The Demise of the Massachusetts Midwife
Cassandra T. Kamuchey traces the social forces behind the end of midwifery in the early 1900s. Noting that proposed legislation at the time was both for and against the practice, and that attempts to ban midwifery did little to deter practitioners. Kamuchey credits midwifery's disappearance to shifting social attitudes rather than legal fiat.
Focusing on Massachusetts, "the self-proclaimed capital of the nationwide anti-midwife campaign," Kamuchey first traces the fate of eleven unpassed bills, introduced between 1906 and 1924, to regulate or ban midwives. This legislative history points to the slow rise of anti-midwife opinion, but the failure to adopt legislation for a long period of time also demonstrates that a solid opposition worked to protect these non-professional caregivers. Kamuchey also recounts the judicial results that effectively banned midwifery by holding that the requirement that medical practitioners register with the state under the Medical Practice Act of 1895 also applied to midwives. As Kamuchey notes, however, midwives continued to practice despite the court rulings and prosecutions were rare.
A major force behind attempts to ban midwifery was the professionalization of medical doctors, who campaigned strongly against the practice. Although doctors cited the advantages of trained medical care, they may have been motivated more by financial gain than by health concerns. Nonetheless, concern over high rates of maternal mortality combined with a contemporary faith in science and professionalism served to strengthen doctors' position. Midwives came to be seen as anachronisms--old-world figures wreathed in folklore and tradition, but ignorant of new practices and out of place in modern society. This shift in perception, strongly pushed by the Massachusetts Medical Society and physicians' journals, played a large role in the move away from midwifery. Wartime concern over the number of babies lost at birth pushed the case into mass-market publications and further strengthened anti-midwife sentiment. This occurred despite data showing that doctors lost a similar, if not greater, number of patients.
In addition, Kamuchey considers a broad array of contemporary attitudes that worked against midwifery. The practice ran contrary to late nineteenth century views as to women's appropriate sphere--the domestic--and their appropriate character--passive. Furthermore, critics argued that midwives were often adept abortionists. This fostered opposition to both the practice of midwifery and to educating and licensing them. Additional medical knowledge on their part might only improve their success in practicing abortion. A contemporary nativist backlash against immigration also contributed to the practice's demise, as a close link was perceived between midwives and immigrants. Kamuchey also discusses the then-current perception that American women were shirking their responsibility to restock the nation's baby population. A call to arms was sounded, urging women to overcome their fears of physical harm from pregnancy and childbirth and embrace their maternal duty. This demand dovetailed neatly with the medical profession's efforts to convince women of the greater safety offered by obstetricians as opposed to midwives.
Altogether, the rush to procreate combined with worship of science and rejection of the foreign to forge a rejection of midwifery. This rejection was completed during the 1920s when a new ideal of womanhood--the efficient housewife, steeped in scientific domesticity--made the use of professional doctors routine. The home itself came to be seen as a germ-filled space needing constant cleaning; hospitals were considered the only appropriate setting for childbirth. The idea of untrained, possibly unsanitary midwives assisting homebirths became unthinkable.
An appendix to the paper contains the text of each proposed piece of legislation and the Medical Practice Act of 1894.
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