Historical Perspectives Series 1911-1925  
 

Controversies
by the
Medical Community
Surrounding the
Formal Education
of Midwives

    Baby Boy Joshua Arritt.1993

Midwife-Friendly Commentary
By Physicians

~ "New York City is entitled to the honor of having established the first School for Midwives in the United States under municipal control. During the summer of 1911, Dr. John Winters Brannan, President of Bellevue and Allied Hospitals of New York, obtained from the city a special appropriation for this purpose, and in July this school was officially opened. It is situated in a separate building, devoted exclusively to that work, and now has accommodations for eight patients, with a possibility of expansion within the near future. The present class of midwives numbers eight.." [1911-G, p. 2??] ^1


~ "Each midwife must witness or assist in at least 80 deliveries and in addition, deliver a minimum of 20 cases. When this course is completed, a practical and oral examination is given by a visiting obstetrician and if the candidate successfully passes these a diploma is granted." [1915-A; EdgarMD p. 98] ^2


~ "The training of midwives in Germany, where they are required to spend 6 months in a Government obstetric hospitals under the instruction and supervision of trained obstetricians, is far superior to that which the great majority of physicians receive in this country before graduation." 1925-A p. 347 ^3


Anti-Midwife Commentary
Rationales for Prohibiting the Establishment
of Midwifery Training Schools


"No attempt should be made to establish school for midwives, since, in my opinion, they are to be endured in ever-decreasing numbers while substitutes are being created to displace them." [1912-B, p.227] ^4

"I am opposed to educating and licensing midwives... I do not believe it possible to train women of the type of even the best of the midwives to practice satisfactorily." [1912-B, p.223] ^5


"So much is needed before we can hope to give to the students gradating from our medical schools adequate training in obstetrics and before we can hope to compete with the German medical schools." [1912-B, p.224] ^6


"If ... the money which would be necessary for the establishment and maintaining 200 schools for midwives, together with what would be necessary to supervise the midwives properly in their practice afterwards, were used to pay physicians and nurses care for the midwife cases, sufficient money would be available, to say nothing of the 5 million dollars which it is estimated in collected annually by midwives in this country and which should be paid to physicians and nurses for doing the work properly." [1912-B, p.225] ^7


"It is quite possible by strict educational requirements, by imposing certain qualification as to the experience and training, AND IN OTHER WAYS, to restrict the practice of midwifery to such a degree as to amount to practical abolition. Such a method is necessarily more slow than direct abolition. It can be carried out, ... according to the forms of law." [1911-E, p. 225] ^8


TRAINING OF MIDWIVES -- Commentary by Dr. Williams:

"In 1850, Dr. James P. White, introduced into this country clinical methods of instruction in obstetrics. Yet, during the following 62 years ... our medical schools have not succeeded in training their graduates to be safe practitioners of obstetrics. If this has been the case with the relatively intelligent medical student, I must confess great skepticism concerning the possibility of doing better or even as well with the class of women who are likely to become midwives, even if abundant facilities for their training were at our disposal." 1911-B; WilliamsMD ^9


"Moreover, the fact that their employment is very restricted in both Boston and Montreal indicates that they (i.e. midwives) are not absolutely necessary and lends additional strength to the argument of those who believe in their ultimate suppression. I am prepared to advocate their gradual abolition, and their replacement by a marked extension of lying-in charities." 1911-B; WilliamsMD ^10


"The majority of respondent to my questionnaire appear to believe that midwives at present do less harm than irresponsible practitioner, they could be left alone with comparative safety. I am dubious of developing satisfactory midwives by any means of instruction." 1911-B; WilliamsMD ^11


"I know that in taking this stand I shall be in opposition to many earnest workers who think otherwise; but I hope that the deplorable condition of obstetrical instruction for medical students, as revealed by this report may cause them to hesitate before definitely committing themselves to a propaganda advocating extensive training of midwives."1911-B; WilliamsMD ^12


"If such conclusions are correct, I feel that ...[we must] insist upon the institution of radical reforms in the teaching of obstetrics in our medical schools and upon improvement of medical practice, rather than attempting to train efficient and trustworthy midwives." 1911-B; WilliamsMD p.166 ^13


"From all information available it seems that what is most needed is the better training of physicians in obstetrics, and not an attempt to educate the midwives to the extent of the European countries. If this is done she may become a fixed element in our social and economic system and assume a legal status which later cannot be altered. It is at present impossible to secure cases sufficient for the proper training of physicians and nurses .... since about 75% of all material otherwise available for clinical purposes, is utilized in providing a living for midwives." 1925-A p.348 ^14


"If anything is to be done, I feel very strongly that it can be accomplished only after a long campaign of education--not of midwives--but of the public and its legislators, who must be taught that effective training [of physicians] will be very expensive, as it will require the establishment of special institutions, where long periods of practical instruction can be given, as well as the development of an efficient system of supervision, with powers of punishment, which will be quite contrary to our usual lawless customs." 1911-B; WilliamsMD ^15


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