......Historical Perspective Series

Informative Comments
by Physicians
& Midwifery

1911 -- 1925

Ancient Historical Background

"The practice of midwifery is as old as the human race. Its history runs parallel with the history of the people and its functions antedate any record we have of medicine as an applied science. Midwives, as a class, were recognized in history from early Egyptian times. The practice of midwifery is closely bound by many ties to social customs and prejudices." [1925-A; Hardin, MD p. 347] ^104

"That Socrates' mother was a midwife bears testimony to the honorable nature of such a profession at a time when civilization in one of its highest forms was at its summit." [1911-G; BakerMD, p. 232] ^108

"As a class midwives were recognized in history from early Egyptian times. In the history of European continent the practice of midwifery by the medical profession did not begin until the middle of the 16th century. In the East the practice is exclusively confined to women for social and religious reasons." [1911-E; PriceMD, p.221] ^103

"The practice of midwifery dates back to the beginning of human life in this world. At this supreme moment of motherhood it is probable that some assistance has always been required and given. Its history runs parallel with the history of the people, and its functions antedate any record we have of medicine as an applied process. To deny its right to exist as a calling is to take issue with the eternal verities of life. The only points upon which we may argue are the training required for its safe and lawful practice, and the essential fitness of those who follow this calling requisite for the safeguarding of the mother and child." [1911-G; BakerMD, p. 232] ^105

Commentary about practicing midwives
-- early decades of 20th century

"She not only performs the duty of an accoucher, but subsequently for a period of a week or ten days takes care of the infant... The greater percentage of all labors being normal ones, and perhaps 95 percent of these in multiparae, the midwife and mother seems to experience very difficulty." [1911-F; BeitlerMD, p. 229] ^109

Discussing to the implementing of his state's midwifery law, noting that: "While the process of licensing and registering is rather complicated, they followed practically every detail, and all of them (who have come) to our notice (34) have been properly licensed and registered in the county of practice." [1911-F; BeitlerMD, p. 223] ^110

"California interviewed 500 midwives, finding that 80% were well-trained Japanese. Half of the remaining number seemed capable of receiving and assimilating instruction." [1925-A p. 350] ^111

Obstetric training in the medical colleges is recognized as inadequate, [yet] there is no voice raised to eliminate the doctor from the practice of midwifery. Dr. Hirst is at present circularizing the State Board of Health to establish a standard for obstetrical experience for (physician) candidates for licensure, and ... he suggests the personal delivery of 6 women. In NYC, the midwife is required to have the personal care of 20 women before a permit is granted to her. The irregular practitioner of medicine is still permitted to be an obstetrician with an experience that is inferior to that possessed by more than half of the midwives. Let us be fair to the midwife, I say, and if she is below the ideal we have for her, though we have never crystallized that ideal into law, let us give her the opportunity to rise and educate herself under proper supervision. [1911-G; BakerMD, p. 224] ^112

Dr. Ira S. Wile, New York City: “But it is manifestly unfair to criticize the lack of an educational standard which has never been established. When nurses were of the Sairey Gamp type, elimination was not the cure. When apprenticeship was the open sesame to the practice of medicine ...elimination was not the cure. Education, training, regulation and control solved these problems just as they will solve the midwife problem. Establish an educational standard, provide sufficient facilities for giving the adequate training, secure the legislation essential to provide the supervision and control and then raise the standard of the midwife so that no further fault may be found. Let us to fair to the midwives and their patients. Let there be an evolution of this class of public servant and not a hasty attempt to check their possible development.” [1911-G; BakerMD, p. 244] ^113

A Member: “I would merely like to state the way we feel about the midwife situation in New York City. The midwife at present delivers about 40 percent of all births and they are doing really excellent work. We find that they obey many of the rules perhaps better even than the physicians; for instance, the rule in regard to treating the eyes and matters of that sort. The tendency in New York does not seem to be, I think, toward the abolishment of the midwife. ... What we do want to achieve, through is the education of the midwife, ... there has been established in connection with Bellevue Hospital, is a training school (for midwives). ... Inasmuch as physicians, ... do not like the work and usually, as the progress in their practice, give it up as rapidly as they can, it seem to me that we ought to recognize the fact that the midwife is a very useful situation.” [1915-H] ^114

Comparison of statistics and safety record of
midwives with physicians of the day

"It is generally admitted that more women die during confinement in the hands of doctors that among midwives. (Dr.) Williams, in his remarkable and epoch-making paper, seems to have demonstrated this as the prevalent opinion. The fact that only about 40% of the women in the US employ midwives does not explain the difference." [1915-C; DeLeeMD] p.117 ^127 ^122

"These figures certainly refute the charge of high mortality among the infants whose mothers are attended by midwives, and instead present the unexpected problem of explaining the fact that the maternal and infant mortality for the cases attended by midwives is lower than those attended by physicians and hospitals." [1917-B; Levy, MD] ^116

"We talk long and loud about supervising the midwife but not a word about supervising the doctor." [1922-A; ZeilgerMD, p.411] ^128

Questionnaire from Dr. Williams to professors of obstetrics in 1910: “Do you believe that more women die from puerperal infection and eclamsia in the practice of midwives or general practitioners? ^117

..of the 35 who answered , 17 stated [that more mother die from the care of physicians] while 13 [from midwives] while 5 held that their death rate was about equal. ...the majority of teachers in this country consider that general practitioners lose as many and possibly more women from puerperal infection than do midwives. This is an appalling conclusion as it is generally believed that infection is the main cause of preventable deaths in the practice of the latter[i.e. midwives].” 1911-B; WilliamsMD p. 179

Questionnaire from Dr. Williams in 1910: “Do as many women die as a result of ignorance or ill-judged and improperly performed operations in the hands of general practitioners, as from puerperal infection in the hands of midwives?”^118

“of the 35 [who answered], 26 said the general practitioner. Moreover, [many report] the unnecessary deaths of large numbers of children resulting from improper operating, and the failures to recognize .. a contracted pelvis. As the argument usually advanced against the midwife is the frequency with which infection occurs in her practice, such conclusion comes as a surprising revelation."1911-B; WilliamsMD, p. 180

"What a showing! The generally accepted motto for the guidance of the physician is “primum non nocere;” and yet more than 3/4 of the professors of obstetrics in all parts of the country, in reply to my questionnaire, stated that incompetent doctors kill more women each year by improperly performed operations than the ... midwife...." 1911-B; WilliamsMD p.180 ^119

“A thoroughly competent professor in one of the large cities, in which more than 1/2 of all labors are conducted by midwives, states [that] although the smaller portion of obstetrical work is in the hands of physicians that they, nevertheless, lose from infection many more women than do the midwives." 1911-B; WilliamsMD p. 181 ^120

If it appears necessary to reform anything, here is the opportunity. Why bother the relatively innocuous midwife, when the ignorant doctor causes many more absolutely unnecessary deaths". 1911-B; WilliamsMDp.180 ^121

"The replies clearly demonstrate that most of the medical schools ... are inadequately equipped for their work and are each year turning loose upon the community hundreds of young men who are not properly prepared for the practice of obstetrics and who cause the unnecessary deaths of thousands of women and young infants, not to speak of a much larger number who are ... permanently injured by improper treatment or neglect. Moreover, the spontaneous admission by more than 3/4 of the respondents that medical men are responsible for more deaths in childbirth than the much maligned and ignorant midwife, forces to acknowledge that improvement in the status of the latter (i.e. midwives) alone will not materially aid in solving the problem." [1911-B; WilliamsMD p.181] ^122

"A priori, the replies seem to indicate that women in labor are safer in the hands of admittedly ignorant midwives that in those of poorly trained medical men. Such conclusion however, is contrary to reason, as it would postulate the restriction of obstetrical practice to the former (midwives) and the abolition of medical practitioners, which would be a manifest absurdity." [1911-B; WilliamsMD] ^123

"The discrepancy is in part explicable by the fact that, with few exceptions, midwives recognize their inability to cope with obstetrical emergencies and therefore limit their activities to the care of apparently normal cases of labor .... On the other hand, the average practitioner does not recognize his own limitations, but in his ignorance feels that he is as competent to cope with abnormal conditions as his efficiently trained confrere, whose aid he solicits only after futile attempts at delivery have demonstrated his inability to complete the task. Consequently, the specialist as a rule does not see the patient until her condition has be come deplorable." [1911-B; WilliamsMD] ^124

"When we recall the homes in which the midwife works, the housing, social, and economic conditions under which her families live, I see little reason for condemnation of elimination of the midwife, or the establishment of costly hospitals to care for all maternity cases. Our experience rather justifies our faith in their usefulness under proper supervision and cooperation." [1917-B; Levy, MD] ^125

“The Relation of the Midwife to Obstetric Mortality, with especial Reference to New Jersey”, p. 816-822 : ..... the stationary or increasing mortality in this country associated with childbirth and the new-born is not the result of midwifery (1) practice, and that, therefore, their elimination will not reduce these mortality rates”, [1924-A; RuckerMD Rebuttal by Dr. Levy, p. 822] ^126

"Moreover an advantage, to the patient, of the midwife over the doctor, which never must be lost sight of in any plan for the elimination of the midwife, rests in the fact, that the midwife not merely delivers the women, but often bathes the mother and baby, cares for the other children of the household and frequently acts as housekeeper and cook as well." [1915-A; EdgarMD p. 94] ^127

"For many physicians, especially some noted obstetricians, there is no midwife problem; they have long since settled the question by vehement condemnation of the midwife and the recommendation that all who engage midwives from tradition or economic necessity should be delivered in finely appointed hospitals at public expense." [1917-B; Levy, MD] ^129