Midwives don’t know much about history

Antique letterpress wood type printing blocks - History

An article in Quartz illustrates the way that midwives are trying to rewrite the history of childbirth. The piece, entitled The reason American women over-medicalize childbirth has its roots in racial segregation, by Annalisa Merelli is pure, unadulterated nonsense.

There were three reasons obstetricians and hospitals came to dominate childbirth in the industrialized world and racism isn’t among them. First, obstetricians and hospitals could offer safe effective pain relief for the agony of childbirth. Second, hospitals offered women something that midwives could not: an opportunity to rest and recover from childbirth without having to care for their husbands and older children. Third, and most important, obstetricians and hospitals made childbirth dramatically safer.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The difference between safe childbirth and dangerous childbirth is not midwives; it’s the routine interventions of modern obstetrics.[/pullquote]

Let’s face it: midwives presided over childbirth for literally thousands of generations and they didn’t make a dent in astronomical rates of perinatal and maternal mortality. It took obstetricians less than 3 generations to reduce both by more than 90%.

This graph makes it crystal clear:


Midwives don’t like to acknowledge that history, so they’re trying to rewrite it. According to Quartz:

Every year in the UK, more than half of babies are delivered with the guidance of a midwife. In Scandinavian countries, it’s more like three quarters, similar to the rate in France. In fact, in these and many other countries, midwives take part in almost all deliveries, as they also assist OB-GYNs in more complicated cases.

But in the US, less than 10% of deliveries are led by midwives. The rate has languished in the single digits since a century ago, when expectant mothers largely stopped using midwives to embrace doctor-led childbirth, believing that was safer. Ironically, that shift has resulted in myriad problems stemming from the over-medicalization of childbirth. Those problems are reflected in the country’s high rates of C-sections as well as in the “cascade of interventions” that comes with medically managing labor …

There’s nothing wrong with properly educated, properly trained midwives. They can provide excellent care but ONLY if they follow the principles of obstetrics and medicine elucidated by doctors and scientists. Childbirth is not inherently safe; it is exceedingly dangerous (as it is among nearly all higher order mammals). Dangers include hemorrhage, infection, pre-eclampsia and obstructed labor among others. The difference between safe childbirth and dangerous childbirth is not midwives; it’s blood transfusions, antibiotics, anti-seizure medications, easy access to Cesarean and anesthesia. How many of those innovations were discovered or invented by midwives? ZERO!

What about the so-called problem of over-medicalization? It’s much more of an economic problem for midwives than a health problem for mothers or babies. In fact, it’s such a problem for midwives that they have resorted to demonizing whatever it is they cannot do. They can’t offer epidurals or C-sections so they insist they are unnecessary. They require a doctor’s supervision to use blood transfusions, antibiotics and anti-seizure medications so they pretend they are rarely needed.

The American Medical Association (AMA) saw midwives as competitors for what would become the most common cause of hospitalization in America, and a reliable source of revenue…

The AMA’s focus on specialized healthcare wasn’t limited to childbirth—it was spread across all disciplines. But its expansion into childbirth was especially effective, partly because the midwives who were, until then, running childbirth were overwhelmingly African American and Native American—both demographic groups that were easy to discredit in a country that had abolished slavery just decades before, and would enforce racial segregation for decades to come.

Midwives were overwhelmingly African American and Native American? What drug was Merelli smoking when she wrote that nonsense? And do the folks at Quartz bother with fact checkers or do they just publish whatever drivel their journalists fabricate? Only a foreign journalist could have blithely accepted the falsehood that the overwhelmingly white population of the US allowed their women to be attended in birth by African Americans and Native Americans. In many states, there were and to this day there are few African Americans and even fewer Native Americans. The claim is absolutely ludicrous.

Sure midwifery remained popular with African Americans far longer than for white women, but that was because black Americans were denied access to the lifesaving technology of hospitals as a result of racism and poverty. There was no Medicaid or welfare; you couldn’t go to a hospital unless you could pay for it. Sadly, the same dynamic still exists today. Black women and babies are dying in childbirth at far higher rates than other minorities because they LACK access to high technology care, not because they have too much of it.

Quartz quotes Jennie Joseph, a black midwife, who is apparently a font of this nonsense:

Midwives continued to deliver the children of women who couldn’t afford medical care, but eventually they all but disappeared. “Slave women delivered America,” says Joseph, but as soon as medically-managed hospital births became the preferred option for anyone who could afford it, the tradition of American midwifery, which had been passed on through generations of black women, was lost. Today, only 4% of the country’s midwives are black. “We all know each other,” says Joseph. “That’s how bad it is.”

Joseph is not from the US, either, or she would be aware that slavery was ended in abolitionist states long before the advent of midwifery and that many states had few African Americans at all.

Only 4% of midwives are black? That’s hardly surprising for two reasons: only 11% of the country’s obstetricians are black as a result of a legacy of racism. More importantly, midwifery has become associated with privilege. Midwives promote natural childbirth and the refusal of interventions. You have to be privileged to have easy access to hospital technology before it becomes a status symbol to refuse it.

The bottom line is that the decline of midwifery in the US has NOTHING to do with racism and everything to do with women wanting access to the safest possible care and the availability of effective pain relief. When women are allowed to choose their care providers, instead of having them forced upon them by the government, they prefer obstetricians and hospitals.