Limited but Still Marginal

The history of direct-entry midwifery shows the difficulties members of an oc- cupation face in gaining acceptance as limited practitioners when the occupation draws only from socially marginal groups—in this case, women, often from mi- nority groups. Although until the 20th century, direct-entry midwives (i.e., midwives who lack nursing degrees) delivered the majority of American babies, they now deliver less than 1%. In this section, we consider how these changes came about and how direct-entry midwives have attempted to regain their lost position. The Struggle to Control Childbirth Until well into the 19th century, Amer- icans considered childbirth solely a woman’s affair. Al- most all women gave birth at home attended by a direct-entry midwife or by female friends or relatives. Although a few local governments during the colonial era licensed midwives, licensure laws did not survive past U.S. independence, so anyone who wanted to call herself a midwife could practice essentially without legal restrictions. Unlike nurse–midwives, who did not exist until the 20th century, these direct-entry midwives had no formal training but learned their skills through experience and sometimes through informal apprenticeships. Typically, they served only women from their own geographic or ethnic community. Doc- tors (all of whom were men) played almost no role in childbirth because Americans suspected the motives of any men who worked intimately with female bodies. Moreover, doctors had little to offer childbearing women beyond the ability to destroy and remove the fetus when prolonged labor threatened to kill the mother. Midwives, meanwhile, could offer only patience, skilled hands, and a few herbal remedies.