When I was pregnant for the first time, I insisted on a male obstetrician. I believed that men had better reflexes, performed better under pressure, and were more technically competent than women. I thought that for the same reason I used to think God made Adam and Eve and not Adam and Steve, the same reason I thought a woman who pursued a career while having small children at home was neglectful. I thought that because of years of religious boarding school and college, a mom and dad who modeled my preconceptions, and some vague scientific stuff I was pretty sure I once read or saw on TV or had the Archangel Gabriel whisper at me. I thought that because it hadn’t occurred to me yet to think anything else.
So I called up Dr. Stone. A man so sleek and well-groomed, he was as antiseptic as his speculum. He was completely devoid of warmth and would only talk to me while examining my body, launching into that “set you at ease so we can both pretend that I’m not pinching your boobies” patter that most OB/GYNs do. But I can’t libel the doctor: When my baby began to die during my labor, within seven minutes of the fetal monitor indicating her distress, he had me stretched out on an operating table and delivered of a healthy newborn.
Still, my friends kept talking about their beautiful experiences in birthing centers, in pools in their own living rooms, the maternal support of midwives. It made me believe I could have a healthy baby and a happy birthing experience. It sounded so much nicer than Dr. Stone’s clean-shaven indifference. I floated the idea of a midwife assisted hospital-birth to my husband.
“Yes! A midwife!” my husband said. “Because I was thinking to myself, ‘Who are we going to get to wave burning sage over your stomach and chant to Gaia while the baby dies?’ CLAP IF YOU BELIEVE!!”
My husband is a smartass, but there’s more to his remark than smartassery; his attitude is the result of a centuries-long smear campaign against midwifery. But go far enough in the past and the campaign vanishes. Men’s grasp on the business of birth is a relatively recent thing, and it appears to be ending.
Finally! Childbirth, By Men, For Men!
Science got a supreme kick in the butt around the beginning of the nineteenth century. Before then, doctors were people who thought diarrhea came from too much soot in the air and that removing two cups of “bad blood” from a patient with pneumonia would rebalance his humors. They were considered a last resort.
But in the 1800s, modern medical science began taking shape. Human bodies were allowed to be dissected and studied, and germ theory—that kooky idea that tiny invisible organisms could make you and everyone you breathe on sick—was becoming accepted. Doctors had opium and cocaine derivatives, and they could perform small but efficient surgeries (if you have the stomach for it, you can read Fanny Burney’s excruciating account of her own mastectomy).
Yet one field eluded them. Women still wanted other women to help them give birth. And since women of the era were not easily admitted to medical schools, doctors were forced to compete in this arena with midwives. So they used their non-secret weapon, the thing doctors could do that many nineteenth-century midwives couldn’t. The doctors started writing books. Books read by people educated and wealthy enough to buy them. And of course, rich people tend to be trendsetters. When rich people started believing what the doctors told them—that midwives were dirty and ignorant—the rest of the population followed suit.
Beware The Filthy Ignorant Midwife
A few samples from those books:
”[Inspecting a woman for pregnancy], on account of decency, is often performed by midwives, ignorant persons, who have no knowledge of human economy, and may be easily deceived.”
Samuel Farr, Elements of Medical Jurisprudence, 1814
Yeah. If there’s one thing a midwife don’t know shit about, it’s signs of pregnancy.
But, over the course of the nineteenth century, the opinion of the medical community was cemented. The word “midwife” was soiled. A Dr. Arschagouni said, disdainfully, that “one confinement and two miscarriages make a midwife proficient.” In 1898, Dr. Walter G. Crump wrote in the North American Journal of Homoeopathy:
A most crying need is the licensing of midwives. Our most common call for the ambulance is in the septic cases after the ignorant management of midwives. Most of those on the East side are women who have only seen a few cases and then put out their own shingle. Abortion is also lamentably common among them.
From a McClure’s Magazine 1909 exposé:
Miss F. Elizabeth Crowell, graduate nurse to the New York Association of Neighborhood Workers examined 10,000 certificates of births in 1906, and personally interviewed 500 midwives in their homes. ‘Of these midwives’ homes, 106 were absolutely filthy, as were the clothing and person of the midwife herself. Of the remaining 394, I should say one third might be designated as excellent, the other two-thirds as fair. As for their bags and equipment, from a professional standpoint by far the greater number would make fit decorations for a chamber of horrors. Out of 303 bags inspected, 34 only were marked as first-class, that is, they were clean and their equipment was complete and sterile.’
In fairness to these midwives, sterile medical sanitation was a new idea when even the latest of these articles were written. There was nothing wrong in wanting those who attended birthing to be clean, educated and accountable, but the doctors were going for self-interested gatekeeping. Requiring official licensing was the first step in shoving women out of the field all together. You couldn’t get licensed from just an apprenticeship, which was the norm for midwifery. Official training and state licensure cost money, an expense passed on to clients. It undermined the centuries-old purpose of the midwife as an affordable option to assist births. Instead, went the parallel argument, physicians wanted the poor to give birth in charity hospitals—where tired, apathetic attendants and untold diseases and infections awaited them.
To compound the problem, 19th century immigration to America was unprecedented. This increased the number of urban, non-English-speaking poor exponentially. Imagine, a heavily pregnant Russian mother who anticipating the comfort and familiarity of her community’s akusherka to deliver her child in her own bed, with all the women she loves nearby, being told that she should, instead, waddle herself through the slums and take up a bed next to 15 other women, many mysteriously dying of puerperal sepsis. There, a man whose mind, body and compassion have all become severely fatigued, will touch her in ways completely inappropriate to her culture, possibly accompanied by a group of other men who watch and take notes. And since it doesn’t even occur to that man to wash his hands after touching the sick woman next to her, childbed fever may soon burn the life out of her body, as it did to so many others who gave birth in public hospitals. Most women in her situation would prefer the sloppiest, sharpest tongue midwife in all of Russia to that scenario.
For black women of the era, their position as slaves and institutionally degraded people might have actually worked in their favor, at least as far as avoiding the often deadly “lying in” hospitals. In the above study of 500 interviewed New York midwives, there included only one, one, “West Indian Negress.” It seems unlikely that an urban population the size of New York had so few black mothers as to warrant only one midwife. It is possible that white midwives served black mothers, but highly unlikely in an era and place where ethnocentricity was king. It is more likely that black society, North and South, experienced far less interference from campaigns intended to improve society.
Women could, of course, go to medical school to become fully licensed obstetricians. But the number was minuscule clear into the 1980s. According to the Journal of the American Osteopathic Association, in the 1970s, only 9 percent of enrolled medical students in any field were women.
But that changed, and it changed fast. According to The US National Library of Medicine, female residency in Obstetrics and Gynecology quadrupled from 1978 to the present. Women now account for 71.8 percent of OB/GYN residents.
“Not One Woman.”
Dr. Chet Smith practiced obstetrics with a surgical specialty for 30 years, delivering around 4,000 babies in his career. (He’s still a practicing gynecologist, but quit obstetrics 10 years ago.) He told me: “We have women who come to our office and ask, ‘Which of you [of Dr. Smith and his medical partner] are female?’ and neither of us are, so we don’t get the client.”
This is an astoundingly different environment than when Smith began his residency in 1974. “In the whole residency program there were 16 residents in obstetrics, not one woman. Surgical obstetrics and gynecology was a male specialty.”
Smith ventured some guesses as to why, considering the social climate of the time. “Surgical obstetrics, obstetrics in general, is a hugely demanding field both physically and mentally; it takes a very special female. It’s hard to be a mother and have a child and being a surgical specialist at the same time. It’s tough.” He reflected on the earliest female OBs he worked with; they were usually unmarried without children, and in his opinion, a tendency to be “hardened.”
Smith speaks from an era before obstetricians routinely belonged to the sort of co-op arrangements typical now. Today, to afford obstetricians a bearable lifestyle, a woman will usually have a primary OB throughout her pregnancy, but when the time comes, she’ll have maybe a one-in-four chance of being delivered by her own doctor—it all depends on who’s on call that night. Smith was on call for all of his clients, 24/7, carefully planning his (usually interrupted) vacations and family time around his patients’ due dates. That sort of stress has been much reduced by the new model of pregnancy and delivery care.
It’s not just that there are more female obstetricians, either. Midwifery, far more sanitary and scientific than its ancient ancestor, is booming again after a near 200-year lag. The difference between the two is most salient in terms of their technical training: obstetricians have gone through medical school, are able to perform C-sections, suturing, circumcision, and are skilled in handling high-risk pregnancies. Midwives come in different flavors, but the majority are medically trained and licensed in all things related to normal pregnancy and birth. They cannot perform surgeries. They probably would burn sage if you asked them to, but it’s not part of the curriculum.
Non-technically, the difference is huge. Your midwife most likely will be there for your birth; if she co-ops within her practice, it is usually with fewer partners and fewer patients. A midwife’s personal attentiveness is part of her business model. Many deliver their clients in a hospital setting, as sort of a safety net. But unlike doctors, many midwives are willing to attend home births.
And then there is the intimacy.
“These mothers would protect their midwives.”
Dr. Smith remembered how devoted women were to their midwives. “I had midwives bring their patients to me with the baby already dead in-utero because they did not [at the time] have proper training or equipment. Had I handled a pregnancy that way, I would have been sued for malpractice. But these mothers would protect their midwives.” This implies something that many midwives and women who choose them already know—that women were capable of forging relationships with each other that Smith couldn’t even understand, much less participate in.
But even deeper than that, perhaps, is that not only is a woman defending her midwife in that situation, she is defending herself. Choosing a midwife and a homebirth means the mother was an active participant in every part of her birth. Had she chosen Dr. Smith, she would simply lie back and let him make every decision, as he is paid and trained to. Any mistakes are on his head alone. But with a midwife and homebirth, the mother is portioned both freedom and responsibility, for good or ill.
I asked Dr. Smith what a woman caregiver could provide during the birthing experience that he could not. “I don’t know,” he said with a resigned sigh. “Maybe perhaps because I’ve not experienced hot flashes and menstrual cramps and trials and tribulations of labor? I can’t offer as much? Also, there is just a new model now.”
Smith refers to the reclamation of the birth experience by the women who are having it. Though Smith understands every woman has a right to control her own body, the new style, which was not the one he was taught, could be frustrating.
“I’d delivered 4000 babies, but since Aunt Selma was in the room and she knew more than me, everyone listened to her. I’ve had birthing coaches whispering in patient’s ears not to submit to a C-section as I’m watching them bleed to death.”
The sudden preference for “natural birth” was something he, a seasoned surgeon, struggled to understand. Almost as difficult as understanding a new generation of mothers who did not defer to a male doctor’s every command.
The Power of the Uneducated Opinion
When I became pregnant again, I chose a different hospital and was given a female obstetrician. She was tiny and Japanese. She would palpitate my belly fat and say sweetly, “Mmm. Sometimes we need extra ultrasounds when our mothers are more on the fluffy side.” She told me the most important part of her job was to make sure I was happy and safe, a gentle maternal declaration that made me want to cry in hormonal gratitude. She was no more able than Dr. Stone, but she was nicer. I hadn’t realized how much I had missed that.
When I went into premature labor, I found the maternity ward staff of the new hospital to be completely female. Everyone on the ward was a woman. Muslim nurses in head scarves, butch lesbian anesthesiologists. My obstetrician was on vacation, so I got one I didn’t know—also a woman. She was calm, tired maybe. She laughed at the jokes I threw around between the merciless spine-gnawing pain of contractions.
She immediately offered me the choice of a controversial vaginal birth after C-section (VBAC), a process which would have been harder on her and put her at greater risk for a malpractice lawsuit. “Of course,” she said, “we run the risk of the same complication you had with your fir-“
“JUST CUT ME OPEN,” I screamed. “Spinal! Spinal spinal spinal right now please!!!!” (Listen, it hurts. It really, really hurts. And it’s not like anyone was gonna give me a medal if I did it the hard way.)
She smiled. “All right. That takes care of informed consent, I think.”
This team of women worked together to deliver my premature son, just as efficiently as Dr. Stone had. Then they listened to me three hours later when I said I thought he was “twitching weird.” The nurse said, “That sometimes happens when you have a premature infant, but we’ll take a closer look at him.”
It’s that last part that mattered. The professionals hadn’t noticed anything wrong, but I, the sloppy weepy mumbling mommy, wasn’t dismissed. Sappily, I felt not just cared for but cared about. Would that have happened in Dr. Smith’s 1974 male-dominated maternity ward? Maybe, maybe not.
In the end, they let my decidedly uneducated opinion dictate action. And I was right. His oxygen levels were plummeting, his heart slowing. His brain hadn’t had enough time to finish teaching his body how to support itself. My son spent a week in the NICU on various life supports, learning to stay alive on his own. And he got there early because of my intuition. The whole time he was cared for by women and women alone.
It isn’t as if the same scenario couldn’t have happened with an all-male staff. But men were not needed, as it had so long been believed they were.
Natural Selection
Today, it is a statistical probability that when a baby arrives in the world, whether it be via a kiddie pool in a garden, or from the bloody side of a partitioning surgical sheet, that baby is passing from the protection of one woman’s body into the (temporary) protection of another. Women want to have more control of their birthings; they want empathy and sometimes even maternal tenderness. Many believe those virtues are easier found in other women.
Meanwhile, improvements in medical practices allow medically trained women to devote their professional lives to helping women have babies, without having to devote their entire lives to it. In every culture, in nearly every corner of history, women helping women with birth has been absolute. The deviation that began 200 years ago—where men dominated and then banished women from their indigenous position—is fascinating, and it’s organically run its course. Men have not been forced out. Rather, their decline has been the result of natural selection. That is, women are not selecting them. Nature has a tendency to right herself, eventually.
Therese Oneill lives in Oregon and writes for Mental Floss, The Week, The Atlantic, Jezebel and many more. Her specialty is the obscure and forgotten. Meet her at writerthereseoneill.com.
Image via Getty.