Midwifery

Historical Transformations

In the United States, as well as in many other nations, the predominance of one model of childbirth over the other has shifted historically. As transformations occur in the ways childbirth is defined, so do the types of providers that are given jurisdiction over the process of childbirth. A number of historical accounts chronicling the history of childbirth care in the United [Page 563]States, as well as several European countries, suggest that similar trends have emerged over time that have contributed to the modern state of midwifery (and, alternatively, obstetrics).

Many would argue that there have been at least three major shifts over time in the practice of midwifery. In the United States, for example, the 17th century was marked by the predominance of midwife-attended births. The midwives of this era were examples of what today would be considered “lay” practitioners (i.e., midwives who learned through observation, apprenticeship, and practical experience, without any formal or institutionalized medical education). These women were sometimes considered to be suspect, often by men, in terms of competence and were occasionally considered to be practitioners of witchcraft. The charge of witchcraft against mid-wives, however, is not unique to this era. During the Middle Ages, when many of the biological processes involved in pregnancy and childbirth were poorly understood, many midwives were feared to be “witches” who possessed power and information from supernatural sources. As a result, many of them were persecuted and even burned at the stake.

In the United States, accusations of witchcraft were emblematic of a more Puritanical era in which women who possessed knowledge or power in general were considered to be suspect and potentially dangerous. Slowly, however, as the 19th century approached, a shift occurred during which men began to infiltrate the previously women-centered realm of childbirth and midwifery. Male midwives sought to professionalize the field and increasingly limit jurisdiction over the process of delivery, which led to a third historical shift in childbirth care, toward the highly professionalized and medicalized modern obstetrics that has continued into the 21st century.

One might argue that there is evidence of a fourth shift on the horizon, as the use of modern midwives, certified nurse midwives (CNMs), is on the rise. In several countries throughout the world, there are institutionalized certification programs for nurses wishing to specialize in midwifery, contributing to both the public and professional confidence in midwifery and the increased utilization of certified nurse midwives. While midwife burning is largely a thing of the past, there are still heated debates among practitioners over who should have jurisdiction over childbirth.

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