Home Delivery MIDWIVES LABOR FOR TRADITIONAL CHILDBIRTH by Joanna Peery Before the rise of obstetrics as a common medical specialty in the last century, women gave birth primarily in the company of midwives, more experienced women who also played the role of friend and educator. Native Americans had midwives within their tribes, and nearly all African-American women in the South gave birth in the presence of a midwife. Beginning in the 1900s, however, the American Association of Obstetrics and Gynecologists began a campaign to eradicate midwifery, portraying midwives as remnants of a superstitious and septic past. Any woman who could afford to do so was strongly encouraged to have her baby in a hospital, under a doctor's care. Midwifery and home birth became the province of the rural (and in many parts of the country, predominantly African-American) poor. In reality, they were the fortunate ones: the urban poor were required to have their babies in filthy, crowded public hospitals. Beginning in the 1920s, the government-sponsored Midwifery Regulation Campaign, made up almost entirely of white male obstetricians, sought to dismantle what remained of the tradition of midwifery, especially in the rural South. The MRC attempted to convince midwives themselves that they were unlearned and superstitious, and to "convince women that there was something almost neglectful on their part, if they didn't use a physician," according to U. Va. anthropology professor Gertrude Fraser. As a result of this program, women, a majority of them African-American, were packed off to clinics. There was an ironic twist to this otherwise unfortunate turn of events: a study revealed "a greater incidence of neurologic damage among white" children as compared to black children at the age of one, in spite of the higher incidence of low birth weight, prematurity, and undernutrition among black populations (Doris Haire, The Cultural Warping of Childbirth). The discrepancy appears to be a result of black patients, often clinic patients, receiving less potentially damaging pain medication during labor, compared to their white counterparts. By 1953, only three percent of births were attended by midwives. As a result of the government's efforts to eradicate midwifery, women had lost their confidence in the ability of their bodies to perform this most natural of functions and, instead, adopted the view that pregnancy and birth were pathological, dangerous, and best left to the "experts" who claimed to know women's bodies better than women themselves. The United States' poor birth statistics and high medical costs tell a different story. The near-extinction of the Southern African-American midwife resulted only in a further alienation and loss of power for the rural, poor black population, rather than the utopian vision of healthy babies and smiling mothers in hospitals. Although midwifery has recently been making a comeback, Adrienne Rich points out that "it is extremely difficult and usually illegal for a woman to give birth ... at home with the aid of a professional midwife." And while there are many midwives in America today, the regulatory system is chaotic and varies greatly from state to state. Some states, including Virginia, have reduced midwives to the status of criminals. In 1996, the Commonwealth Attorney of Loudoun County brought a charge of involuntary manslaughter against midwife Martha Hughes. During a home birth she was attending, the baby lost heart tones before delivery. Although a rescue squad was summoned immediately, the child died. The parents, who made an informed, educated decision to have a home birth, do not support the state's actions. Meanwhile, poor women, frequently African-American, must go to clinics where they wait hours for a rushed appointment with a doctor who is likely overburdened with appointments and cannot spend the extra time women may need. It seems impossible that these complicated social, racial, and economic problems could be solved or the situation improved by a single change in the medical world. But midwifery is constantly proving itself superior (in normal pregnancies, as most are) to the current hospital-dominated method. Midwife-attended births result in a greatly reduced number of caesarean births, often unnecessary, performed primarily for the convenience of the physician. The same is true of episiotomies, the need for which is exacerbated considerably by the lithotomy position (feet up in stirrups), deemed by the World Health Organization as the worst position in which to give birth. Painkillers which, as mentioned before, can have a damaging effect on babies are used far less often by midwives, and are often avoided altogether in hopes of allowing a woman to remain in touch with her body and, therefore, herself throughout the process of labor. Finally, midwife care costs a fraction of hospital care, making it accessible to those who cannot afford a hospital stay (Medicaid reimbursement is available for midwives in six states). The widespread use of midwives in this country, the only industrialized country without midwives as an accepted part of the health care system, would dissolve the presently formidable barriers between women and affordable, committed health care.

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