Midwives in the Changing Health

For the first two and half centuries of colonial rule in America, midwives were practically the single providers of women maternal health care as few educated physicians had immigrated to America. According to puritan ideals until the end of 18th century, midwives were highly respected women who must have given birth themselves. Granny midwives migrated to Western countries such as America with early slaves from Africa and passed their knowledge to their close female relatives in consequent generations. In the 17th century, the development of forceps and application of opium during childbirth in British medical field marked decline in European midwifery by letting physicians intervene in childbirth. The similar effect was experienced when opium and forceps were introduced to America. By the mid 17th century, prosperous women sought physicians with drugs and instruments hoping for easier and safer childbirth. The infant and maternal rates were high, and a lot of disability cases resulted from complications during childbirth. The need for midwives became associated with the lower social class and immigrants’ minorities who could not afford the services of trained physicians. Midwives were associated with the poor rural and were usually accused of practicing precariously since they lacked formal education. There were few doctors who were available and willing to serve poor women (Edwin R. Van Teijlingen, 2004).

Development of the maternal health in the US was implemented by various organizations, among them: the Federal Children’s Bureau (FCB), the Frontier Nursing Service (FNS) and the Maternity Center Association (MCA). In 1912, the FBC was founded to provide accurate information concerning children’s health and to highlight the need for change through research. This organization established federal plans and set the states codes to promote maternal and child health services. After its inception, FCB documented high mortality rate, equally appalling infant mortality rate of approximately 124 per 1000 live births and poor status of maternal health. To respond to these findings, in 1918 nurses were trained to educate women and provide prenatal care, since there were no trained midwives before that time. The core value of midwifery practice in 20th century focused on the prevention through prenatal training (Edwin R. Van Teijlingen, 2004).

Little is known about English midwives before the 15th century, but there is in Parliamentary records dated 1469 on an annual pension of 10 pounds that was granted to Margaret Cobbs, who offered midwifery service to Elizabeth, Edward the fourth’s Queen. From the church writings and other records, however, the duties that were laid on the midwives prohibited them to conspire at contraception, child destruction, abortion or concealment of birth. They were also ordered to take the weak infants to the priests for baptism rite. If an expectant mother died during labor before giving birth, the midwives were supposed to cut and remove the child while it yet lived.  In England, the midwives’ duties were integrated into the vow they took under the licensing system that operated as part of the church.

During the progress of 16th century, the regeneration spirit of enquiry was applied by the principal surgeons to the anatomy of childbirth. Well-known among these pioneers was Ambrose Pare, a surgeon to the four French kings. The fame of men like Ambrose Pare, spread through the printing using vernacular language rather than the traditional Latin, he encouraged male attendance into childbirth services. This development gradually spread all through Europe, being further developed in 1720s by availing new midwifery forceps which were used by surgeons. In the meantime, church licensing that had given the midwives their official standings was gradually discontinued (Pamela Abbott, 1998).

There were no initiatives that came from England’s government, the few midwives, though without votes, sought allies among male members of Parliament to promote a private Bill. The Bill was initiated into the Commons in 1890. Despite stern opposition from the medical profession, the Midwives finally obtained the legality of actions. In 1918 similar legislation was enacted in England.

Despite the restrictions on the midwives’ independence, the Act applied gradually to reverse the decline of midwives not only in the UK, but also throughout Europe. Progressively, training for the midwives was intensified; midwives accessed direct representation on the Board. In 1939, the Midwives’ Act made way for the nation-wide salaried Municipal Midwife Services. Without these Acts, there was a high probability that the situation would have deteriorated even more and eventually disappearance of this honorable and ancient female profession (Pamela Abbott, 1998).

Medicine and Midwifery

The midwifery representation of care has traditionally seen pregnancy as a normal part of the women’s life, whereas the medical (obstetricians and gynecologists) representation evolved to dealing with the pathologies resulting from pregnancy and come to perceive birth as condition requiring intervention. As this new model dominated American health care, more cases of pregnancies were labeled abnormal as screening became a routine. Interventions became the standard practice and the child birth process became medical-based. By 1900, doctors attended more than half of births in America. Less than five per cent of all the births were in hospital, whereas a substantial improvement was made by the mid 1900s, where more than 50% birth were from hospital by 1940, and 99% by 1979. This shift to hospital-based care occurred as women placed their faith in medical advances and increased dependence on drugs, which were best monitored by trained specialists such as gynecologists and obstetricians in hospital.

The obstetricians aimed to make the process of giving birth less painful and safer, while gynecologist were trained mostly to deal with the complications that were related to childbirth. However, by the 1900s, in America, the mortality rates were comparable between the midwives and physicians, indicating that the physicians had not improved the safety during the childbirth in spite of their improved instruments. In medically undeserving fields, a decline of infant mortality and maternal rates has consistently been correlated with the midwives when compared by obstetricians and gynecologists (Sally Pairman, 2010).

The USA spending per capita health care is the highest globally, as is the application of technologies and obstetricians for normal births, though the infant mortality rates are rising.

In 1910, America was recording the third highest maternal mortality rate globally, and its infant mortality rate was higher than in any other Western country. The FCB attributed more than a half of all maternal mortalities to puerperal Sepsis resulting from infectious agents that are transmitted by the midwives or other birth attendants.  Midwives were used as a scapegoat by physicians, in spite of hospital births and superfluous medical interventions having been found largely responsible for the increased maternal mortality rate. This led to a campaign against midwives (The Midwife Debate) who were mostly poor minority women without access to finances, education or authority to defend their rights. The campaign urged that midwives were unclean, untrained, incompetent, and, therefore, poorly prepared to care for women in threatening conditions of pregnancy, which needed intervention of highly trained medical specialists such as gynecologists and obstetricians.

The midwifery in America would have died out altogether if not for it necessity among the poor and rural populations that lacked the services of physicians. The chief concern was that, if only physicians existed, there would be acutely lowered maternity care for the rural populace where only few would afford the costs of obstetricians’ care. The decline in the maternal mortality rates, by 1925, was attributed to the supremacy of obstetricians in the maternity care, though this attribute is actually due to multiple variables. These included, among others, implementation of regulation of hospital obstetricians’ practices, adoption of sulfonamides, antibiotics, blood transfusions and surgical advancements. The increased use of birth control in order to reduce complications associated with multiparity, as well as programs that increased prenatal nutrition through food supplement programs (Sally Pairman, 2010).

In countries with medicalised approach to childbirth and pregnancy, the obstetricians provide the majority of the cares. Whereas, in most rural areas with less medicalised approach, the trained midwives offer the services, often in collaboration with other professionals, the services of obstetricians are only sought in case of complication. Currently, across most communities there are mixes of childbirth services providers. Regardless of these mixes, the progress attained over the past several decades in this field, has resulted into a major reduction in the prenatal mortality in both developed and developing countries.

In the 2009, the number of qualified gynecologists and obstetricians was recorded to be highest in the Czech Republic, Italy, Greece and the Slovak Republic. In these European countries, the obstetricians take the primary role in providing childbirth services. The numbers were lowest in New Zealand, Ireland, Japan and Canada.

Women in most countries have the right to chose where to give birth to their children. Though the UK women have the rights to home births; in 2007 only 2.7% of them chose to give birth at home. There are many reasons for choosing the home birth over hospital birth. Most women who choose home birth are more relaxed and comfortable in their home environment (Clarke, 2005). Conversely, many women are assured that medical expertise is available only in the hospital environment. In hospital, there are more alternatives for pain relief, and practically, the mother does not have to clean up the mess after childbirth (Sally Pairman, 2010).

According to psychologist, being at home and familiar environment facilitates Physiological labor birth, which is significant for emotional and physical wellbeing of woman and baby. Recovery is faster in case of physiological labor, and there are limited chances that the newly born baby will suffer distress. Being in a familiar environ tend to offer emotional rest and so help in labor progress.  Giving birth at home is not interrupted, so it is likely progress without intervention. Pain is manageable, and there are limited risks of infection. At home, there would be no restrictions on fathers. The father will not be asked leave his baby and mother during the night (which might happen in case the mother spends the night in a labor ward). Finally, friends and family are not restricted from visiting at any time.

However, home birth has some disadvantages over hospital birth. If things go wrong during labor, the woman is reliant on assistance, which should be readily available; in case of home birth, it could be a nervous time. Woman is also limited to the scope of pain relief they would expect. There is no alternative to have an epidural in case pain intensifies without going to a hospital. Emotionally, most women would prefer the knowledge that medical assistance is available whether it is offered or not. In hospital, facilities such as beds are maneuverable and designed to allow a variety of positions during giving birth with safety and comfort. Such facilities are rarely available in home environment (Edwin R. Van Teijlingen, 2004).

Conclusion

It is logical that midwife has been a subject to the shifting social, religious, economic and political changes. At some point, this has been to their favor. Changes were not instantaneous to all cultures or geographical areas, but it has to be admitted that with widespread use of the forceps a revolution has occurred upon which the current hospitalized medical supremacy can be identified.