next. Midwives were not only the keepers of birth, but also generally valued as healers and teachers in their communities. Compensation for midwives took many different forms. Midwives were sometimes given land and a home, with their needs cared for by the population in which they were serving; other times midwives were paid a fee.
The Patriarchy had left birth to women for millenia, but as allopathic medicine grew in dominance and power, the eyes of men turned to childbirth as a source of income and prowess. It’s a painful story of loss, in some cases welcomed by unsuspecting women who trusted “science” to deliver them from their pains; and in some cases, hard fought by wise women who sought to protect the birth-rights of their sisters. Doctors had exclusive rights to the use of obstetric tools like forceps, and when a birth was difficult it became the standard of care to call for a doctor. As doctors grew in power, the tradition of social childbirth was disintegrating, as modern technology and the sensibilities of the industrial revolution created more and more distance between women and their network of support.
In the early 19th century, wealthy women began to hire doctors to attend their births at home – believing the care to be superior despite the highly interventive and harmful practices of doctors at the time. Now when a birth was traumatic, the narrative became “aren’t you so glad the doctor was here to save you,” when the doctors’ actions were often the cause of harm (Sound familiar? This narrative is still pervasive in maternity care today). By 1900 around 50% of births were attended by doctors at home. In the early 20th century, the promise of “scientific birth” lured families into hospitals: causing an increase of the maternal mortality rate in the period between 1915 and 1920. By 1960 96% of births took place in the hospital with fully medicalized care. The shift from mother-led, midwife supported birth at home to fully allopathic hospital-based care was swift and decisive.
As I studied the history of midwifery, the enormity of the offence against midwives took me off guard: using sexism, racism, and deceit the midwife was systematically crushed by laws, licenses, and regulations to make way for obstetrics. Doctors formed a monopoly of self-protection that established them as the indisputable authority on all matters relating to the human body and birth. Though unable to deliver on their promises of safe and painless birth, hospitals and doctors wielded enough social and monetary capital to establish laws and community sentiment in their favor. This monopoly was not and has never been based on results: Midwives have consistently provided more intuitive and safe care for mothers and babies. The truth that the Medical Industrial Complex (MIC) desperately needs us to ignore, is that by the system’s own standard, midwifery care is undeniably superior for healthy women.
We have been lied to about birth, and it’s up to each of us to find the truth. The MIC would have us believe that homebirth and midwifery are outdated practices that have naturally been relegated to the fringe of society by “superior” practices in hospitals with medicalized care. This is the mainstream narrative that is easy to believe if you’re not paying attention. But when history is observed closely, it’s apparent that homebirth and excellent midwifery care protects women and children and has been unfairly maligned by the MIC. Even “science” – claimed as the champion of OB care – has consistently proven that while hospital-based care may be an excellent choice for those with exceptional needs, for healthy women, midwifery care offers many benefits that can’t be duplicated by the obstetric model.
Despite the many attacks and barriers to practice midwives have faced, women have persisted in seeking each other out in our childbearing years. Midwifery is in our blood. It is intuitive and instinctual for women to care for other women around the time of birth, and as such midwifery can never be fully eradicated – as many doctors over the years have hoped. While inhumane human birth in hospitals became the norm, there have always been women who wanted something more. In the 1960s we saw the reemergence of the midwife and homebirth, as families were drawn back to a more natural lifestyle. The practice of midwifery has gained incremental ground here and there since that time but has remained a very small part of maternity care in the United States. For midwifery care to be accessible to every mother, many passionate individuals must take radical responsibility for their own wellbeing and radical interest in the welfare of their communities. We need more midwives, and we need to share the truth that birth was never meant to become a medical event. We cannot be afraid to speak the truth about the routine mistreatment of women in hospital birthing rooms. Let this new generation of mothers and midwives boldly tell the world that birth is sacred, that mothers are powerful, and that midwives are the guardians of birth.
Notably, the role of Birth Doulas also began to emerge in the 60s, gaining momentum in the 80s and then in the early 2000s as clinical evidence proved the drastic improvements doulas could provide to hospital-based care. I see doulas as a modern iteration of midwifery to modify and respond to medicalized birth. Today, many women find it necessary to birth in hospital because of specific health concerns or societal pressures. Women are extremely vulnerable in these situations and having a privately hired doula to navigate the MIC with them can be immensely comforting and beneficial. Doulas provide many of the same non-medical skills typical of traditional midwifery. Through attunement, touch, affirming words, education, and advocacy doulas help new mothers find their way to more physiologic birth. Though doulas are great, we are extremely limited by hospital policies and routines.
Doulas and Midwives can only do so much. You are the only person who can birth your baby. No one can do this for you, and you only get one shot at birthing this child. Ultimately, it is the birthing woman herself who must take responsibility, stand in her authority over her birth and baby, and make choices in alignment with the truth. Imagine the possibilities of giving birth in your own power and take steps towards that vision: seek out the midwives, the doulas, the sisters, and the community that will honor and support your motherhood journey. As midwives and mothers find each other, we can be a part of renewing our world. When birth is treated with dignity and tenderness, mothers come to the other side of birth as Queens: powerful women who raise powerful children, free to build a better world.
