In 1998, I was thrilled to visit the shrine for historians: The Smithsonian Institution in Washington, D.C. This museum is unlike any other. Nineteen buildings host various exhibits—so many, in fact, that it is impossible to see everything in one day.
While I have forgotten many of the historical displays, one definitely stands out in my memory. It was a poster depicting a “Man Midwife.”
Now the title alone was enough to intrigue me, especially since I was a registered nurse, then working in a mother/baby unit at a local hospital. The display at the Smithsonian highlighted the debate going on in the late 1700s concerning male physicians undertaking the business of delivering babies.
The picture shows a person of two parts—half physician with his tools of the trade, including forceps and medications; the other half, a female midwife with her arms outstretched in motherly care. The symbolism of interfering medical practitioner vs. comforting, female arms was loud and clear. But the image was also prompted by the disapproval of many who were offended by males becoming involved in such intimate medical care of women.
A letter addressed to “All men in general and to all married men in particular,” was written in 1764 by Philip Thicknesse. His words expressed his outrage at the growing practice:
“Let it be remembered that my motive is thereby to put a stop to impure acts, immodest actions, and the indelicate, unchaste, and unnecessary transactions of Men Midwives, such as they avowedly and publicly profess and such that every man of sense, decency, sentiment, and spirit must and will disapprove, or be totally indifferent as to his wife’s conduct or his own honor.”
In 2012, it is difficult to relate to the emotion and concern of Mr. Thicknesse. But considering the history of childbirth, it is not surprising that only female midwives were considered the acceptable assistants in the birthing process.
Since earliest recorded childbirths in the Bible, midwives were called upon to assist in a birth. And ever since Bridget Lee Fuller delivered the first Colonial babies on board the Mayflower in 1620, midwives had established themselves as the ones to call upon when labor began in the New World. For the next 200 years, midwifery reigned.
Midwives did not go to school to learn the craft—the skill was taught by other midwives. There was no formal training in the early colonies until 1765 when an institute for training was offered in Philadelphia. But many could not afford such schooling and most still apprenticed under more experienced trainers. Many midwives were widows who delivered babies as a way to make a living.
When a pregnant woman knew that birth was imminent, she “called her women together” for the event. Friends, relatives, the midwife—whoever a woman wanted to attend her and speak words of comfort to her—became a part of the birthing scene. It was definitely a female affair, although occasionally, husbands were needed to assist.
Childbirth in Early America was difficult, to say the least. One in eight births resulted in the death of the mother, usually as a result of exhaustion, dehydration, infection, or excessive bleeding. Women often looked toward impending childbirth with dread, one referring to it as “the greatest of earthly miseries.”
A midwife with great skills was highly valued. A diary kept by a late 18th century midwife from Maine named Martha Ballard describes the difficult life that she faced—fording rivers in winter, spending hours and days tending to laboring patients, and occasionally, preparing a deceased patient for burial. But Martha’s record was a successful one for the times: Out of 996 deliveries, there were only four fatalities.
Highly devoted to her profession, Martha continued delivering infants in her community until just before her death in 1812 at the age of 77.
But long before Martha Ballard passed away, the tide was beginning to turn.
By the late 1700s, doctors in England had begun to play a greater role in childbirths. They, in turn, influenced American doctors who trained across the ocean and then brought these ideas home.
The practice of physician-assisted childbirth became popular in the urban areas of Philadelphia, Boston, and New York. These man-midwives brought with them medications and forceps. While the forceps could be handy during difficult deliveries—perhaps saving many infants and mothers who would otherwise have died—the physicians tended to interfere more in a delivery rather than allowing the child to be born at a natural pace like the midwives.
By 1790, midwifery was losing ground to the doctor-assisted delivery. But midwives continued to reign in many areas as the main caregivers of laboring women.