Midwifery

Summary

Midwifery is the practice of attending women in labor and guiding the delivery of infants. In the ancient world, birth attendance was women’s work: the earliest named midwives appear in Hebrew scripture, Egyptian tomb inscriptions recorded female professors specializing in obstetrics, and the Roman physician Soranus of Ephesus wrote the most influential ancient manual on the subject. Medieval midwives occupied a specific niche, attending births in ways that male physicians formally could not. The early modern period introduced printed manuals, state licensing, and eventually the obstetric forceps, which gave male surgeons entry to the birth chamber and ultimately displaced midwives from practice with wealthy patients. By the nineteenth century, male physicians attending births without hand-washing generated catastrophic rates of puerperal fever, documented by Gordon, Holmes, and Semmelweis. The history of midwifery is a case study in how gender, professional authority, and institutional power shape who attends the body at its most vulnerable moment.

Ancient Midwifery: Egypt, Greece, and Rome

In prehistoric and early historic societies across the world, women were the primary healers, midwives, bone-setters, and gatherers of medicinal herbs, roles they held before and during the development of formal medicine.(Hurd-Mead, 1938) The word for midwife in Greek — obstetrix — derived from the same root as obstare, “to stand before,” marking the position of the attendant at the birth. But the social role was far older than any Greek term for it.

Egyptian medicine assigned obstetrics particular institutional prestige. At the medical school of Sais, near the Nile Delta, women were professors specializing in gynecology and obstetrics, and students came from across the known world to study there; an inscription survives reading “I have come from the school of medicine at Heliopolis, and have studied at the woman’s school at Sais where the divine mothers have taught me how to cure diseases.”(Hurd-Mead, 1938) By 1500 BCE, women were recorded as students at the medical school of Heliopolis itself.(Hurd-Mead, 1938) These are the oldest institutional attestations of women as medical teachers and pupils.

Hebrew scripture names two practicing midwives: Shiphrah and Puah, recorded in Exodus as resisting Pharaoh’s order to kill male infants at birth — among the earliest named female medical practitioners in any text.(Hurd-Mead, 1938) Their resistance was practical rather than passive: they told Pharaoh that Hebrew women delivered so quickly that the midwife arrived too late to intervene. The passage assumes their expertise and authority as a matter of course.

Greek medicine produced a contested account of female medical practice. The story of Agnodice — a pupil of the Alexandrian anatomist Herophilus, practicing obstetrics in Athens disguised as a man, eventually prosecuted, and then defended by a crowd of Athenian women who demanded her acquittal — illustrates the tension between women’s practical knowledge and male institutional barriers.(Hurd-Mead, 1938) Whether the story is historically accurate or exemplary, it records a real structure: the knowledge to attend childbirth was recognized as valuable, and women’s access to it was contested by men who controlled formal credentials.

The most systematic ancient account of the midwife and her practice comes from Soranus of Ephesus (born c. 50s CE, practicing in Rome under Trajan and Hadrian).(Temkin, 1956) Soranus was a member of the Methodist medical sect, which rejected elaborate etiological inquiry in favor of identifying three basic disease states — constriction, flux, and mixed — and treating by opposites.(Temkin, 1956) This stance shaped his gynecology: he set aside theoretical questions about hidden causes and focused on what was practically necessary for managing pregnant women, labor, delivery, and infant care.

Soranus organized the Gynecology in two main sections: one on the midwife (her qualifications and formation), and one on “the things with which the midwife is faced” — covering normal and abnormal conditions of pregnancy, labor, the puerperium, and infant care.(Temkin, 1956) This organizational structure was itself a statement about where practical knowledge resided. The midwife, for Soranus, was not a subordinate executing the physician’s orders but the primary practitioner of obstetrics.

His portrait of the ideal midwife is worth examining in detail. A suitable candidate must be literate — “in order to be able to comprehend the art through theory too” — possess good memory, love work, be sober and respectable, have sound limbs and, ideally, long slim fingers with short nails for internal examinations.(Temkin, 1956) Soranus’s phrase here is striking: he wrote that a woman who wishes to acquire such vast knowledge “needs manly patience” — embedding a gendered assumption even while describing the qualifications of a female practitioner. Hurd-Mead’s version of the same passage renders the ideal obstetrix as one who must know how to read and write, be free from superstitions, have good sight and hearing, sharp intellect, strong arms and legs, soft hands, and long, thin fingers with short nails, and understand anatomy, hygiene, and therapeutics.(Hurd-Mead, 1938)

The best midwife, he continued, must be trained in all branches of therapy: diet, surgery, and drugs, since different cases require different approaches. She must follow the course of the disease rather than changing her methods with every change in symptoms. She must be “free from superstition so as not to overlook salutary measures on account of a dream or omen or some customary rite or vulgar superstition.” And she must not be greedy for money, “lest she give an abortive wickedly for payment.”(Temkin, 1956) That last clause reveals an ancient ethical dispute: one faction cited the Hippocratic oath to reject all artificial abortion; Soranus’s group permitted it when the mother’s life was at risk, but drew the line at abortion for payment.(Temkin, 1956) He distinguished carefully between contraceptives, abortives, and expulsives, preferring contraception as the safer option, and listed specific vaginal suppository preparations for contraceptive use.(Temkin, 1956)

Elliott notes that Soranus was recognized as a very accomplished obstetrician and gynecologist whose descriptions of uterine anatomy, obstetric complications, and the qualifications of a good midwife distinguished his systematic textbook from mere compilations of received opinions.(James Sands Elliott, 1914) From the seventh month of pregnancy, Soranus directed the midwife to begin regularly dilating the uterine orifice with a finger to prepare for delivery — a practical instruction whose clinical logic remains sound.(Temkin, 1956)

Soranus’s Gynecology survived precariously: the Greek text barely escaped loss in a single badly corrupted fifteenth-century manuscript discovered in Paris in 1830–31, and his influence on the Latin West came primarily through later transmission.(Temkin, 1956) His Methodist approach (dismissing theoretical anatomy as “useless for our purpose” while demanding full practical skill) proved to have staying power: it continued to shape obstetric practice through medieval into sixteenth-century Europe.(Temkin, 1956) Temkin notes that Soranus’s influence and fame in the Latin West equalled that of Galen; only with the spread of Arabic influence from the eleventh century onward did he definitively recede into the background.(Temkin, 1956)

Medieval Practice: Trotula, Midwives, and the Limits of University Medicine

The medieval medical world placed birth attendance at the intersection of gender, religious authority, and professional hierarchy. University-trained physicians — always male — could consult in complicated cases, but their institutional distance from the female body left practical obstetric knowledge in the hands of women practitioners.

Soranus’s transmission into medieval practice occurred through a Latin paraphrase by Muscio (c. 500 CE), who condensed the Gynecology into a question-and-answer format suitable for midwife instruction; this in turn was used by Eucharius Rosslin when he composed the Rosengarten in 1513, which was then translated into Latin, French, English, Dutch, and Spanish — ensuring that Soranian obstetrics reached early modern midwives across Europe.(Temkin, 1956)

At Salerno, the earliest organized center of medical learning in Latin Christendom, women participated in medical education in ways that would be systematically closed off once universities crystallized in the thirteenth century.(Hurd-Mead, 1938) The most significant Salernitan woman healer is Trota (also called Trocta or Trotula), an eleventh-century physician whose name is attached to extant medical writings and whom her son Matteo Platearius called his “learned mother,” noting proudly that she had looked after sick women “as a magistra, not as an empiric.”(Hurd-Mead, 1938) The distinction mattered: magistra implied formal medical learning, not mere experience. Trota is the only Salernitan woman healer whose name is attached to any extant medical writings, and there is no doubt that such a healer existed.(Green, 2001) Her literary fame persisted for centuries: Geoffrey Chaucer mentioned Trotula by name in the Prologue to the Wife of Bath’s Tale (c. 1390), placing her alongside learned male authorities.(Hurd-Mead, 1938)

The texts known as the Trotula ensemble — three distinct Salernitan works on women’s conditions, treatments, and cosmetics — attest to a broader culture of female medical practice at Salerno. Green describes them as remarkable witnesses to the explosion of medical thought and writing that occurred in southern Italy in the eleventh and twelfth centuries.(Green, 2001) Twelfth-century male medical writers cited the mulieres Salernitanae (Salernitan women) more than five dozen times as empirical practitioners credited with specific remedies, though never with medical theory or writings.(Green, 2001) This pattern reveals the limits of what women’s knowledge could claim: credited with experience, denied with theory. The legal context reinforced such limits: under Lombard law, women spent their lives under male guardianship (mundium) — first the father’s, then the husband’s, then adult male relatives’ — and could not alienate property without a guardian’s permission, a framework that circumscribed women’s autonomous practice throughout much of medieval Italy.(Green, 2001)

The Salernitan male physicians who wrote systematic texts on women’s diseases acknowledged a practical problem: it was doubtful that they ever directly touched the genitalia of their female patients.(Green, 2001) This “limitation of male gynecological and obstetrical practice left room for the existence of female practitioners whose access to the female body was less restricted,” as Green puts it — an institutional gap that midwives occupied for centuries.

Once university faculties of medicine were established across Europe in the thirteenth century, women were excluded from advanced medical education and consequently from the most prestigious varieties of practice.(Siraisi, 1990) Siraisi documents that 24 women described as surgeons are known in Naples between 1273 and 1410, and references have been found to 15 women practitioners in Frankfurt between 1387 and 1497, but they represent only about 1.5 percent of all practitioners in France and 1.2 percent in England.(Siraisi, 1990) The actual number of women attending births was almost certainly far higher — midwives rarely appear in the licensing records that constitute most of the surviving evidence.

Medieval midwives also occupied a forensic role. In cases involving alleged impotence and marital annulment, midwives were regularly called by courts to examine the female party, while physicians and surgeons examined the husband; by the fourteenth century this arrangement had become standard procedure in France.(Danielle Jacquart and Claude Thomasset, 1988) One peculiar therapeutic assignment — derived from medical interpretation of uterine suffocation (suffocatio matricis) — required midwives in extreme cases to administer vaginal massage to expel retained seed in sexually abstinent women, a practice recommended by Arnald of Villanova and John of Gaddesden when marriage was not possible.(Danielle Jacquart and Claude Thomasset, 1988)

The Hospital of Beaune (Hôtel-Dieu de Beaune, founded 1443) illustrates one institutional form of midwifery training: the Beguine nursing sisters were taught obstetrics by their superior, performing medical and nursing tasks in rotation, three years at each.(Hurd-Mead, 1938) This religious institutional framework — women learning from women in structured settings — was the primary route for midwifery transmission in communities where no printed manuals existed.

By the fifteenth century, the witchcraft mania intersected with medical licensing restrictions in ways that specifically deterred women from midwifery. Hurd-Mead notes that “with the bans against women physicians, and the witchcraft mania, women became afraid to undertake even midwifery, although men were not particularly interested in it.”(Hurd-Mead, 1938) A new rule in this period provided that if a midwife could not accomplish a delivery, she must summon a male surgeon, who would then insert a speculum or, later, other instruments — establishing the institutional structure through which men would eventually claim the birth chamber.(Hurd-Mead, 1938)

Early Modern Professionalization: Printed Manuals, Licensing, and the Man-Midwife Debate

The printing press transformed midwifery knowledge by making it reproducible, portable, and subject to institutional authorization. By the end of the fifteenth century, printing had made midwifery books available in vernacular languages for the first time, extending the reach of learned obstetric knowledge beyond Latin-literate physicians to midwives who could read in their native tongues.(Hurd-Mead, 1938) In England, bishops had been authorized to license midwives within their diocese from 1511, with the licence dependent on patients’ references as to professional ability and moral character; the church also required that midwives be qualified to baptize a child likely to die before a priest could arrive.(Stapley, 2024) Eucharius Rosslin’s Rosengarten (1513), written at the request of the Duchess Katherine von Braunschweig, included woodcuts showing fetal positions in utero and illustrations of lying-in rooms; it was translated across European languages and reached both learned and practitioner audiences.(Hurd-Mead, 1938) This single text — drawing heavily on the Soranic tradition through Muscio — shaped obstetric practice from Germany to England through most of the sixteenth century.

In England the standard obstetric text was Of the Birth of Mankind, translated from the Latin by Richard Jonas around 1540 and constantly reprinted through 1654; it was revised in 1545 by the physician Thomas Raynalde, who added new anatomical knowledge from Vesalius, and remained the primary reference for women and midwives until Culpeper’s Directory for Midwives appeared in the same year of 1654.(Stapley, 2024) Culpeper’s Directory was characteristically written for female midwives, ranging from desire for copulation and the signs of conception through to weaning, and explicitly directed midwives to consult his work rather than the College of Physicians for their teaching.(Stapley, 2024)

Simultaneously, states began formalizing midwifery regulation. In France, a 1560 statute made it obligatory for practicing midwives to belong to the fraternity of the medical saints Cosmo and Damien, to pass examinations, and to treat the poor without fees.(Hurd-Mead, 1938) In Germany, the office of Stadtshebamme (municipal midwife) provided public employment, a stipend, and a formal caseload. Margarita Fuss of Havelberg (fl. 1555), daughter of a noted midwife, studied with her mother, traveled to Strasbourg and Cologne for further training, and eventually became so celebrated that she was consulted across Germany, Holland, and Denmark; when she died in 1626, the cathedral bells of Havelberg were rung in her honor.(Hurd-Mead, 1938)

The most important midwifery writer of the early modern period was Louise Bourgeois, royal midwife to Marie de Medici, whom she successfully confined seven times (the queen called her “Ma Resolue”).(Hurd-Mead, 1938) Her Observations diverses (1609) named twelve positions of the presenting infant and the rules for managing each; covered every stage of pregnancy, all abnormalities of labor, the anatomy of the female pelvis, theories of sterility, abortion, and hydramnios; and drew on her experience at more than two thousand births.(Hurd-Mead, 1938) The scale and systematic character of this documentation placed it alongside any male physician’s publications on the subject.

The competing tradition of male obstetric practice expanded through the seventeenth and eighteenth centuries, initially in response to demand from wealthy women who found it fashionable to employ men for their confinements. Hurd-Mead’s characterization captures the pattern: “The field of obstetrics was being quietly but steadily invaded by men, who were lured to it by the growing fashion among rich women to employ men for their confinements… Among the women of the middle classes, there was still a feeling that it was immodest for a woman to allow a man to be present in her lying-in room except in time of great stress.”(Hurd-Mead, 1938)

The obstetric forceps — a pair of curved levers designed to grip and extract the fetal head — gave men the decisive instrumental advantage. After forceps became commercially available around 1773, male physicians urged women midwives to learn their use, but the cultural association between the instrument and male surgical authority was already established.

The eighteenth century produced remarkable figures on both sides of the divide. Angélique du Coudray, appointed by royal commission in 1759 at a stipend of 3,000 livres a year, invented an obstetric training manikin — a fabric female torso with a movable fetus — and used it to train four thousand pupils across the French provinces.(Hurd-Mead, 1938) Marie-Louise Lachapelle, head of the Maternité in Paris, attended over 40,000 deliveries; her rate of instrumental intervention was 1.73%, using forceps only 93 times and performing Caesarean section but once.(Hurd-Mead, 1938) Her colleague Madame Boivin was awarded an honorary M.D. from the University of Marburg in 1827 — the honorary title being necessary because no French university would award her the degree she had earned by scholarly production and clinical record.(Hurd-Mead, 1938)

The Exclusion of Women from Medical Education

The exclusion of women from medical universities was not a single event but a cumulative institutional consolidation, achieved through licensing statutes, guild charters, and university rules that required credentials women could not obtain. Jacobina Felicie, a Florentine Jew practicing in Paris in 1322, was prosecuted for practicing medicine without a license; seven witnesses testified to her skill, and the popular demand for her release was so insistent that the prosecution was eventually withdrawn — but the legal structure that demanded the license remained.(Hurd-Mead, 1938) The Paris Faculty of Medicine’s position was explicit: no woman, no matter how skilled, could practice legally without university authorization, and no woman could attend a university to receive that authorization.

In Germany, fifteen women physicians were licensed in Frankfurt-am-Main in 1394, including eye specialists — one of whom, Marguerite of Naples, became court physician to King Ladislaus.(Hurd-Mead, 1938) Italian universities, particularly Bologna, admitted women throughout the medieval period: Dorothea Bocchi was appointed professor of medicine and moral philosophy at Bologna in 1390, succeeding her father, and taught for forty years.(Hurd-Mead, 1938) Earlier at Bologna, Alessandra Giliani of Persiceto served as prosector to the anatomist Mondino de Luzzi, devising a method of injecting colored liquids into blood vessels to trace their courses — a contribution to anatomical technique recorded by her contemporaries.(Hurd-Mead, 1938) These exceptions illuminate the rule: where formal gates did not exist, women practiced and taught; where professional guilds or university exclusions operated, women were expelled or confined to informal practice.

The seventeenth century’s English midwife Jane Sharp pressed the argument directly. She published The Midwife’s Book (1671) in the hope that “the common people of the land” might have deliveries as safe as the ladies of the nobility — explicitly linking the quality of care to the quality of education available to practitioners.(Hurd-Mead, 1938) Sharp and Elizabeth Cellier both demanded that midwives be given better medical education and greater formal training, arguing that the problem was not women’s incapacity but institutions’ refusal to teach them.

Justina Siegmund, a Silesian midwife, published a midwifery textbook in 1689 in the form of a dialogue between herself and a pupil named Christina — an instructional format reaching back to Muscio’s Soranic paraphrase, but now in German and addressed explicitly to the community of practicing midwives she was trying to train.(Hurd-Mead, 1938)

Puerperal Fever and the Cost of Medicalization

The entry of male physicians into the birth chamber had a demonstrable lethal consequence: mortality from puerperal (childbed) fever was dramatically higher in hospital wards attended by doctors than in those attended by midwives or in home births attended by traditional practitioners.

Alexander Gordon of Aberdeen, investigating an epidemic that began in December 1789, published in 1795 the first coherent argument that puerperal fever was not caused by miasma but by the medical staff itself, which spread the fever to new patients after attending those already infected.(Fitzharris, 2017) Oliver Wendell Holmes made the same argument in 1843 in “The Contagiousness of Puerperal Fever,” building on Gordon’s work but failing to convince his contemporaries — partly because the implication was that respected physicians were disease carriers.(Fitzharris, 2017)

Ignaz Semmelweis, working in the first obstetric clinic of the Vienna General Hospital in 1847, demonstrated the argument numerically. The first clinic, staffed by medical students who came directly from autopsy rooms, had a mortality rate of 18.3% in April. After he required hand-washing in chlorinated water before all examinations, rates fell to 2.2% in June and 1.2% in July.(Fitzharris, 2017) Ackerknecht notes that Semmelweis’s data confirmed that puerperal fever in the first clinic was “produced primarily by contact with the contaminated hands of doctors and medical students coming from the autopsy room,” and that in 1865 Semmelweis died of sepsis — the very disease he had spent his life fighting — in a Vienna asylum at age forty-seven.(Ackerknecht, 1955)

The irony was structural: the midwife tradition Semmelweis’s work implicitly vindicated had managed births without entering autopsy rooms and without the particular mortality pattern he documented. The medicalization of birth had introduced a lethal variable. Crede’s later introduction of silver nitrate drops into every newborn’s eyes to prevent gonorrheal blindness, and Lister’s antiseptic principles applied to obstetric practice, eventually reduced puerperal mortality — but not before the period of hospital-based, physician-attended childbirth had established a death toll that home midwifery had never approached.(Ackerknecht, 1955)

Farr’s Vital Statistics on Maternal Mortality

The scale of preventable maternal death in Victorian England was documented with particular precision by William Farr, whose annual reports to the Registrar General provided the first systematic national record of puerperal mortality. Puerperal fever mortality declined from 61 deaths per 10,000 live births in 1848 to 47 per 10,000 in 1854, but even at this reduced rate approximately 3,232 mothers died annually from puerperal causes in that period.(Farr, William (Humphreys, Noel A., ed.), 1885) Over thirty years from 1847 to 1876, England recorded 106,565 maternal deaths, averaging 5 per 1,000 live births, ranging from a low of 42 per 10,000 in 1857 to a high of 69 per 10,000 in 1874 — a total Farr described as “a deep, dark, and continuous stream of mortality.”(Farr, William (Humphreys, Noel A., ed.), 1885) Annual maternal deaths in England during 1872—76 stood at 4,610.(Farr, William (Humphreys, Noel A., ed.), 1885)

Farr was insistent that a substantial portion of these deaths was preventable, and he backed the argument with comparative institutional data. Le Fort’s international survey showed aggregate hospital delivery mortality of 1 in 29 — against 1 in 212 for home deliveries — a difference Farr used to argue strongly against institutional obstetric care as then constituted.(Farr, William (Humphreys, Noel A., ed.), 1885) He also defended the accuracy of puerperal registration against critics who doubted the data: a London survey of six weeks found 66 properly returned puerperal deaths with only 1 doubtful case, and Birmingham’s 1856 data returned 5 puerperal fever deaths plus 17 other childbirth deaths, demonstrating the registration system’s reliability.(Farr, William (Humphreys, Noel A., ed.), 1885) The general English puerperal mortality rate he calculated was approximately 5 per 1,000 deliveries (1 in 200); in 1870, 3,875 deaths from puerperal fever and accidents combined with 719 other deaths post-childbirth gave a rate of 1 in 172 “in childbirth.”(Farr, William (Humphreys, Noel A., ed.), 1885)

The operative comparison was institutional. The Royal Maternity Charity, founded in 1757, employed 22 midwives in 1876 and achieved 3,069 deliveries in that year, with only 21 deaths recorded across 9,019 deliveries between 1875 and 1877 — a rate of 2.33 per 1,000, at a cost of 9 shillings per case.(Farr, William (Humphreys, Noel A., ed.), 1885) The Obstetrical Society confirmed the context: 30 to 90 percent of country village deliveries were performed by midwives in this period, with 5 to 10 percent in small towns, and midwives surveyed were found to be uninstructed; the College of Surgeons had no midwifery examination for membership.(Farr, William (Humphreys, Noel A., ed.), 1885) From these figures Farr drew a direct calculation: if all English deliveries were conducted at the quality level achieved by the Royal Maternity Charity and the Birmingham Lying-in Charity (both at 2.33 per 1,000), England would have had 2,009 rather than 4,610 annual maternal deaths — meaning 2,601 maternal deaths per year were preventable by achievable improvements in the quality of birth attendance.(Farr, William (Humphreys, Noel A., ed.), 1885)

Colonial and Non-Western Traditions

Birth attendance across non-Western and indigenous traditions is poorly documented in the evidence cards available for this entry. Jewish midwives practiced throughout medieval Europe, frequently subject to licensing restrictions that other women were spared; in southern France, Jewish women educated probably at Salerno were known practitioners through the thirteenth century, hunted as heretics but “nevertheless loath to pretend to be Christians.”(Hurd-Mead, 1938)

The Aztec medical tradition, transmitted through the Cruz-Badianus codex (1552) and related sources, contained plant preparations used for obstetric management. Tucker and Janick identify a distinct Nahuatl category — cihuapahtli, “woman-medicine” — naming plants used specifically for labor induction, evidence that Aztec botanical taxonomy included gender-specific therapeutic categories.(Tucker, Arthur O.; Janick, Jules, 2020) Folio 57v of the codex prescribes a multi-route remedy for difficult labor combining cihuapahtli bark, gemstones, opossum tail, and animal products applied by oral dosing, external anointing, and vaginal washing.(Tucker, Arthur O.; Janick, Jules, 2020) A separate folio (58v) describes an abdominal-washing protocol for women near parturition, distinguishing antepartum care from intrapartum intervention.(Tucker, Arthur O.; Janick, Jules, 2020) The codex documents the materia medica without naming the practitioners; the organizational structure of Aztec midwifery requires sourcing beyond the current evidence base.

Chinese Obstetrics: Male Knowledge, Female Labor

Chinese obstetrics developed along a distinctive axis: male physicians claimed intellectual authority over pregnancy management and postpartum therapeutics while leaving the physical act of delivery entirely to female midwives.(Wu, Yi-Li, 2010) This division was not contested or resented in the manner of the European man-midwife debates; it was instead rationalized through a Daoist non-interventionist philosophy that reframed the male physician’s distance from delivery as a mark of superior understanding.

The most influential statement of this position was Ye Feng’s Treatise on Easy Childbirth (1715), which argued that labor was a cosmologically resonant process requiring no outside compulsion — as self-sufficient as plant shoots emerging from the earth or nestlings leaving the egg.(Wu, Yi-Li, 2010) Ye’s practical slogan — “sleep, endure the pain, delay approaching the birthing tub” — instructed parturient women to conserve stamina and avoid assuming the birthing posture until the last possible moment.(Wu, Yi-Li, 2010) Ye drew his title from the mythically easy birth of Lord Millet in the Classic of Odes, using this Confucian canonical allusion to frame easy delivery not as miraculous exception but as the default natural order, subvertible only by human error.(Wu, Yi-Li, 2010)

Ye Feng’s non-interventionism was a deliberate break from Song dynasty practice. Thirteenth-century doctors had recommended routine use of fetal-slimming and birth-expediting medicines in the final month of pregnancy, including bitter orange fruit and rabbit-derived preparations valued for their symbolic association with speed and emergence.(Wu, Yi-Li, 2010) Between the fourteenth and seventeenth centuries, medical writers shifted from these drugs that attacked stagnation toward replenishing medicines that nurtured maternal qi and Blood, reframing difficult labor as a consequence of qi debility rather than physical obstruction.(Wu, Yi-Li, 2010) Ye Feng radicalized both positions by rejecting all ritual and fatalistic explanations of birth difficulty — declaring that “childbirth is not an illness” and that complications arose solely from avoidable human interference.(Wu, Yi-Li, 2010)

The practical consequence was that male physicians reconceived fetal malpresentation not as a problem requiring manual version by the midwife, but as an internal disharmony amenable to drug therapy — thereby expanding the range of obstetrical conditions they could treat from a distance.(Wu, Yi-Li, 2010) In one exemplary case, Ye Feng overruled attendants who had diagnosed labor and ordered complete rest with fetal-stabilizing medicines; the pregnancy continued four more months to a safe delivery, and the grateful family declared Ye the child’s “father.”(Wu, Yi-Li, 2010)

Pregnancy: Diagnosis, Uncertainty, and Management

Male physicians’ claim to obstetric authority rested heavily on the elaborate pregnancy-management literature that accumulated between the sixth and eighteenth centuries. The Golden Mirror of 1742 catalogued pregnancy ailments from morning sickness to corrupted fetuses, ghost fetuses, and “child seizures” resembling preeclampsia, framing the management of pregnancy as a central concern for literate male doctors because of the ever-present risk of maternal and fetal harm.(Wu, Yi-Li, 2010)

Central to this literature was the problem of diagnostic uncertainty. Three conditions were most commonly confused with true pregnancy: intestinal spreading (changtan), stony accumulation (shijia), and ghost fetus (guitai), all of which could produce cessation of menses and abdominal swelling. By the late imperial period, these conditions were reconceived as arising not from demonic invasion but from internally generated disharmonies within the female body: the Golden Mirror, for instance, classified stony accumulation as a form of “stopped menses due to stagnant Blood.”(Wu, Yi-Li, 2010)

Miscarriage prevention generated its own theoretical controversies. Chen Nianzu had followed the orthodox approach of using cooling drugs to prevent miscarriage, but revised his views after his own wife suffered repeated pregnancy losses under his treatment. A warming formula combining psoralea fruit, deer antler gelatin, eucommia, and lovage saved her pregnancy: a combination he would normally have argued against on doctrinal grounds. He concluded that life-gate fire was the very thing that sustained a fetus, not a threat to it.(Wu, Yi-Li, 2010) Zhang Jiebin located the cause of arrested fetal growth in maternal qi and Blood deficiency arising from diverse sources: digestive organ disease, pent-up anger causing liver qi stagnation, or disorders of cold or heat. Rather than a fixed pregnancy protocol, he counseled individualized treatment aimed at restoring the root imbalance.(Wu, Yi-Li, 2010)

Chinese medical doctrine also held that gestation could last substantially longer than ten months. Authorities such as Yang Zijian (fl. eleventh century) cited pregnancies extending four to five years, explained as arising from maternal Blood and qi deficiency that arrested fetal development without causing miscarriage; premature birth and prolonged gestation were understood as two expressions of the same underlying problem of deficient or unruly maternal vitalities.(Wu, Yi-Li, 2010) For healthy women with strong constitutions, Zhang Jiebin went further in challenging obstetric convention: he argued that blood expulsion during childbirth might represent not depletion but the elimination of a gestational surplus, restoring the woman to equilibrium. This view undercut the assumption that all postpartum states required warming supplementation. If childbirth was not depleting, the physician should look for internal injury or external pathogens rather than automatically supplementing.(Wu, Yi-Li, 2010)

Postpartum care occupied its own substantial literature. The custom of zuoyue (“doing the month”) confined women to home seclusion for roughly thirty days, restricting washing, cold exposure, and exertion in a regime that simultaneously facilitated recovery and contained the pollution of birth within the household.(Wu, Yi-Li, 2010) Medical writers identified the central postpartum therapeutic dilemma as the opposition between two pathological states that both threatened newly delivered women: stagnation of waste Blood and depletion of qi and Blood.(Wu, Yi-Li, 2010) Whether birth inherently produced sickness, whether postpartum pathology was rooted in excess or deficiency, and whether the resulting imbalance was hot or cold — these three binaries directly determined drug selection and had occupied writers for centuries.

The physician Zhang Jiebin went furthest in rejecting rote supplementation, proposing that for healthy women, expulsion of blood during childbirth might itself constitute a return to bodily harmony rather than a depletion requiring correction.(Wu, Yi-Li, 2010) Zhang Congzheng and Zhu Zhenheng, despite their otherwise opposed therapeutic orientations, both used the cosmological argument that a successful delivery already proved the woman’s yin and yang were in balance.(Wu, Yi-Li, 2010)

The most dramatic postpartum emergencies involved what medical writers called the “three dashings” of corrupted Blood into heart, lungs, or stomach. Blood dashing into the heart manifested as manic behavior — singing and dancing in mild cases, climbing walls, biting, and shrieking the names of deities in severe ones; such cases had a mortality rate of nine in ten.(Wu, Yi-Li, 2010) Sun Simiao’s seventh-century writings identified postpartum sexual intercourse as a direct cause of “childbirth wind,” a condition whose symptoms — jaw clenching, opisthotonic arching, limb spasms — overlap substantially with maternal tetanus as understood in modern medicine.(Wu, Yi-Li, 2010) The etiological framing (pathogenic wind entering via genital wounds or careless exposure) is consistent with tetanus as a wound infection with a characteristic incubation period.(Wu, Yi-Li, 2010)

By the Qing dynasty, lay obstetric publishing had reached a scale that bypassed professional medical authority entirely. The Bamboo Grove Monastery texts, dosing manuals listing syndromes with observable symptoms and appropriate remedies for home use without medical expertise, circulated in some eighty distinct editions across the empire — from frontier regions of Yunnan and Taiwan to the heartland provinces of Zhejiang and Jiangsu.(Wu, Yi-Li, 2010) Scholar-officials distributed them on official travels, provincial governors endorsed them in prefaces, and one educational commissioner in 1890 gave free copies to candidates at the provincial examinations.(Wu, Yi-Li, 2010)(Wu, Yi-Li, 2010) The physician Xu Dachun criticized such literate amateurs who believed that browsing medical texts qualified them to treat illness, classifying them among three types of people whose errors could cause death.(Wu, Yi-Li, 2010) Yet the demand persisted because medical consumers distrusted fuke specialists — unable to distinguish good doctors from charlatans, families preferred handbooks that bypassed professional intermediaries altogether.(Wu, Yi-Li, 2010)

The magistrate Xu Lian exemplified this lay obstetric activism. In 1813 his wife Ms. Wei died from what he came to believe was misguided postpartum treatment — the strategy of attacking Blood stagnation directly with dispersing drugs. Three decades later, he published and distributed a 1728 manuscript endorsing Generating and Transforming Decoction (shenghua tang), a warming formula that promised to simultaneously generate new Blood and transform away the old, thereby resolving the central postpartum dilemma without dangerous dispersal.(Wu, Yi-Li, 2010) The formula’s appeal lay in its apparent reconciliation of the opposing imperatives: addressing stagnation while replenishing depletion.(Wu, Yi-Li, 2010)

The standard scholarly history of childbirth in America is Wertz and Wertz’s Lying-In (1977; expanded edition 1989), which recovered the social history of birth at a moment when medical historians had treated the subject mainly as the story of instruments and eminent physicians. The Wertzes argued that modern medicine’s defining paradox is its neglect of simple preventive care in favor of heroic technical interventions, and that childbirth in America offers the cleanest case study of how that paradox developed.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

When the English settled in America they brought traditional English customs with them. Birth was the exclusive province of women, and remained so for more than 150 years: women friends and kin attended each other through labor, delivery, and the weeks of “lying-in” that followed, and midwives provided skilled attendance. Educated doctors did not seek to attend births until the revolutionary period.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The custom had its own ritual closure. In New England the new mother often gave a “groaning party” at the end of her lying-in, a feast for the women who had helped her; the term referred both to the groans of labor and to the groaning of the laden table. The wife of Judge Samuel Sewall of Boston served Boil’d Pork, Beef, Fowls, Rost Beef, Turkey Pye and Tarts to her seventeen helpers.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

Demographic evidence from New England gradually corrected the older picture of colonial childbirth as a near-uniform calamity. One historian estimated that even if all the women in seventeenth-century Plymouth who died during childbearing years were assumed to have died of birth complications, birth was still successful 95 percent of the time; many of those deaths were in fact from infections and other diseases unrelated to delivery.(Wertz, Richard W. & Wertz, Dorothy C., 1989) American women had lower maternal mortality than their English contemporaries. The Wertzes attribute this to better nutrition and less urban crowding, which kept American women healthier and gave the midwife less occasion to intervene; American midwives could often simply be present, offering psychological comfort, while natural processes produced healthy delivery.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Midwives also caused no recorded epidemics of puerperal fever among their patients. A medical historian of Virginia calculated that the illiterate Black midwives of that state spread less infection than the doctors did, a pattern that held until the end of the nineteenth century.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The most precise surviving record of a working colonial midwife is the diary of Martha Moore Ballard of Hallowell, Maine. Ballard began practice as midwife and “doctoress” in 1778 at the age of forty-three and continued until her death in 1812. She delivered 996 women with only four maternal deaths recorded in the printed portion of her diary, and went nine years before her first maternal death.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Stapley’s reading of the same diary notes that Ballard specifically delivered 814 babies from her fiftieth year until her death twenty-seven years later, and also served as a principal source of herbal remedies for her community, drawing on plants found in Culpeper.(Stapley, 2024) Her herbal treatments included syrups of mullein, currant, and balsam; a compound of comfrey, plantain, agrimony, and Solomon’s seal; and baths of hyssop, tansy, chamomile, and mugwort for complications in childbirth.(Stapley, 2024) These figures are not anomalous; they reflect the general performance of competent rural midwifery in a healthy population.

Puritan culture nevertheless framed birth as a possible occasion for death and eternal judgment. The minister Cotton Mather, in a widely distributed printed sermon, counseled pregnant women that “your Death has entered into you” and that “No Midwives can do what Angels can!”(Wertz, Richard W. & Wertz, Dorothy C., 1989) The dread that this theology produced was not the same as obstetric danger, and as Puritan religious authority weakened during the eighteenth century, women’s perception of birth shifted toward a more matter-of-fact view, encouraged by a mechanistic worldview that understood human bodies as part of nature, open to understanding and intervention by people, while souls remained sacred to God.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The Wertzes propose that Protestant reform had a second, less obvious effect on American birth: it eliminated magical practices more thoroughly than reform did in England.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Where magical birth practices continued, as in many outlying parts of Britain, midwives’ rituals satisfied pregnant women and kept doctors away. Doctors hesitated to practice where the distinction between natural and spiritual causes was not clearly drawn, because they did not want to be thought of as magicians. In America, the matter of magic was settled early, and the comforts it had once offered did not exist to resist or offend doctors. American women, the Wertzes argue, were therefore more ready than the majority of Englishwomen to look positively on doctors’ new knowledge and technical skills.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The accommodation that resulted was a divided one. Women gradually gave doctors medical control of birth, the manipulation of their bodies, while keeping the spiritual meaning of birth for themselves; social childbirth continued as a divided affair, with the body in the hands of men and the spirit in the company of women.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

Colonial regulation of midwifery, where it existed, treated the midwife as a servant of the state rather than as a professional. The 1716 New York City ordinance required women practicing as midwives to take an oath before the mayor or an alderman: to be diligent and ready to help any woman in labor, poor or rich; to refuse abortifacients; to refuse to collude in concealing the true paternity of a child; to be of good behavior; not to conceal the births of bastards. The structure echoed earlier English episcopal licensing and placed the midwife within an order of moral surveillance rather than within a professional guild.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The Rise of the American Obstetrician (1800–1910)

The displacement of American midwives by male physicians was not a story of superior technique displacing superstition. It was driven, in the Wertzes’ analysis, by economic competition, gender ideology, and a profession whose institutional culture demanded action.

A Boston doctor wrote frankly in 1820 that doctors had to eliminate midwives in order to protect the gateway to their whole practice: “If female midwifery is again introduced among the rich and influential, it will become fashionable and it will be considered indelicate to employ a physician.” If midwives were allowed to deliver upper-class women, women would then turn to them for treatment of other illnesses, and male doctors would lose half their clientele.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Samuel Thomson, the New England farmer who founded American botanical medicine, made the same point from the opposite side. Thirty years earlier, he wrote, the practice of midwifery had been principally in the hands of experienced women; the doctors had now taken most of it for themselves, and what midwives had done for one dollar physicians charged twelve to twenty.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The sectarian movements of the early nineteenth century (Thomsonianism, Eclecticism, Homeopathy, Hydropathy) were all more open to women practitioners than regular medicine and held that women should be attended by midwives or women doctors.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

Doctors who taught the next generation knew that nature was usually sufficient. Dr. Chandler Gilman, Professor of Obstetrics at New York’s College of Physicians and Surgeons from 1841 to 1865, told his students that “Dame Nature is the best midwife in the world… Meddlesome midwifery is fraught with evil… Non-interference is the cornerstone of midwifery.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) The instruction often went unheeded. Walter Channing, Professor of Midwifery at Harvard, named the structural reason in a remark about a case in which forceps were used unnecessarily: the doctor “must do something. He cannot remain a spectator merely, where there are too many witnesses and where interest in what is going on is too deep to allow of his inaction.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) Even doctors who recognized that natural processes were sufficient had to perform before the family, for their authority depended on visible action.

The exclusion of women from American obstetrical training amplified this pattern. In France, the principal maternity hospitals trained doctors clinically alongside student midwives, and hospital midwives often supervised and trained the doctors in normal deliveries; French doctors never lost touch with the conservative tradition that “Dame Nature is the best midwife.” In America, where midwives were not trained at all and medical education was sexually segregated, medicine turned away from the conservative tradition and became more interventionist.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The English coinage that ratified the new arrangement appeared in 1828, when an English doctor proposed “obstetrician” as a replacement for “male-midwife”; derived from the Latin meaning “to stand before,” it had the advantage of sounding like other honorable professions in which men variously understood and dominated nature.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

A second technical change marked the Americanization of obstetrics. In 1808, Dr. John Stearns of upper New York State learned of ergot from an immigrant German midwife. Ergot is a fungus that grows on rye and other stored grains, and it stimulates powerful and unremitting uterine contractions. Stearns prized it for saving the doctor’s time and shortening labor. There was no antidote to its rapid effects until anesthesia became available decades later, and if the fetus did not move as expected, the drug could rupture the uterus and kill the child.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The drug entered American practice through a midwife and was promptly redirected toward physicians’ convenience.

The first woman to earn a US medical degree, Elizabeth Blackwell, did not lament the older midwife’s passing. In 1855 she observed that “the midwife has been entirely supplanted by the doctor” and called the old midwife “an imperfect institution” that “will disappear with the progress of society.” “The midwife,” Blackwell wrote, “must give place to the physician. Woman therefore must become physician.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) Blackwell’s solution to the displacement of midwives was to put trained women into the physician’s role; whether that solution would arrive in time, and at what scale, were both open questions.

The medical education that supported the new American obstetrics was in fact, by international standards, very weak. The Flexner Report of 1910 revealed that 90 percent of doctors then practicing had no college education and that most had attended substandard medical schools. Only after its publication did the profession impose serious educational requirements, accredit medical schools, and close diploma mills.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Until then the average doctor had little defined sense of his limits or to whom he was responsible.

Plantation Midwifery and Enslaved Birth Attendants

The displacement narrative that organized white midwifery in the Northeast does not describe what happened on southern plantations, where enslaved women’s healing work supplied the obstetric labor that the chattel-economy required and that white physicians could not, on their own, provide. Sharla Fett’s Working Cures recovers this parallel history. Enslaved women’s healing work, she argues, embodied a contradiction between skill and servitude: their labor was indispensable to plantation health, yet was associated with menial domestic tasks and denied the medical authority extended to white practitioners.(Fett, Sharla M., 2002) In 1832, the Georgia planter Alexander Telfair instructed his overseer that, except in rare cases, the enslaved woman Elsey was to serve as Thorn Island Plantation’s doctor; well into her seventies, Elsey had a healing reputation that reached beyond the boundaries of the plantation, and her work also extended to caring for enslaved children, feeding poultry, and rendering tallow.(Fett, Sharla M., 2002)

Midwifery in particular afforded enslaved women unusual mobility across plantation boundaries, enabling travel to Black and white households alike and giving them a form of geographic freedom that other enslaved persons did not possess; midwives carried news, sustained kin networks, and could in some circumstances contribute to plans of escape or insurrection.(Fett, Sharla M., 2002) Within enslaved communities, older women healers held authority grounded in spiritual empowerment, elder respect, and herbal knowledge transmitted through fireside apprenticeship after the workday ended; the same women, however, were rated at the lowest market values in slaveholders’ plantation ledgers.(Fett, Sharla M., 2002) Fett locates this work in a relational vision of health that connected individual well-being to community relationships, spiritual power, and ancestral connection — a framework that diverged from the slaveholder’s chattel logic of soundness.(Fett, Sharla M., 2002)(Fett, Sharla M., 2002) Enslaved women grew herbs, made medicines, cared for the sick, prepared the dead for burial, and attended births in Black and white households across the South, drawing on Igbo, Yoruba, Bambara, Kongo, and other African healing traditions transformed in the Americas.(Fett, Sharla M., 2002)(Fett, Sharla M., 2002)

A representative case is Mildred Graves, an enslaved Hanover, Virginia midwife in the years before the Civil War. Graves attended both Black and white women, and at one delivery she was openly mocked by white doctors who told her, “Get back, darkie. We mean business an’ don’ wont any witch doctors or hoodoo stuff.” The white patient, Mrs. Leake, insisted on Graves anyway, and Graves delivered the baby successfully where the physicians had given up.(Cooper Owens, Deirdre, 2017) On the Glover plantations of Colleton County, South Carolina, enslaved women diagnosed with prolapsed uteri (“falling of the womb”) were transitioned from field hands into long-serving plantation nurses; “Old Lizzett, Old Peg, Maria, Prissy, Hagar, and Phoebe” served the medical needs of the Glovers’ large plantations from 1844 through 1859, despite being classified by their owners as “infirmed.”(Cooper Owens, Deirdre, 2017) Mississippi slave nurse Rena Clark, refusing to attend men, identified herself as an “herb doctor” who could cure almost any woman’s ailment; Cooper Owens reads her use of the West African category over “midwife” as a deliberate invocation of African healing tradition rather than the colonial English label, and proposes Clark and others like her as “mothers of gynecology” in their own right.(Cooper Owens, Deirdre, 2017)

These enslaved women’s expertise was harvested by the early American gynecology then taking shape. Cooper Owens has shown that during their five years on Sims’s Mount Meigs slave farm, Anarcha, Betsy, Lucy, and roughly nine other enslaved women — first patients, then surgical nurses — came to know more about the repair of obstetrical fistulae than most physicians of the day; she names them as the rightful “mothers” of American gynecology.(Cooper Owens, Deirdre, 2017)(Cooper Owens, Deirdre, 2017)(Cooper Owens, Deirdre, 2017) After 1808, when Congress banned the importation of African-born slaves, U.S. slaveholders’ interest in increasing slave births domestically expanded reproductive medicine alongside slavery, integrating the rising profitability of the slave-based nation with the rapid development of gynecology as a discipline.(Cooper Owens, Deirdre, 2017) Frances Kemble’s 1838–39 Georgia plantation journal documented the lying-in conditions on the Butler plantation — laboring women lying “prostrate on the earth … with no covering but the clothes they had on and some filthy rags of blanket” — and the practice of an old enslaved midwife who, witnesses said, tied a cloth tightly around laboring women’s throats nearly to suffocation as part of her birthing technique.(Cooper Owens, Deirdre, 2017) Fett warns against reading such episodes as evidence of plantation midwives’ ignorance: planter advice literature was internally contradictory, simultaneously acknowledging the indispensability of the older slave nurse and warning of her “ignorance and temerity,” a contradiction Fett reads as evidence that what slaveholders feared most was not Black healers’ skill level but their autonomous judgment.(Fett, Sharla M., 2002)

The structural relation between enslaved midwives and white medicine was distorted at its core. Slavery, Fett writes, transformed the physician-patient dyad into a three-way relationship among patient, physician, and slaveholder, in which the enslaved person’s interests were structurally subordinated to the slaveholder’s economic calculations.(Fett, Sharla M., 2002) White southern medicine in the antebellum period built itself by drawing on enslaved women’s knowledge while denying them medical authority. Several enslaved male healers in colonial Virginia and South Carolina were manumitted in exchange for herbal secrets, and southern herbal medicine more broadly was characterized by high cross-cultural exchange across lines of race, ethnicity, class, and region — practitioners borrowed, purchased, and stole remedies across a porous boundary that the law and medical professionalism kept invisible.(Fett, Sharla M., 2002)(Fett, Sharla M., 2002) Cooper Owens documents that the medical statistics of the Virginia midwives, by white doctors’ own count, were better than those of doctors. The Wertzes, drawing on a medical historian of Virginia, reported that the illiterate Black midwives spread less infection than physicians did, a pattern that held until the end of the nineteenth century.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

A Caribbean parallel runs through this same period. In the seventeenth-century Spanish Caribbean, enslaved Black women like Ana de la Cruz worked as licensed midwives — Ana de la Cruz charged four pesos around 1638 for attending a birth — and Black creole women like Ana de Reinoso and Leonor María administered medicines in the Grillos’ Portobelo slave-trade infirmary, working “in the office of nurse” for newly arrived sick African captives.(Gómez, Pablo F., 2017) Pablo Gómez has shown that hundreds of people of African descent manufactured, traded, and employed the Atlantic materia medica across the colonial Caribbean.(Gómez, Pablo F., 2017) The pattern that came to define plantation medicine in the antebellum United States — Black women’s reproductive labor extracted by white medicine while Black women themselves were denied medical standing — had a longer Atlantic history than nineteenth-century American historians once recognized.

Modesty, Class, and the Boundaries of the Clinical Gaze

Nineteenth-century American obstetrics developed under a peculiar cultural constraint: the same modesty norms that gave doctors entry to the birth chamber as moral confidants made it almost impossible for them to learn the practical anatomy and pathology of the female body. Women’s modesty became a barrier to clinical training, and the workaround that doctors devised had its own moral costs.

In 1850 Dr. James White of Buffalo demonstrated a delivery on a living patient before a group of medical students. The patient was a woman from the county poorhouse, an Irish immigrant having her second child outside of marriage; she belonged to a class doctors could classify as not deserving the same symptomatic protection given to respectable women. The protest that followed had little to say about the patient’s feelings; it focused on the impropriety of the men’s conduct.(Wertz, Richard W. & Wertz, Dorothy C., 1989) A committee of the American Medical Association responded by deprecating any exposure of the patient during delivery as unnecessary, holding that a physician had to learn to conduct labor by touch alone or he was unfit to practice.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The fit doctor, on this view, was essentially a blind man. The same year that the Buffalo controversy crystallized the question, the AMA also recommended in 1851 against routine use of the vaginal speculum on the same grounds: visual examination was too embarrassing for women and too hazardous for the doctor’s reputation, even though it allowed earlier detection of tumors and other abnormalities not disclosed by touch alone.

After the Civil War a different solution emerged. Charity maternity hospitals struck a quiet bargain with their patients: in exchange for medical treatment, poor women would allow themselves to be exposed to the eye of medicine. What the doctors learned in treating the poor they could then apply, without speaking of it, to respectable women in their homes.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The class structure of American clinical training was set early, and on a foundation that obstetrics shared with general surgery and gynecology.

Hospital Birth, the DeLee Routine, and the Pathologization of Labor

Two further changes set the conditions for the twentieth-century pattern of American childbirth: the migration of birth from home to hospital, and the simultaneous redefinition of normal labor as a pathological process requiring routine intervention.

The migration was rapid. In 1900 less than 5 percent of American women delivered in hospitals; by 1921 more than half the births in Minneapolis-St. Paul, Spokane, San Francisco, Hartford, the District of Columbia, and Springfield, Massachusetts, took place there. In Cleveland hospital deliveries jumped from 22 percent in 1920 to 76 percent in 1937. By 1939, half of all American women and three-quarters of urban women were giving birth in hospitals.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Women were drawn there largely by the prospect of pain relief not readily available at home; the bargain, the Wertzes write, was that women gained release from birthpain at the expense of being processed as possibly diseased objects, and birth was transformed from home to hospital, from suffering to painlessness, from patient care to disease care.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The intellectual architect of routine intervention was Dr. Joseph DeLee of Chicago, whose 1920 article “The Prophylactic Forceps Operation” became a benchmark for American obstetric practice. DeLee urged that outlet forceps and episiotomy be made routine in normal deliveries, alongside sedation, ether, ergot, and manual extraction of the placenta. He argued that labor itself was pathological. “It always strikes physicians as well as laymen as bizarre,” he wrote, “to call labor an abnormal function, a disease, and yet it is a decidedly pathologic process. Everything, of course, depends on what we define as normal.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) DeLee then offered a striking framing of nature’s intent toward the mother: “I have often wondered whether Nature did not deliberately intend women to be used up in the process of reproduction, in a manner analogous to that of the salmon, which dies after spawning”; on his account, only a small minority of women escaped damage, and many babies were killed or damaged by the natural process itself.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The hospital regime that codified DeLee’s outlook was already well developed before he wrote. Dr. William Goodell of Philadelphia’s Preston Retreat had described his system in 1874. On admission, days or weeks before delivery, every woman was placed on quinine. Each received drugs for constipation, headaches, and sleeplessness. When labor began, each was given a cathartic and a bath. The staff then ruptured the amniotic sac, applied forceps to expedite delivery, gave ergot when the head appeared, hurried the expulsion of the placenta by pressing on the stomach, and, after cutting the cord and bathing the woman, administered morphine each hour until afterpains subsided.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The striking feature was that this routine treated every woman as if she was diseased, regardless of her health.

Interventions multiplied with hospital admission. In one Boston maternity hospital, procedures including forceps, versions, Caesarean section, and mechanical induction grew from 29 percent of all deliveries in 1910 to 45 percent in 1921, largely through greater use of forceps and Caesareans. A Vienna-trained doctor reported in 1886 that he needed forceps in only 5 percent of his cases in Vienna but in 40 percent of his cases in New York, partly because his colleagues advised him to do so and partly because he believed his American patients were less healthy.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The pattern was an institutional one, not a clinical one; the same physician acted differently in different professional cultures.

The training that American obstetricians received was, by their own profession’s account, inadequate. J. Whitridge Williams, Professor of Obstetrics at Johns Hopkins (the best medical school of the time), conducted a survey published in 1911 of obstetrics teaching at the leading American medical schools. Williams concluded that students were “unfit on graduation to practice obstetrics in its broad sense, and are scarcely prepared to handle normal cases.” In the best situations a graduate might have attended thirty births. In most, he had attended none or one.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The puerperal fever question that Holmes and Semmelweis had raised in the 1840s and 1850s was answered in the 1870s and 1880s by germ theory. Holmes had concluded in 1843 that puerperal fever was contagious, spread by doctors’ hands, and that “the existence of a private pestilence in the sphere of a single physician should be looked upon, not as a misfortune, but a crime”; Charles Meigs of Philadelphia rejected the argument with the assurance that “gentlemen’s hands were clean.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) The matter was settled empirically only when Pasteur demonstrated, around 1880, that the streptococci he had identified two decades earlier were the major cause of the fever, and that parturient women, having wounded genitalia, were particularly susceptible to the infection.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The Wertzes’ conclusion is sober: puerperal fever is the classic example of iatrogenic disease, and doctors’ need to prevent it contributed to the dehumanization of birth, because each woman had to be treated as potentially diseased regardless of her own health.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Self-studies by the medical profession in the 1930s found that uneducated immigrant midwives in New York had septicemia rates no worse than doctors in either home or hospital deliveries, and that women doctors in Boston hospitals lost fewer patients to puerperal fever than men did, both because they scrubbed more rigorously and because they used instruments to hasten deliveries less frequently.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The Midwife Problem and Sheppard-Towner (1900–1929)

By the early twentieth century the American midwife had become, in public health discourse, “the midwife problem.” The historian Frances Kobrin divided the discussants into four positions: those who advocated immediate abolition of midwives with legal prosecution of any who continued to practice; those who believed in eventual abolition with careful regulation in the meantime; those who wished to educate the midwife to the standard of English and European midwives; and those (mostly Southerners) who believed that if midwives could be trained to wash their hands and use silver nitrate eye drops, no more could be expected of them. The one thing on which most discussants agreed was that the worst birth attendants were not midwives but the general practitioners who tended to intervene needlessly in normal births.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

Immigrant midwives still served large fractions of urban birth populations. As late as 1920 they attended between 20 and 40 percent of all births in mid-Atlantic cities. In Detroit in 1917 a midwife charged seven to ten dollars including five days of postnatal visits, while a doctor charged twenty to thirty dollars and the family had also to hire a nurse for subsequent care, doubling the fee. Italian women in particular preferred midwives over male doctors. Josephine Baker, the New York public health official, observed that “if deprived of midwives, these women would rather have amateur assistance from the janitor’s wife or the woman across the hall than submit to this outlandish American custom of having a male doctor for a confinement.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) The empirical record favored the midwives. The New York Academy of Medicine’s study of 1930 found that midwives had a maternal mortality rate of 1.4 per 1,000 against 2.5 per 1,000 for general practitioners; public health authorities believed that trained Bellevue midwives were better birth attendants than three-quarters of medical graduates.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The American maternal-mortality picture in the 1910s and 1920s was, by international standards, a scandal. In 1913, some 15,000 American women died in childbirth, half of them from puerperal fever; childbirth killed more women aged fifteen to forty-four than any condition except tuberculosis, and showed no sign of decrease between 1900 and 1913. Black women’s mortality was typically double that of whites in the same areas. Florence Kelley, testifying for the Sheppard-Towner bill, pointed out that during the two and a half years Congress had been deliberating, 625,000 babies had died from causes connected with birth or with lack of prenatal care, and the United States had fallen to seventeenth place among nations in maternal mortality.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The Sheppard-Towner Maternity and Infancy Act, passed in 1921, was the first federal program to fund maternal and infant care in the United States and the first major piece of legislation responding to women’s new political power as voters. Between 1921 and 1929 it supported 183,000 health conferences, almost 3,000 prenatal-care centers, and more than three million home visits by nurses; mortality for infants under one year fell from 75 per 1,000 in 1921 to 64 in 1929. Despite the evidence, opponents forced an end to appropriations in 1929. The American Medical Association had become an even more powerful lobby against it.(Wertz, Richard W. & Wertz, Dorothy C., 1989) The character of the AMA’s opposition is preserved in an article in the Illinois Medical Journal that denounced the bill as “a piece of destructive legislation sponsored by endocrine perverts, derailed menopausics and a lot of other men and women working overtime to devise means to destroy the country.”(Wertz, Richard W. & Wertz, Dorothy C., 1989)

Southern states made their own use of Sheppard-Towner funds. Rather than upgrade rural Black midwives to the level of English or European training, public health departments enforced a minimal program: handwashing, silver nitrate drops, no drugs, summon a doctor for complications. Public health nurses organized rural Black midwives into “midwives’ clubs” with potluck suppers, regular meetings, instructional talks, and a “midwives’ song”; the atmosphere was designed to parallel a religious meeting, fitting in a region where midwifery was often considered a religious calling. Manuals presented the women as “servants of the state.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) The Southern policy locked in a pattern of racially segregated, professionally limited Black midwifery that persisted into the late twentieth century.

The most positive American institutional alternative to physician-controlled birth grew out of rural Appalachia. Mary Breckinridge, a nurse who had cared for children in postwar France, founded the Frontier Nursing Service in Hayden, Kentucky, in 1925, choosing a remote area accessible only on horseback and lacking any doctor or trained midwife. Breckinridge had taken her midwifery training in England and, until World War II, brought trained English midwives to America or sent Americans to England for theirs. Only after the war began did the Frontier Nursing Service train its own nurse-midwives.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

Natural Childbirth and Feminist Critique (1940s–1970s)

By the 1950s, hospital birth had become an alienating, industrial experience for many American women. A 1958 Ladies’ Home Journal feature drew letters describing women “herded like sheep through an obstetrical assembly line, drugged and strapped on tables while their babies are forceps-delivered”; about one in seven correspondents reported instances of cruelty or neglect, although a number of doctors and other readers wrote to defend the care they provided. Many maternity wards, the Wertzes conclude, had lost the human element by 1958.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The critique that gave shape to a popular alternative came from a British obstetrician. Grantly Dick-Read began his crusade for what he called fearless birth after attending a delivery in a poor home, where for the first time in his experience a woman refused chloroform and gave birth without fuss or noise, telling him afterward, “It didn’t hurt. It wasn’t meant to, was it, doctor?” From this clinical encounter Dick-Read developed his “fear-tension-pain syndrome”: a woman suffered pain in birth to the extent that she was afraid; relaxed women experienced little pain. Education and relaxation, he proposed, could eliminate up to 95 percent of birth pain.(Wertz, Richard W. & Wertz, Dorothy C., 1989) Dick-Read’s framework had a deeply Victorian inflection. He glorified motherhood as woman’s supreme fulfillment, associated essential femininity with purity, piety, and submissiveness, and called for the return of “the Victorian mothers of seven and ten children.” The Victorianism opened the door to an antifeminist co-optation that many American doctors adopted: as recently as 1970, one widely dispensed obstetric manual explained that natural childbirth essentially meant having complete confidence in one’s doctor.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

A second method came from a different direction. After the Second World War, Russian doctors applied Pavlovian conditioning theory to labor pain, calling their method psychoprophylaxis. In 1951 two French physicians, Ferdinand Lamaze and Pierre Vellay, traveled to Russia to study the new approach. Lamaze added the rapid shallow breathing or “panting” that became the hallmark of his method. Unlike Dick-Read, who promised childbirth without fear, Lamaze promised childbirth without pain. Unlike Dick-Read, Lamaze also framed birth as an active performance in which the laboring woman controlled her own labor.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The psychoanalytic counter-position remained influential well into the 1960s. Helene Deutsch held that a woman who wanted active control of her delivery had distorted her femininity into masculinity and would have birth complications, and that the woman who could not be passively feminine before birth could not mother her child afterward. Deutsch nevertheless agreed with Dick-Read that hospitals routinely drugged women so heavily that one could not speak of an act of childbirth at all; when such women awakened, she observed, they often felt no love for the child and sometimes declared that the children presented to them were not theirs.(Wertz, Richard W. & Wertz, Dorothy C., 1989) By the 1970s, most American “natural childbirth” was a peculiarly American compromise. Doctors offered it readily, provided it could be combined with episiotomy, outlet forceps, Demerol, and even epidural anesthesia. Doctors were satisfied with the Lamaze method only insofar as they could adjust it to keep birth from being overly time-consuming and to permit them enough activity to justify their professional presence and fees. Many women accepted the assurance that they had had a natural delivery even when many interventions had been made.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

The resurgent feminist movement of the 1970s changed the political register of these debates. The 1970s feminist movement examined the behavior of the medical profession and the workings of medical institutions in the treatment of women. The natural childbirth movement, which had been a loosely organized cultural preference among middle-class women, acquired a social and political cast. Women of all classes began to organize, to educate one another, and to try to change or avoid the professional and institutional structures that exerted such dominance over birth.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

Nurse-Midwifery and the American Anomaly

By the late twentieth century the institutional position of the American midwife was unusual among industrialized nations. The American College of Nurse-Midwives defined its own practitioners as never independent: “the American nurse-midwife always functions within the framework of a medically directed health service. She is never an independent practitioner.”(Wertz, Richard W. & Wertz, Dorothy C., 1989) In other industrialized countries the balance was very different. In Switzerland in 1961 there were 1,682 professional midwives, no lay midwives, and only 284 obstetricians.

The American figures from the early 1970s show the asymmetry clearly. In 1973 there were an estimated 1,300 nurse-midwives in the United States, mostly in the eastern half of the country, who attended an estimated 4,000 of that year’s 3.1 million births. They were heavily outnumbered both by 20,500 obstetricians and by 2,900 licensed lay midwives clustered in Texas, Alabama, Mississippi, and other Southern states. England and Wales, for comparison, had 17,370 professional midwives (twenty-one per 1,000 births, against 0.62 obstetricians per 1,000), and no lay midwives at all.(Wertz, Richard W. & Wertz, Dorothy C., 1989)

What the American story reveals is not a story of progress from primitive to scientific birth attendance. Trained female practitioners had managed births at high competence in every era for which records survive: literate in Soranus by the sixteenth century, keeping case records with Louise Bourgeois by 1609, training with manikins under du Coudray by 1759, managing forty thousand births with minimal intervention under Lachapelle by the early nineteenth century, and delivering rural Maine with Martha Ballard at a fatality rate of four in 996. Their displacement from American practice was driven, as the Wertzes show, by economic competition for upper-class patients, by Protestant cultural assumptions that demystified birth and made women receptive to male technical authority, by exclusion of women from medical education, and by the AMA’s organized opposition to public health alternatives. It was not driven by superior physician technique. The puerperal fever epidemics of the nineteenth century and the routine intervention of the early twentieth, both unique to physician-attended births, are the counter-evidence: where medicalization replaced traditional practice without preserving its lower-risk profile, mortality and harm increased. The American anomaly in midwifery licensing, a country with very few independent midwives in a world where independent midwifery was the international norm, is the institutional residue of that history. Hurd-Mead’s central thesis — that women’s decline from primary healer status was not due to incompetence but to economic and cultural shifts, and that women continued to practice in every period despite marginalization — is confirmed by each successive chapter of this history.(Hurd-Mead, 1938)

Sources

Evidence cards used in this entry:

ID	Source	Locator
hm38-ch01-001	Hurd-Mead, A History of Women in Medicine (1938)	ch. 1
hm38-ch01-002	Hurd-Mead, A History of Women in Medicine (1938)	ch. 1
hm38-ch01-005	Hurd-Mead, A History of Women in Medicine (1938)	ch. 1
hm38-ch01-007	Hurd-Mead, A History of Women in Medicine (1938)	ch. 1
hm38-ch01-009	Hurd-Mead, A History of Women in Medicine (1938)	ch. 1
hm38-ch01-010	Hurd-Mead, A History of Women in Medicine (1938)	ch. 1
hm38-ch01-013	Hurd-Mead, A History of Women in Medicine (1938)	ch. 1
sor56-intro-001	Temkin, trans., Soranus, Gynecology (1956)	Introduction, p. xxiii
sor56-intro-004	Temkin, trans., Soranus, Gynecology (1956)	Introduction, p. xxv
sor56-intro-010	Temkin, trans., Soranus, Gynecology (1956)	Introduction, pp. xxix–xxx
sor56-intro-019	Temkin, trans., Soranus, Gynecology (1956)	Introduction, pp. xl–xli
sor56-intro-023	Temkin, trans., Soranus, Gynecology (1956)	Introduction, pp. xliv–xlv
sor56-book1-001	Temkin, trans., Soranus, Gynecology (1956)	Book I, ch. I–II, pp. 3–4
sor56-book1-002	Temkin, trans., Soranus, Gynecology (1956)	Book I, ch. I (par. 3), pp. 5–6
sor56-book1-003	Temkin, trans., Soranus, Gynecology (1956)	Book I, ch. II (par. 4), pp. 6–7
sor56-book1-037	Temkin, trans., Soranus, Gynecology (1956)	Book I, ch. XVI (pars. 55–56), pp. 55–58
sor56-book1-040	Temkin, trans., Soranus, Gynecology (1956)	Book I, ch. XIX (pars. 60–63), pp. 62–66
green01-intro-001	Green, ed., The Trotula: A Medieval Compendium of Women’s Medicine (2001)	pp. 19–20
green01-intro-011	Green, ed., The Trotula (2001)	pp. 31–32
green01-intro-012	Green, ed., The Trotula (2001)	pp. 49–51
green01-intro-018	Green, ed., The Trotula (2001)	pp. 49–50
green01-intro-019	Green, ed., The Trotula (2001)	pp. 25–26
hm38-ch03-001	Hurd-Mead, A History of Women in Medicine (1938)	ch. 3
hm38-ch03-002	Hurd-Mead, A History of Women in Medicine (1938)	ch. 3
hm38-ch03-005	Hurd-Mead, A History of Women in Medicine (1938)	ch. 3
hm38-ch05-001	Hurd-Mead, A History of Women in Medicine (1938)	ch. 5
hm38-ch06-001	Hurd-Mead, A History of Women in Medicine (1938)	ch. 6, p. 272
hm38-ch06-004	Hurd-Mead, A History of Women in Medicine (1938)	ch. 6, p. 273
hm38-ch06-005	Hurd-Mead, A History of Women in Medicine (1938)	ch. 6, p. 277
hm38-ch07-001	Hurd-Mead, A History of Women in Medicine (1938)	ch. 7, p. 321
hm38-ch07-004	Hurd-Mead, A History of Women in Medicine (1938)	ch. 7, pp. 332–333
hm38-ch07-007	Hurd-Mead, A History of Women in Medicine (1938)	ch. 7, p. 313
hm38-ch07-008	Hurd-Mead, A History of Women in Medicine (1938)	ch. 7, pp. 877–883
hm38-ch08-001	Hurd-Mead, A History of Women in Medicine (1938)	ch. 8, p. 363
hm38-ch08-002	Hurd-Mead, A History of Women in Medicine (1938)	ch. 9, pp. 420–421
hm38-ch08-004	Hurd-Mead, A History of Women in Medicine (1938)	ch. 8, pp. 343–344
hm38-ch08-005	Hurd-Mead, A History of Women in Medicine (1938)	ch. 8, p. 358
hm38-ch08-007	Hurd-Mead, A History of Women in Medicine (1938)	ch. 9, p. 420
hm38-ch09-002	Hurd-Mead, A History of Women in Medicine (1938)	ch. 9, p. 427
hm38-ch05-009	Hurd-Mead, A History of Women in Medicine (1938)	ch. 5, pp. 378–379
hm38-ch10-001	Hurd-Mead, A History of Women in Medicine (1938)	ch. 10, p. 492
hm38-ch10-002	Hurd-Mead, A History of Women in Medicine (1938)	ch. 10, pp. 494–495
hm38-ch10-003	Hurd-Mead, A History of Women in Medicine (1938)	ch. 10, p. 493
hm38-ch10-007	Hurd-Mead, A History of Women in Medicine (1938)	ch. 10, pp. 474–475
siraisi90-ch02-006	Siraisi, Medieval and Early Renaissance Medicine (1990)	pp. 27–28
siraisi90-ch02-007	Siraisi, Medieval and Early Renaissance Medicine (1990)	p. 28
jac88-ch05-001	Jacquart & Thomasset, Sexuality and Medicine in the Middle Ages (1988)	ch. 5, pp. 62–66
jac88-ch05-003	Jacquart & Thomasset, Sexuality and Medicine in the Middle Ages (1988)	ch. 5, pp. 102–107
fitz17-ch07-002	Fitzharris, The Butchering Art (2017)	ch. 7
fitz17-ch07-003	Fitzharris, The Butchering Art (2017)	ch. 7
fitz17-ch07-004	Fitzharris, The Butchering Art (2017)	ch. 7
ack55-ch17-002	Ackerknecht, A Short History of Medicine (1955)	ch. 17
ack55-ch17-006	Ackerknecht, A Short History of Medicine (1955)	ch. 17
elliott14-ch08-005	Elliott, Outlines of Greek and Roman Medicine (1914)	ch. 8
wer89-ch01-006	Wertz & Wertz, Lying-In: A History of Childbirth in America, expanded ed. (Yale UP, 1989)	p. xiii
wer89-ch02-001	Wertz & Wertz, Lying-In (1989)	pp. 1–2
wer89-ch02-002	Wertz & Wertz, Lying-In (1989)	p. 5
wer89-ch02-003	Wertz & Wertz, Lying-In (1989)	pp. 9–11
wer89-ch02-004	Wertz & Wertz, Lying-In (1989)	pp. 12–13
wer89-ch02-005	Wertz & Wertz, Lying-In (1989)	pp. 19–20
wer89-ch02-006	Wertz & Wertz, Lying-In (1989)	pp. 21–22
wer89-ch02-007	Wertz & Wertz, Lying-In (1989)	pp. 23–25
wer89-ch02-008	Wertz & Wertz, Lying-In (1989)	pp. 25–26
wer89-ch02-009	Wertz & Wertz, Lying-In (1989)	p. 26
wer89-ch02-010	Wertz & Wertz, Lying-In (1989)	pp. 13–14
wer89-ch02-011	Wertz & Wertz, Lying-In (1989)	pp. 7–8
wer89-ch02-012	Wertz & Wertz, Lying-In (1989)	pp. 24–25
wer89-ch03-001	Wertz & Wertz, Lying-In (1989)	p. 64
wer89-ch03-002	Wertz & Wertz, Lying-In (1989)	pp. 65–66
wer89-ch03-004	Wertz & Wertz, Lying-In (1989)	pp. 62–63
wer89-ch03-005	Wertz & Wertz, Lying-In (1989)	p. 60
wer89-ch03-006	Wertz & Wertz, Lying-In (1989)	p. 55
wer89-ch03-007	Wertz & Wertz, Lying-In (1989)	pp. 51–52
wer89-ch03-008	Wertz & Wertz, Lying-In (1989)	pp. 52–54
wer89-ch03-009	Wertz & Wertz, Lying-In (1989)	p. 56
wer89-ch03-010	Wertz & Wertz, Lying-In (1989)	p. 66
wer89-ch03-011	Wertz & Wertz, Lying-In (1989)	p. 65
wer89-ch06-001	Wertz & Wertz, Lying-In (1989)	pp. 85–86
wer89-ch06-002	Wertz & Wertz, Lying-In (1989)	pp. 86–87, 90
wer89-ch06-003	Wertz & Wertz, Lying-In (1989)	pp. 89–90
wer89-ch07-001	Wertz & Wertz, Lying-In (1989)	pp. 123–124
wer89-ch07-002	Wertz & Wertz, Lying-In (1989)	p. 128
wer89-ch07-003	Wertz & Wertz, Lying-In (1989)	pp. 125–126
wer89-ch07-004	Wertz & Wertz, Lying-In (1989)	p. 133
wer89-ch07-005	Wertz & Wertz, Lying-In (1989)	pp. 141–142
wer89-ch07-006	Wertz & Wertz, Lying-In (1989)	p. 143
wer89-ch07-007	Wertz & Wertz, Lying-In (1989)	pp. 145–146
wer89-ch07-008	Wertz & Wertz, Lying-In (1989)	pp. 137–138
wer89-ch07-010	Wertz & Wertz, Lying-In (1989)	p. 128
wer89-ch07-011	Wertz & Wertz, Lying-In (1989)	p. 143
wer89-ch07-012	Wertz & Wertz, Lying-In (1989)	p. 127
wer89-ch11-001	Wertz & Wertz, Lying-In (1989)	pp. 173–174
wer89-ch11-002	Wertz & Wertz, Lying-In (1989)	pp. 183–184
wer89-ch11-003	Wertz & Wertz, Lying-In (1989)	pp. 184–186
wer89-ch11-004	Wertz & Wertz, Lying-In (1989)	pp. 193–194
wer89-ch11-005	Wertz & Wertz, Lying-In (1989)	pp. 189–190
wer89-ch11-008	Wertz & Wertz, Lying-In (1989)	pp. 194–195
wer89-ch11-009	Wertz & Wertz, Lying-In (1989)	pp. 195–196
wer89-ch15-001	Wertz & Wertz, Lying-In (1989)	pp. 205–209
wer89-ch15-002	Wertz & Wertz, Lying-In (1989)	pp. 208–210
wer89-ch15-003	Wertz & Wertz, Lying-In (1989)	p. 208
wer89-ch15-004	Wertz & Wertz, Lying-In (1989)	pp. 212–214
wer89-ch15-005	Wertz & Wertz, Lying-In (1989)	pp. 211–212
wer89-ch15-006	Wertz & Wertz, Lying-In (1989)	pp. 214–215
wer89-ch15-007	Wertz & Wertz, Lying-In (1989)	pp. 214–215
wer89-ch15-008	Wertz & Wertz, Lying-In (1989)	pp. 217–218
wer89-ch15-009	Wertz & Wertz, Lying-In (1989)	p. 218
wer89-ch15-010	Wertz & Wertz, Lying-In (1989)	pp. 218–219

Editorial Notes

Gaps the encyclopaedia compiler flagged for future evidence work, collected from inline markers in the body and frontmatter.

Early Modern Professionalization: Printed Manuals, Licensing, and the Man-Midwife Debate

Colonial and Non-Western Traditions

American Midwifery: 20th-century licensing

The US story is now substantially built out from Wertz & Wertz, Lying-In (1989), the standard scholarly history. Borst 1995 Catching Babies and Witz 1992 Professions and Patriarchy (UK) remain on the WISH_LIST as supplementary sources for state-by-state licensing detail and comparative UK analysis.

Midwifery

Summary

Ancient Midwifery: Egypt, Greece, and Rome

Medieval Practice: Trotula, Midwives, and the Limits of University Medicine

Early Modern Professionalization: Printed Manuals, Licensing, and the Man-Midwife Debate

The Exclusion of Women from Medical Education

Puerperal Fever and the Cost of Medicalization

Farr’s Vital Statistics on Maternal Mortality

Colonial and Non-Western Traditions

Chinese Obstetrics: Male Knowledge, Female Labor

Pregnancy: Diagnosis, Uncertainty, and Management

Colonial American Midwifery: Social Childbirth in the New World

The Rise of the American Obstetrician (1800–1910)

Plantation Midwifery and Enslaved Birth Attendants

Modesty, Class, and the Boundaries of the Clinical Gaze

Hospital Birth, the DeLee Routine, and the Pathologization of Labor

The Midwife Problem and Sheppard-Towner (1900–1929)

Natural Childbirth and Feminist Critique (1940s–1970s)

Nurse-Midwifery and the American Anomaly

See Also

Sources

Editorial Notes

Sources