Midwifery's Renaissance

Dismissed, disrespected, and hunted like witches, midwives are finally being recognized-but misunderstandings and myths endure

Because the midwives feared God, they did not do as commanded by the king.
-Exodus 1:17

A midwife is lectured at by committees, scolded by matrons, sworn at by surgeons, bullied by surgical dressers, talked flippantly to if middle aged and good humored, seduced if young.
-London Times, 1857


After working as a practicing physician for several years, I became a perinatologist and perinatal scientist, as well as a full-time faculty member at the Schools of Medicine and Public Health at UCLA. Then I became a director of maternal and child health for the California state health department. In that capacity, I learned that in the rural town of Madera, California, doctors had decided that they no longer wanted to attend births in the Madera County Hospital. They complained that it took too much of their time and didn't pay enough. So in 1968 the county recruited two midwives to fill the gap. After two years, the rate of babies dying around the time of birth in the hospital was cut in half. Alarmed that their style of maternity care was being made to look bad, the doctors in town agreed that they would once again attend births in the hospital if the two midwives were fired. The hospital fired the midwives, the doctors returned, and soon the rate of babies dying around birth rose to its earlier higher levels.

This natural experiment comparing the safety of doctors and midwives left me confused and full of questions, because, in spite of my years of experience as a physician, I had no real knowledge of midwifery. What are these midwives? How are they trained? Could it be that, as seen in Madera County, they are generally safer birth attendants than doctors? Through no fault of their own, Americans, including obstetricians, have little understanding of midwifery. In the early years of the 20th century, a witch hunt against midwives in the United States and Canada eliminated midwifery as a legitimate health profession. The profession has gained ground in the past two decades, but most people today have no personal experience with midwives and have been exposed to considerable misinformation about midwifery.

From California I left for Europe, where I joined the staff of the World Health Organization. There I was exposed to the essential role midwives play in maternity care in other highly industrialized countries and in developing countries.

7/7/2009 3:07:17 PM

Thank you for this timely piece (although the book is already three years old). As I have said over and over, re: serving women during pregnancy and childbirth: what we need is for women to have the safe and satisfying options, and THEN we need a smooth transition into the medical world if their care warrants it. I hope I live to see it in every state and territory for every woman and baby.

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