It's one thing to lose our patients to doctors but to those charlatans?
It makes me sick.
That’s an episode of the Mindy Project, in which a fight brews between Mindy Lahiri
- a doctor - and a midwifery practice.
Midwives!
Who the hell do you think you are?
Let's say I have a heart attack.
How would you handle that?
Would you, uh, rub eucalyptus leaves all around my chest, huh?
This is an exaggerated sitcom plot, but the idea points to a long-standing culture war
between doctors and midwives - that's rooted in race and class in America.
Alright, ladies. Let's go downstairs, let's set up appointments with some real doctors.
Midwifery is an incredibly common practice in a lot of countries.
In the UK, midwives deliver about half of all babies, including Kate Middleton's.
In Sweden, Denmark and France, midwives oversee around three quarters of births.
But here in the US, they participate in less than 10 percent of births.
In these countries - the ones that tend to rely on midwives more frequently - maternal
mortality rates are a fraction of America’s.
In fact, maternal mortality has risen in the U.S. as it has declined elsewhere.
So if midwives are popular and effective in many other industrialized countries, why is
the U.S. medical system still wary of them?
The answer is complicated.
For most of human history, babies were delivered by midwives.
Midwifery can be found in the Old Testament.
They were respected for bringing their knowledge and training to childbirth.
In America, midwives were integral to both indigenous and immigrant groups.
And in the South, they known as “granny midwives.”
Midwives have always existed.
It's just that we have changed over time.
That’s Patricia Loftman, a midwife of 37 years and a member of the board of directors
for the American College of Nurse-Midwives.
When you look at midwifery, say in the time of enslavement,
the midwife was actually the
person who made certain that women were able to produce healthy babies.
Now, after slavery
ended she was no longer valuable because she was not making certain that there was a continued
slave labor.
I want you to meet Mrs. Mary Coley.
A midwife who lives in Albany, Georgia.
Generally in the South, most of these women were black women taking care of women, both
black and poor white, because during the days of segregation you could not access hospitals.
In the mid-to-late 1800s, the professionalization of medicine became a major trend, and male
doctors began taking control of childbirth away from female midwives.
It was determined that in order to get women into the hospital, you had to get rid of these
midwives who were taking care of all of these women in the home.
All of these women who had been attending births all of these years, they were blamed
for maternal deaths, infant deaths.
Two days ago a baby, delivered by a midwife, died, when it
ought to have lived.
My examination showed that its cord got infected.
And you all know what that means.
Something wasn’t clean.
Joseph DeLee of Chicago, the most influential OB-GYN of his day, called midwives,
"relics of barbarism" and "a drag upon the science and the art of obstetrics."
In the South especially, much of the attack on midwifery was rooted in race.
One Alabama doctor dismissed black midwives as having
"fingers full of dirt and brains full of arrogance and superstition."
Some states outlawed home-birth midwives, while most others created new regulations
that made it harder to enter the profession.
By the 1950s, a vast majority of women gave birth in hospitals, attended by doctors.
But something changed in the 70s: Middle-class white women wanted more of a voice in their
maternity care and that led to a rise in midwifery.
Except this time, most midwives were white women.
The US currently has around 15,000 certified midwives.
It’s a growing profession, but still overwhelmingly white.
Just about 5 percent of the nation’s midwives are women of color.
In addition to being from the community and understanding not only linguistically and
culturally what women need,
midwives of color protect women in a system that is hostile
to them.
With black mothers three to four times more likely to die from causes related to pregnancy
or childbirth, there’s evidence that empowering midwives might change outcomes for moms and
babies.
Researchers found that some states have clearly done more to integrate midwives than others.
And while there are many factors that can influence maternal and infant health,
many states with the least integration
also had some of the highest rates on key indicators including
premature births, neonatal mortality, and C-sections.
In recent years, groups like the American Congress of Obstetricians and Gynecologists
have become much more welcoming to licensed midwives.
We're all in this together.
But that hasn’t resolved the culture war between doctors and midwives just yet.
There is a role for a midwifery and physician collaborative relationship.
We're not enemies.
We are colleagues who need each other.
Thanks for watching!
ProPublica has been reporting on the disparities in maternal mortality in the US, and how it’s
the most dangerous industrialized country in which to give birth.
There’s a lot more to the story of midwives in America that we couldn’t fit, including
the current barriers to entry that a lot of midwives - especially midwives of color - face
in certain states.
For more on that and ProPublica's latest reporting on maternal health, click on the link below.