Case II

Midwifery in the 1830s

Book excerpt

By: Horton Howard

Date: 1832

Source: Horton Howard. A Treatise on the Complaints Peculiar to Females: Embracing a System of Midwifery; the Whole in Conformity with the Improved System of Botanic Medicine. Columbus, Ohio: Horton Howard, 1832.

About the Author: William Ripley, a physician whose notes on one woman's labor and delivery are reprinted in the excerpt below, was part of a movement in the early nineteenth century to replace female midwives with male physicians.

INTRODUCTION

Midwives provided most obstetrical and gynecological care for women until the 1800s. Birth was largely regarded as a natural process that did not require specialized medical knowledge, although an experienced midwife's skills were considerable. Anyone who had borne several healthy children and observed several births was considered qualified by these experiences to assist other women through pregnancy and delivery.

Midwives usually provided mostly moral support as nature took its course during pregnancy, although they were capable of providing some assistance, such as attempting to turn a fetus in the womb to enable a better presentation for birth. Intervention during labor was uncommon, and was usually undertaken only in the case of an impossible delivery or the death or near death of the mother or fetus. Midwives did not use forceps, which were reserved for physicians, nor did they possess the instruments necessary for performing an embryulcia (extraction of the fetus from the uterus) in the event of fetal death or high risk of maternal death. They did not engage in bloodletting, purging, or other complicated procedures. Nevertheless, they probably (and unwittingly) contributed significantly to maternal deaths by delivering a series of children in the course of a day without washing their hands. Unaware of the dangers of germs, both midwives and physicians spread puerperal (childbed) fever, a common infection of the reproductive organs that often proved fatal.

Traditional midwifery began to disappear in urban centers in favor of medical obstetrics between 1760 and 1820 as a consequence of both new medical technology and physician's strong opposition to midwives. With their forceps and opiates, physicians promised a safer and more comfortable delivery. Pregnant women believed that the superior training of these men meant safer and shorter labor. In reality, it did not. Mothers faced an increasing threat of infection from the use of unwashed forceps as well as a possible anesthesia overdose or damage from forceps. Only after 1940 did medicine achieve the record of safety that it had promised to women in earlier centuries.

White midwives gradually disappeared in the United States by the mid-nineteenth century, as (male) physicians took over their practices. The few who remained worked essentially as physician's assistants. Birth became a medical event to be managed by interventionist attendants. The situation among the black population was markedly different. Africans Americans generally lacked the money to pay physicians fees. This combination of economics and racial prejudice allowed black midwives to maintain thriving practices into the twentieth century, long after their white colleagues had vanished.

The following passage from A Treatise on the Complaints Peculiar to Females Embracing a System of Midwifery illustrates, in one laboring woman's case, the initial role of the midwife, and the ensuing consultation of two physicians.

PRIMARY SOURCE

On the 12th day of Oct. 1830, at 9 o'clock, P.M. I was called on by Jesse Adams to see his wife, who was attacked with puerperal convulsions. She had been in hard labor about fourteen hours, with very little progress. A midwife was called in at first, but when she was attacked with convulsions Dr. Ramsay was called, who was then President of the Medical College of Ohio. When Dr. R. arrived, she lay in a state of total insensibility, and could not be aroused. The Doctor, after an examination, said his engagements were such that he could not undertake her case, as it might detain him a longer time than he could spare, and advised that another doctor should be sent for immediately, and left her. I arrived about two hours after he left; but there was no material change in her condition, excepting that she could be roused a little, and she swallowed some medicine, viz: a tea of raspberry leaf and valerian, and a little of the third preparation of Dr. Thomson; after which she soon revived, and labor came on. On examination, I found the os tineæ (mouth of the womb) dilated, and the child's head at the inferior strait of the pelvis. The pains were regular, with regular intervals, effectual but not severe. She was in this condition when I had been there about twenty minutes, and Dr. Ramsay came in again. He inquired of me how long I had been there; I told him about twenty minutes: he then inquired of the midwife how she had been in his absence; and on being informed, he asked me what I thought was the prospect. I told him I thought it favorable, and I did not apprehend any difficulty. He staid by while she had several pains, and then advised to give the ergot tea. I told him I thought we could do without it. He then took his leave; but as he went out, several women who were present went out with him to learn what was his opinion of the case. He answered them freely, that he thought it a very bad case, and very dangerous; and said he was much mistaken if she got through safely. However, the child was born within about fifteen minutes after his departure, and the woman had a very comfortable night; and she and the child are both well at this time, it being the 9th of February, 1832.

                                        WILLIAM RIPLEY.

SIGNIFICANCE

By the late 1960s, and spurred by the scientific advances of the germ theory of disease, midwives had largely vanished from the landscape of American medicine. The women's health movement spawned by feminism in the early 1970s prompted many to challenge some aspects of traditional modern medicine. Male obstetricians typically practiced a patriarchal style of medicine with the patient expected to follow orders. Midwifery, with its focus on women caring for women, offered a less hospital-centered and more informed, supportive birth experience.

When physicians replaced midwives, their holistic approach vanished as well. Midwives traditionally supported women throughout labor by explaining the physical process, offering words of encouragement, and helping to lessen their patients' fears. Focused almost entirely on delivering a healthy baby, physicians did not always consider the mother's needs and concerns.

Modern midwives are often advanced practice nurses with master's degrees who can prescribe medication, so some of the old advantages offered by physicians no longer apply. Nurse midwives additionally provide gynecological services such as annual exams, contraception information, and menopause care that some women prefer to receive from another woman.

In the first decade of the twenty-first century, coaches who provide physical and emotional support for laboring mothers called doulas enjoyed a resurgence in popularity. The term, which means "wise women," dates to ancient Greece; a modern doula fulfills all the duties of a midwife except for actually delivering the baby. Although the number of doulas nationwide remained quite small at 5,000 in 2004, the steadily increasing popularity of such helpers reflected the trend toward a more patient-centered delivery.

FURTHER RESOURCES

Books

Walzer Leavitt, Judith. Brought to Bed: Childbearing in America, 1750 to 1950. New York: Oxford University Press, 1986.

Periodicals

Robinson, Sharon A. "A Historical Development of Midwifery in the Black Community, 1600–1940." Journal of Nurse Midwifery 29, no. 4 (1984): 247-250.