In the seventeenth-century colonies, childbirth was the exclusive province of midwives--unschooled but respected women who learned their craft by observation and personal experience. Their role was to offer encouragement and reassurance to the woman, tie off the umbilical cord after delivery, be sure the placenta was expelled, and generally care for the mother and child. Since the great majority of births, then as now, were normal and uneventful, this was usually sufficient attention. In the case of difficult or lengthy labors, there was little the midwife could do, other than turn to a more experienced midwife. Women were not permitted to receive medical schooling, and though men were, they were never permitted in the lying-in chamber for reasons of modesty.
Gradually, midwives became licensed, which was merely a matter of the woman taking an oath to be "patient and caring," to report the "true father" to the authorities, to never "conceal a birth," to minister to the poor as well as the rich, and so on. The church also took an interest in a midwife's activities out of concern that she might be a witch who would practice her sorcery upon the infant--a child born with a deformity was a suspicious matter. (The first person executed in the Massachusetts Bay Colony was Margaret Jones, a midwife accused of witchcraft, in 1648.)
With the advent of the scientific revolution in the eighteenth century, the situation slowly changed. Young American men went to Europe to study medicine and the "new obstetrics," becoming men midwives as well as general practitioners on their return. But women were not admitted to schools and, moreover, did not have access to or training in the use of the new medical instruments like forceps. Thus, they found themselves relegated more and more to the practice of normal births and were expected to turn over difficult labors to the trained men. Middle- and upper-class women now gradually overcame their qualms about modesty, as the superiority of these men over untrained women became evident.
Competition between the two groups grew steadily between 1760 and 1800, with both advertising their services in newspapers and seeking to spread their reputation for safe births via word of mouth. But by 1820, Walter Channing, the first obstetrics professor at Harvard, could write with satisfaction, "Heretofore, where midwifery has been in the hands of women, they have only practised among the poorer and lower classes, . . . the richer and better informed preferring to employ physicians.... It was one of the first and happiest fruits of improved medical education in America, that ... [women] were excluded from practice."
It was only when women in the course of the nineteenth and twentieth centuries gradually gained access to medical schools that they were able to compete on equal terms with male obstetricians.
See also Medicine.
