Return of the Midwife

Midwifery may not be the world's oldest profession, but it is described in the earliest books of the New Testament. The midwife was an accepted member of the social structures of ancient Greece and Rome, and once held the exclusive right to assist women at childbirth. In most countries she is still a respected member of the medical-care system. In the U.S., midwives dominated obstetrics as late as the 19th century, when their role was taken over by doctors, many of whom considered these women anachronistic and unqualified and supported efforts to legislate them into obscurity.

Today, with the advent of new professional requirements and certification, midwifery is on the increase in this country. According to figures released last week at the 50th anniversary meeting of the International Confederation of Midwives in Washington, D.C., the number of certified midwives in the U.S. has climbed to 1,200; a decade ago, it was only 400. Demand for their services is increasing faster than supply, and at least a dozen hospitals and medical centers, including the Yale University School of Nursing and the Johns Hopkins School of Hygiene and Public Health, offer midwife-training programs for graduate nurses. The U.S. Air Force has plans to offer a course for nurses who wish to be midwives in Air Force hospitals.

There are several reasons for the resurgence. One is the relative scarcity of women doctors and the desire of some Women's Liberationists to avoid male obstetricians. Another reason is the gradual acceptance of home delivery outside of remote rural areas, where it is often a necessity. "The difference between a home delivery and a hospital delivery is the difference between day and night," says Mary Edna Fitzpatrick, recently retired from teaching at the Medical College of Virginia and a veteran of about 140 deliveries during her own years as a public-health nurse. "At home you don't get any screaming and yelling, and you don't have to use as much medication. Labor is shortened by hours."

Yet another reason for the midwife's growing popularity is the quality of care she is able to provide her patients. Some doctors feel it unnecessary to remain with their patients from the beginning of labor to its conclusion; midwives stay with theirs throughout the entire process. They can also perform other important services, providing prenatal care for the mother as well as postnatal care for her and her child, and advising on family planning and hygiene. Says Ruth Freeman, professor emeritus of Johns Hopkins University: "Midwifery focuses on health rather than illness, on helping families to deal with their own problems rather than to rely on artificial outside support."

Midwives, many believe, can also help to ease the shortage of medical manpower, particularly in rural areas where doctors are few. Bethel, Alaska, had a high infant and maternal mortality rate before the Indian Health Service sent a lone midwife there in 1969; her work has proved so successful that 20 other communities have asked for similar help.

New Laws. The laws on midwifery vary from state to state, but generally a nurse trained in the profession may deliver a baby unaided as well as give local anesthetics, perform minor obstetric surgery and fit contraceptives. Midwives work in maternity clinics connected with hospitals as well as in homes, but wherever they work, a doctor must be always on call in case of emergency. Several states even require that a doctor be in the room when a baby is delivered, no matter how normal the circumstances. In a speech to last week's convention, Dr. Roger Egeberg, special assistant to the Secretary of HEW in the area of health policy, called midwives "urgently needed health-care professionals," and called for legislation to enhance their status.

Dr. G.J. Kloosterman, professor of obstetrics and gynecology at the University of Amsterdam, told the conference that approximately 70% of all babies born could be satisfactorily delivered by midwives. A substantial number already are--and not merely in the underdeveloped countries of Africa and Asia. Professional midwives handle the majority of normal births in such technologically advanced countries as Sweden, Germany and The Netherlands. In England, which has one of the world's most advanced health-care systems, 80% of all births are handled by midwives.

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