Midwifery And The Medicalization Of Childbirth

This book provides an introduction to the sociological study of midwifery. The readings have been selected to highlight the interplay between midwifery and medicine, reflecting the medicalization of childbirth. It highlights the major themes in both a historical and a current context, as well as western and non-western societies. Two major themes underlie the organization of this book: that the conception of midwifery must be broadened to encompass a sociological perspective; and that the ongoing trend toward the medicalization of midwifery is crucial to an understanding of the historical, current, and future status of midwifery. By medicalization of childbirth and midwifery the author mean the increasing tendency for women to prefer a hospital delivery to a home delivery, the increasing trend toward the use of technology and clinical intervention in childbirth, and the determination of medical practitioners to confine the role played by midwives in pregnancy and childbirth, if any, to a purely subordinate one.

The World Health Organization is currently promoting a policy of replacing traditional or lay midwives in countries around the world. As part of an effort to record the knowledge of local midwives before it is lost, Midwives and Mothers explores birth, illness, death, and survival on a Guatemalan sugar and coffee plantation, or finca, through the lives of two local midwives, Do�a Maria and her daughter Do�a Siriaca, and the women they have served over a forty-year period. By comparing the practices and beliefs of the mother and daughter, Sheila Cosminsky shows the dynamics of the medicalization process and the contestation between the midwives and biomedical personnel, as the latter try to impose their system as the authoritative one. She discusses how the midwives syncretize, integrate, or reject elements from Mayan, Spanish, and biomedical systems. The midwives' story becomes a lens for understanding the impact of medicalization on people's lives and the ways in which women's bodies have become contested terrain between traditional and contemporary medical practices. Cosminsky also makes recommendations for how ethno-obstetric and biomedical systems may be accommodated, articulated, or integrated. Finally, she places the changes in the birthing system in the larger context of changes in the plantation system, including the elimination of coffee growing, which has made women, traditionally the primary harvesters of coffee beans, more economically dependent on men.

First published in 1996. Childbirth: Changing Ideas and Practices is intended to pro-vide readers with key primary sources and exemplary historio-graphical approaches through which they can more fully appreciate a variety of themes in British and American childbirth, mid-wifery, and obstetrics. The articles in this series are designed to serve as a resource for students and teachers in fields including history, women’s studies, human biology, sociology, and anthropology. They will also meet the socio-historical educational needs of pre-medical and nursing students and aid pre-professional, allied health, and midwifery instructors in their lesson preparations.

As Puerto Rico rapidly industrialized from the late 1940s until the 1970s, the social, political, and economic landscape changed profoundly. In the realm of heath care, the development of medical education, new medical technologies, and a new faith in science radically redefined childbirth and its practice. What had traditionally been a home-based, family-oriented process, assisted by women and midwives and "accomplished" by mothers, became a medicalized, hospital-based procedure, "accomplished" and directed by biomedical, predominantly male, practitioners, and, ultimately reconfigured, after the 1980s, into a technocratic model of childbirth, driven by doctors' fears of malpractice suits and hospitals' corporate concerns. Pushing in Silence charts the medicalization of childbirth in Puerto Rico and demonstrates how biomedicine is culturally constructed within regional and historical contexts. Prior to 1950, registered midwives on the island outnumbered registered doctors by two to one, and they attended well over half of all deliveries. Isabel M. Córdova traces how, over the next quarter-century, midwifery almost completely disappeared as state programs led by scientifically trained experts and organized by bureaucratic institutions restructured and formalized birthing practices. Only after cesarean rates skyrocketed in the 1980s and 1990s did midwifery make a modest return through the practices of five newly trained midwives. This history, which mirrors similar patterns in the United States and elsewhere, adds an important new chapter to the development of medicine and technology in Latin America.

In a unique and detailed historical study, Nurse-Midwifery: The Birth of a New American Profession, Laura E. Ettinger fills a void with the first book-length documentation of the emergence of American nurse-midwifery. This occupation developed in the 1920s involving nurses who took advanced training in midwifery. In Nurse-Midwifery, Ettinger shows how nurse-midwives in New York City; eastern Kentucky; Santa Fe, New Mexico; and other places both rebelled against and served as agents of a nationwide professionalization of doctors and medicalization of childbirth. Nurse-Midwifery reveals the limitations that nurses, physicians, and nurse-midwives placed on the profession of nurse-midwifery from the outset because of the professional interests of nursing and medicine. The book argues that nurse-midwives challenged what scholars have called the "male medical model" of childbirth, but the cost of the compromises they made to survive was that nurse-midwifery did not become the kind of independent, autonomous profession it might have been.

Originally published in 1977 and as a second edition in 1988, this book introduces the reader to the women at the top of the midwifery profession up until the 17th Century who attended the aristocracy and Royalty. The author shows how their successors were gradually driven out of the better paid work until in the middle of the 19th Century it appeared that attendance on childbearing women would inevitably become the male monopoly it has virtually become in North America. This downward trend was reversed, thanks to efforts to preserve for women the choice of female attendance in childbirth and also to the labour of philanthropists to improve maternity services to the poor. However, the drive for the institutionalization and mechanization of childbirth during the 20th Century as well as a chronic shortage of midwives, has once again shone a spotlight on the profession. This unique history of developments in midwifery will be of interest to students of medical politics, 19th Century social history, the sociology of the professions and gender studies.

This lively history of childbirth begins with colonial days, when childbirth was a social event, and moves on to the gradual medicalization of childbirth in America as doctors forced midwives out of business and to the home-birth movement of the 1980's. Widely praised when it was first published in 1977, the book has now been expanded to bring the story up to date. In a new chapter and epilogue, Richard and Dorothy Wertz discuss the recent focus on delivering perfect babies, with its emphasis on technology, prenatal testing, and Caesarean sections. They argue that there are many viable alternatives--including out-of-hospital births--in the search for the best birthing system. Review of the first edition: "Highly readable, extensively documented, and well illustrated...A welcome addition to American social history and women's studies. It can also be read with profit by health planners, hospital administrators, 'consumers' of health care, and all those who are concerned with improving the circumstances associated with childbirth."--Claire Elizabeth Fox, bulletin of the History of Medicine "A fascinating, brilliantly documented history not merely of childbirth, but of men's attitudes towards women, the effect of a burgeoning medical profession on our very conception of maternity and motherhood, and the influence of religion on medical technology and science."--Thomas J. Cottle, Boston Globe "This superb book...is both an impeccably documented recitation of the chronological history of medical intervention in American childbirth and a sociological analysis of the various meanings given to childbirth by individuals, interested groups, and American society as a whole."--Barbara Howe, American Journal of Sociology Richard W. Wertz, a builder in Westport, Massachusetts, is formerly an associate professor of American history at the Massachusetts Institute of Technology. Dorothy C. Wertz, is a research professor at the School of Public Health, Boston University

By the mid-twentieth century, two things appeared destined for extinction in the United States: the practice of home birth and the profession of midwifery. In 1940, close to half of all U.S. births took place in the hospital, and the trend was increasing. By 1970, the percentage of hospital births reached an all-time high of 99.4%, and the obstetrician, rather than the midwife, assumed nearly complete control over what had become an entirely medicalized procedure. Then, seemingly out of nowhere, an explosion of new alternative organizations, publications, and conferences cropped up, documenting a very different demographic trend; by 1977, the percentage of out-of-hospital births had more than doubled. Home birth was making a comeback, but why? The executive director of the American College of Obstetricians and Gynecologists publicly noted in 1977 the "rising tide of demand for home delivery," describing it as an "anti-intellectual-anti-science revolt." A quiet revolution spread across cities and suburbs, towns and farms, as individuals challenged legal, institutional and medical protocols by choosing unlicensed midwives to catch their babies at home. Coming Home analyzes the ideas, values, and experiences that led to this quiet revolution and its long-term consequences for our understanding of birth, medicine, and culture. Who were these self-proclaimed midwives and how did they learn their trade? Because the United States had virtually eliminated midwifery in most areas by the mid-twentieth century, most of them had little knowledge of or exposure to the historic practice, drawing primarily on obstetrical texts, trial and error, and sometimes instruction from aging home birth physicians to learn their craft. While their constituents were primarily drawn from the educated white middle class, their model of care (which ultimately drew on the wisdom and practice of a more diverse, global pool of midwives) had the potential to transform birth practices for all women, both in and out of the hospital.