Tuesday, April 24, 2012

Midwifery; a David and Goliath Tale

The story of midwifery in America is a classic power struggle for women’s rights, respect and choice; a tale of the clash of women’s culture and values with the male dominated spheres of science, medicine and finance. It is an ugly story laced with racism and class war fare. This struggle continues to walk the halls of political power and sits in insurance industry board rooms today.
It began as the eighteenth century was drawing to a close and the science of medicine was on the rise. Men for the first time began to move deeply into the privacy of the birth room, a place that in most cultures around the world is traditionally populated almost exclusively by women. This slow and determined encroachment into what had previously always been a woman’s world began the battle.

Before men became involved American midwives had always held a place of respect within their communities. Their skill at helping women during the birth process was of vital importance to all in the community. Women were encouraged to stay mobile as long as possible during the birth, the pain of the process was recognized but not believed to be insurmountable, the passage of time was noted but there were no standardized graphs labors had to abide by, and women utilized up-right physiologically sound positions for pushing a baby out.

When male doctors took over this all changed. Pain relieving drugs were used as an inducement to have doctors attend women’s births. These medications changed the balance of power forever; stripping the woman’s innate abilities. She became an object to practice medicine upon; someone who needed her baby delivered to her like a pizza instead of using her own physical power to bring her baby forth. Soon untested scientific “theories” blended with necessities created by using pain medications and women were routinely being cut and babies were being pulled out with forceps.

As the prestige of the medical profession rose, so did their power. In the end it came down to dollars and cents. In order to corner the market doctors began a campaign to stamp out midwifery. First they created a belief that birth was a medical event which could only be safe if attended by a physician. Doctors traveled in the upper circles of society. They convinced bankers, lawyers and other prominent society men to avail themselves of the best that the science of modern medicine could offer for their wives by using a physician. Men controlled the medical schools and women were not allowed to attend so female care providers slowly began to die out. In the early twentieth century not satisfied yet, they convinced the government to begin a propaganda campaign slandering midwives as dirty, illiterate, and ignorant. Eventually only poor women or newly arrived immigrants were still turning to midwives for care.

Meanwhile another huge shift in health care in our country was taking place. Hospitals were on the rise, with their bureaucracies, standardizations, schedules and sanitization of birth. Women were told it was best when labor began to leave their homes, where they had some control, and travel to a hospital, where they had no control. Hospitals lead to the immediate separation of the newborn from its mother and scheduled feedings. These disruptions in the process along with the drugs created babies who could not suck effectively, needing to be force fed from bottles. Soon the women of America thought their bodies were so defective they couldn’t even breastfeed their own children. Meanwhile the practice of midwifery was outlawed in most states.

But it’s hard to hold good women down. It is hard to stop women from answering the call to serve women; especially women in need. In the 1920’s nurses began to step forward to get additional training in the skills required to help low income women, the rural and urban poor. These were women who couldn’t pay doctors and hospitals, therefore providing them care did not threaten the medical establishment’s monopoly. They eventually founded specialized nurse midwifery schools and associations. From this branch was born the certified nurse midwife. In the 1960’s couples living on communes had turned their backs on many forms of the “establishment”. These female rebels began to birth their babies at home with the help of other women in their communities. The daring women who answered this call eventually became highly trained homebirth midwives. It took courage to be a midwife, to practice midwifery without a license. Not only could you lose everything, your home and your practice, you could be thrown in jail. In our county one traditional midwife was brought up on charges and convicted in 1982. Over time this branch of midwifery also adopted standards for training, created associations and worked hard to become legal once again. In California the legal battle culminated in 1993 in the creation of a system to license out of hospital midwives but it took 4 more years for the first group of midwives to be licensed by the state medical board.

All midwives are still fighting for the right to work as autonomous, respected members of the birth provider community. Whether they are CNMs who have made the choice to work in a doctor’s practice under his supervision because even if they could find a company willing to cover them medical malpractice insurance is prohibitive, or the LMs who can’t get insurance company’s to reimburse their clients for basic care the struggle continues. The California Medical Board is currently reviewing whether to change the language in the regulations governing LMs to allow them to order the life saving medications and tools they need to attend birthing women. And so the struggle continues.

This year on May 5th, the International Day of the Midwife, the women and their families who have been cared for so well for so many years by our community’s midwives will gather in Mission Plaza to honor 41 courageous, tireless, and caring professional women. The Birth & Baby Resource Network along with the co-sponsors of this year’s Birth & Baby Fair wish to invite you to join us at 10:30 for this historic event in the annuls of San Luis Obispo women’s rights.

Participate in BBRN’s on-line Midwifery Project at: www.bbrn.org.
Learn More about the History of Midwifery:
A Midwife’s Tale; Martha Ballard her Diary by Laurel Thatcher Ulrich
Motherwit; an Alabama Midwife’s Story by Onnie Lee Logan
Listen to Me Good; the Life Story of an Alabama Midwife by Margaret Charles Smith
Birth Matters; a Midwife’s Manifesta by Ina May Gaskin
A Short History of Midwifery: from Midwife Info an independent internet resource 
I am a Midwife, a movie trailer by the Midwives Alliance of North America
Fiction with Midwifery themes:
The Midwife's Apprentice by Karen Cushman
The Red Tent by Anita Diamant
Midwives by Chris Bohjalian
A Midwife's Story by Penny Armstrong and Sheryl Feldman

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