Demise of Midwives as Primary Caregiver of Childbearing Women - Literature review Example

Running Head: The Demise of Midwives as Primary Caregiver of Childbearing Women Student’s Name: Instructor’s Name: Course Code and Name: University: Date Assignment is due: Abstract This paper follows the thread of history from when midwives were the sole and primary caregivers to childbearing women, through their replacement with doctors and the eventual comeback in the contemporary society. The crucial mandate of the paper is to identify any historical factors have contributed to the demise of midwives as the primary caregiver of childbearing women and increased their subordination to doctors in the progress of the discussion. It emerges from the paper that, the important role that midwives have played through the ages as the primary caregivers of childbearing women, especially in Western cultures, faded into obscurity due to several factors. According to the paper’s argument, the first factor in play towards the loss of esteem among midwives was lack of formal training. Secondly, the midwives’ reputation over the years since the Middle Ages, castigated them towards the loss of esteem and respect. For many years, midwives had been portrayed as ignorant, dirty and illiterate women. Thirdly, advances and developments in the practice of medicine gradually gained power and social legitimacy by the end of the 19th Century, thus eliminating the role of untrained midwives. Another of the contributing factors was the fact that childbearing was becoming a distinct field of medicine with specialists emerging in pre-pregnancy care, delivery and post-pregnancy care. These physicians were trained in such specialty areas as obstetrics and gynaecology. Further, governments started controlling their populations and eliminating the high child mortality rates associated with home deliveries, while at the same time, the traditional social setups were changing and thus instilling changes in gender roles and perceptions, thus admitting men into childbirth processes. All these factors led to the misplacement of midwives by doctors as primary caregivers to childbearing women. Discuss what historical factors have contributed to the demise of midwives as the primary caregiver of childbearing women and increased their subordination to doctors Introduction Since time immemorial, midwives have always been a part of human existence. They are there in the times of the bible and in the times of the Koran MidwiveInfo (2010). They have always been part of the society, and in for a long time, they were the only help available for child bearing women. Jews used to call them wise women, the French called them ‘sage-femme’, the Germans called them the ‘weise frau’ MidwiveInfo (2010). In Latin they were called cum-mater, The Portuguese and the Spanish called them ‘comadre’ while the English called them 'midwives' MidwiveInfo (2010). These women were respected, they had an honourable calling and they survived within all classes and social setups, across all cultures and among all peoples (Kitzinger, 1988; Siegemund & Tatlock, 2005). In the bible, Genesis 35:17, explains about a midwives comforting words to Rachael as she delivered a son, and in Exodus 1:20, the bible says, “God dealt well with the midwives, the people multiplied and waxed very mighty." That is a singular historical context which captures the importance of midwives in the society (Kitzinger, 1988). This importance of the profession is evident in the ancient times and also in the primitive societies, since the role of midwives had a technical, a manual aspect and a mystical or magical aspect to it, equivalent to the preciousness of life itself (Rooks, 1999; Siegemund & Tatlock, 2005). Midwives were thought of as people who saved the life of the mother (owing to the huge number of women who died in childbirth) and who gave life to the newborns (owing to the huge number of stillbirths) (Rooks, 1999). In many traditional societies, midwives were revered, feared and at times, even acknowledged as the leaders of their society. Midwives were rightly thought of as people who bridged the path to life for every new child born, an area that was held in deep mystery and respect by many societies (Rooks, 1999; Siegemund & Tatlock, 2005). Every childbearing woman relied on the skill and knowledge of the midwives in that particular area (Kitzinger, 1988; Siegemund & Tatlock, 2005). The irony is that at the time that midwives were as important as they were in the society then, they had no formal education. Even in the late stages of civilisation, across Europe and America, midwives had no formal education (Rooks, 1999). It was more of a trade, an inheritance from parents and an art that people chose and learnt to practice informally (Kitzinger, 1988; Siegemund & Tatlock, 2005)). Surprisingly, rather than from learning, most societies assumed that midwives' ability and power came from supernatural sources (Ehrenreich & English, 2000). Some midwives were thus attributed with good gods, others were thought of as and lack, others were said to have alliances with devils etc (Ehrenreich & English, 2000). It is this perception and ignorance that made midwives during early and late Middle Ages’ massacres of women (Kitzinger, 1988). The church and their subjective civic authorities burnt and killed millions of women for being midwives, witches and healers (Ehrenreich & English, 2000). Achterberg’s 1990 book, Woman as Healer, she describes witch-hunts based on human ignorance of a European society that feared midwives to the extent of authorities classifying them as ‘an evil that surpassed all rational understanding’. Yet this did not in any way reduce the owe and respect accorded to midwives even in these communities (Rooks, 1999). According to Achterberg (1990), the community knew and recognized the special role of midwives, especially the childbearing women, and loathed the fact that pretty much of life was in the hands of the skilled, mysterious and sometimes strange women. That role would remain pretty much throughout civilization until very recently (Achterberg, 1990). Yet in a very strange turn of events, midwives would for a time be phased out of the society, their role scraped and their duties discredited (Ehrenreich & English, 2000). Midwives would eventually lose their pedestal in the society as the primary caregivers of childbearing women in many communities, especially Western communities for a host of reasons (Rooks, 1999). Newly emerged in the society, the physicians (doctors) would assume the important role of being primary caregivers to childbearing women and replace the midwives who had forever held that role. What lead to such change of fortunes? What happened to midwives and why were they replaced so easily? In the next section, this paper will review several factors that were responsible for the midwives loosing they esteemed position to doctors, as the primary caregivers to childbearing women. Factors that Have Contributed to the Demise of Midwives as the Primary Caregiver of Childbearing Women and Increased their Subordination to Doctors Following the discussion above, it is evident of the important role that midwives have played through the ages as the primary caregivers of childbearing women. Yet as it was noted at the end of the introduction, there came a time, especially in Western Cultures inclusive of European, American and Australian communities, that the midwives were replaced by doctors (Rooks, 1999). Asian, African and Middle East communities retained the important role of midwives for the longest period and only in their belated civilisation times that midwives started competing with midwives. That trend has been reversed now and midwives are, once again, becoming the primary caregivers of childbearing women. The reasons for their comeback, explains why midwives faded out of their importance with civilisation in the first place. According to MidwiveInfo (2010), today the world respects the professional midwives as the best attendants to women in labor or during birth. Midwifery has become a distinct medical field. The countries of the world recording the childbirth outcomes; have midwives as the primary care providers to pregnant women. But the difference between modern and traditional midwives is that, modern midwives are professionally trained to execute their duties (Breckenridge, 1981). a) Formal Training The first factor in play towards the loss of esteem among midwives was lack of formal training. The traditional midwives had no formal training in their practice and some of them practiced the art poorly and without skill (Ehrenreich & English, 2000). The fact that they were not trained made them lesser than the merging physicians who had the formal training. Between the 1770’s and the 1820’s, most upper-class women across Europe and America preferred physicians (Rooks, 1999). Scholten Catherine in her esteemed book, Childbearing in American Society: 1650-1850, writes about a change of attitude among childbearing women and their families with the arrival of the trained physicians who had every advantage over the practising midwives (Scholten, 1985). As the society progressed in training their medical practitioners and as professionally trained physicians took centre stage in solving the medical problems of the society, midwives were fading into obscurity just as much as blacksmiths were when swords became the lesser weapons in the emergence of guns (Scholten, 1985). b) Reputation Secondly, the very reputation of midwives which had survived through the years, of mysterious and sometimes evil women, plagued a society that was striving towards the light of civilisation (Ehrenreich & English, 2000). More than anything else, the attribute of midwives as mysterious, evil, sorcerers and insidious, made the men and women of class to abhor them as the society progressed (Kitzinger, 1988). Their reputation over the years, from the Middle Ages at a time when they were actually burnt alive, castigated them towards the loss of esteem and respect (Kitzinger, 1988). For many years, midwives had been portrayed as ignorant, dirty and illiterate women to the extent that women were convinced, by and by, that it was safer to be in the hands of trained doctors in hospitals, than under the primary care of midwives (MidwiveInfo, 2010; Ehrenreich & English, 2000). In essence therefore, having provided primary care to childbearing women for all the formative decades of the contemporary society, the midwives were stamped out effectively during the years past the 20th Century (MidwiveInfo, 2010). c) Developments in Medicine The practice of medicine gradually gained power and social legitimacy by the end of the 19th Century (Rooks, 1999). People started going to the hospital and many government, most remarkably the American government, called for an abolition of home-based midwifery and home-birth where untrained midwives were the primary caretakers of childbearing women (Rooks, 1999). The new primary caregivers became obstetrics in the hospital setting (Rooks, 1999). It is important to note that in 1900, the midwives had attended more than half of all the births in America while at 1935, only 12.5% births had been conducted by midwives (Rooks, 1999). People had slowly started to view hospitals as the safest place to have a delivery, mainly because of the developments registered in the medicine field (Rooks, 1999). Hospitals were using disinfectants, anti-bacteria and pain killers (during labour) as opposed to midwives. Childbirth was becoming more and safer and less painful in hospitals as compare to home delivery under the hands of midwives. This explained why many women increasingly preferred the doctors over the midwives (Rooks, 1999). d) Medicalization of Childbirth Another of the contributing factors to the misplacement of midwives by doctors as primary caregivers to childbearing women was the fact that childbearing was becoming a distinct field of medicine with specialists emerging in pre-pregnancy care, delivery and post-pregnancy care (Rooks, 1999). These physicians were trained in such specialty areas as obstetrics, gynaecology etc, and they thus declared themselves as the best and most proper caregivers to childbearing women. This eventually saw the evolvement of births from physiological events into medical procedures. It would only require ma few years for hospitals to become the most esteemed setting for childbearing, especially for the high class (Ulrich, 1990). Dr. J. DeLee, a foremost authority of the day, childbirth at home and with midwives became a dangerous process from which very few women ever escaped unscathed (Ulrich, 1990; Ehrenreich & English, 2000). Hospitals on the other hand management the procedure properly, or seemingly better, that the midwives could (Ulrich, 1990). To most upper class women, their pathological condition was seen to require a routine medical intervention and not just therapeutic care of the midwives. According to DeLee as quoted in Ulrich (1990), the recommended hospital-based interventions that women trusted most included episiotomy, anesthesia and assisted delivery (forceps). Ulrich (1990) notes that by the 1960’s, all these medical interventions during childbirth were available in many hospitals across the world. By the end of the cold war, most European and American women were ignorant or unaware of any other way in which they could give birth but in hospitals (MidwiveInfo, 2010). For the first time ever, women were giving birth without the pains of labor and having their infants taken care of after delivery in newborn nurseries (MidwiveInfo, 2010). It was in this age that bottlefeeding emerged as a norm (MidwiveInfo, 2010). The available literature, as documented by Ulrich (1990) and MidwiveInfo (2010), any baby born outside such a sterile environment as provided by a hospital’s operating room was labelled as contaminated. Controversially, as claimed by MidwiveInfo (2010), there lacked a scientific rationale in and for most of these procedures to the extent that, ‘many were eventually proved to be harmful’. e) Legal Control As governments started to control their populations, and to eliminate the high child mortality rates, home deliveries were seen as a threat. Most governments advocated for and demanded that women give birth in hospitals under the care of qualified doctors. In this development, midwifery was ultimately declared as illegal in numerous jurisdictions of the world and the old grannies (midwives) died out (MidwiveInfo, 2010). The society saw the profession almost die with these talented women, women who had served generations and generations since the emergence of mankind (MidwiveInfo, 2010). During the post-cold war years, there was a stiff policy and public debate campaign against midwifery, to the extent that the humble profession almost succumbed to the social changes (MidwiveInfo, 2010). The war against home deliveries was waged against women who still trusted midwives and the practitioners of midwifery. However, it never died out completely (MidwiveInfo, 2010). The only place that midwives were viewed as important and occasionally used, not out of choice but due to economic and infrastructural backwardness, were in such marginalized poor communities as the black Americans in Southern states (Clark, 1989). In these areas, the government was not as vigilant to eliminate home deliveries or to provide enough hospitals for the childbearing women in the communities (Clark, 1989). f) Change of Gender Roles In the traditional social setups, women had their place under the complete domination of men. The roles assigned the feminine gender in most communities was that within the homestead. Women lacked the recognition or admission in important functions of the society. Midwifery had for long been considered the jurisdiction of women. It was an exclusive area or practice for women. However, gender roles were progressively changing encourse civilisation, and educated women were coming out of the domestic cocoon. More importantly, male doctors were being trained and charged with the responsibility of hospital deliveries. The emergence of male physicians in hospitals conducting childbirth became a novel idea that many women liked (Clark, 1989). For the first time ever, men were involved in childbearing and this was only possible in hospitals and not under the midwives. During the 19th Century, more and more women preferred, as they still do, to be under the hands of male specialists. It was deemed better to give birth in hospitals, where most physicians were predominantly male, than at home (Breckenridge, 1981). Even when women were admitted into the medical field, the scenario had forever changed with the changing urban life and changing social perceptions. Male obstetricians remain the prime choice of many women today (Clark, 1989). g) Towards the Future – Emergence of Nurse-Midwifery According to MidwiveInfo (2010), it was in these darkest times of midwifery, that the seeds of its future were planted, forever cementing midwifery into the domains of medicine. Without forewarning, midwives found their way into hospital establishments and into the medical field. Public health nurses began specialising in child delivery, such as the 1920’s Frontier Nursing Service of Kentucky or the Maternity Center Association of New York City (Breckenridge, 1981). The nurses sought to acquire the professional training in midwifery the lack of which, had decimated their pioneer midwives. Such pioneers as Mary Breckenridge are today honoured for introducing modern nurse-midwifery in America based on a model being practiced in Britain in the 1970’s (Breckenridge, 1981). It was a slow and unheralded revolution, but it has today seen the midwives emerge in health care establishments, with a central role in modern times’ childbearing (Breckenridge, 1981). Conclusion The paper’s argument has followed the thread of history from when midwives were the sole and primary caregivers to childbearing women, through their replacement with doctors and the eventual comeback in the contemporary society. It was the crucial mandate of the paper is to identify any historical factors have contributed to the demise of midwives as the primary caregiver of childbearing women and increased their subordination to doctors in the progress of the discussion. It thus emerged that, the first factor in play towards the loss of esteem among midwives was lack of formal training. Secondly, the midwives’ reputation over the years since the Middle Ages, castigated them towards the loss of esteem and respect. For many years, midwives had been portrayed as ignorant, dirty and illiterate women. Thirdly, advances and developments in the practice of medicine gradually gained power and social legitimacy by the end of the 19th Century, thus eliminating the role of untrained midwives. Fourthly, childbearing was becoming a distinct field of medicine with specialists emerging in pre-pregnancy care, delivery and post-pregnancy care, with physicians being trained in such specialty areas as obstetrics and gynaecology. Fifthly, governments started controlling their populations and eliminating the high child mortality rates associated with home deliveries. Finally, the traditional social setups were changing and thus instilling changes in gender roles and perceptions, thus admitting men into childbirth processes. According to the paper’s argument, all these factors led to the misplacement of midwives by doctors as primary caregivers to childbearing women. References Achterberg, J. (1990). Woman as Healer. Boston: Shambhala Publications. Breckenridge, M. (1981). Wide Neighborhoods: A Story of the Frontier Nursing Service. Lexington: The University Press of Kentucky. Clark, K. (1989). Motherwit: An Alabama Midwife's Story. New York: E.P. Dutton. Ehrenreich, B. & English, D. (2000). Witches, midwives, and nurses: a history of women healers. Second Edition. New York: The Feminist Press. Kitzinger, S. (Ed). (1988). The Midwife Challenge. London: Pandora Press. MidwiveInfo (2010). A Short History of Midwifery. Retrieved 13 September 2010, From http://midwifeinfo.com/articles/a-short-history-of-midwifery Rooks, J. (1999). Midwifery & Childbirth in America. Philadelphia: Temple University Press. Scholten, C. (1985). Childbearing in American Society: 1650-1850. New York: New York University Press. Siegemund, J & Tatlock, L. (2005). The court midwife. Chicago: University of Chicago Press. Ulrich, L. (1990). A Midwife's Tale: The Life of Martha Barrard, Based on Her Diary 1785- 1812. New York: Random House. Read More