Medicine, as a profession, is far different today than when the nation was founded and precedes accredited medical colleges and universities.
In colonial America, the midwife’s post was one of the most important in the community. Since it was beneath the dignity of male physicians to act as obstetricians, women had a virtual monopoly over the practice… Midwives were rather well thought of and prominent members of the community.
It’s not a surprise, then, that New York City began licensing midwives in 1716.
The Bill of Rights, passed in 1791, granted states the right to regulate health. State governments began establishing medical boards in the 19th century. However, those practicing medicine with the designation “medical doctor” were overwhelmingly White men. Early medical educational institutions were private and had few requirements for admission. Most were owned by the teaching faculty; students paid faculty directly.
- 1765, Philadelphia College of Medicine, founded by John Morgan (now University of Pennsylvania)
- 1787, Harvard Medical School, Cambridge, Massachusetts
- 1797, Dartmouth Medical School, Hanover, New Hampshire
- 1813, Columbia University College of Physicians (merger of Kings College, 1767, and College of Physicians and Surgeons of New York, 1807)
In mid-19th century America, doctors “had little status and required little training.” Medicine was a White male occupation.
In order to professionalize the field, on 07 May 1847 in Philadelphia about 200 delegates from 40 medical societies and 28 colleges, representing 22 states and the District of Columbia, created the American Medical Association (AMA).
Between 1802 and 1876, 62 fairly stable medical schools were established. In 1810, there were 650 students enrolled and 100 graduates from medical schools in the United States. By 1900, these numbers had risen to 25,000 students and 5,200 graduates. Nearly all of these graduates were white males (emphasis added).
- Dr. James McCune Smith was the first Black man in the U.S. to receive a medical degree. He received his medical degree from at the University of Glasgow in Scotland in 1837, at a time that “American medical schools did not admit Black people.”
- Dr. David Jones Peck was the first Black man to receive a medical degree from a U.S. institution. He graduated from Rush Medical College in Chicago in 1847, the same year the AMA was founded.
- Dr. Elizabeth Blackwell was the first woman in the US to receive a medical degree; she graduated first in her class from Geneva College of Medicine in upstate New York in 1849, two years after AMA was founded.
- Dr. Daniel Hale Williams, one of the first Black men in the US to receive a medical degree, graduated from Northwestern University in 1883. He was “one of the first doctors in the world to perform a successful open-heart surgery.”
AMA members actively sought a monopoly over the practice of medicine by “identify[ing] and educat[ing] the public about those they considered unqualified to practice medicine.”
Then the field of obstetrics entered the picture.
In the late 19th and early 20th centuries, American obstetricians sought to overtake the entire field of childbirth and declare major war against the traditional midwives in the United States. Midwives wanted an education, but obstetricians fought hard against this idea… The next push by American obstetricians was to move the place of birth from homes to hospitals, where midwives were forbidden to practice (emphasis added).
In southern states, African-American communities relied on midwives who “were often the sole health care providers for their communities.”
In the mid-19th century, “regular” physicians, riding the wave of medical professionalization, began to challenge rival practitioners.
In Chicago, the home of AMA, physicians proposed “solving ‘The Midwife Problem’ with legal measures designed to dismantle midwifery practice.” These measures “disproportionately” affected African-American and foreign-born midwives. Many poor women also lost access to care.
If we use maternal mortality rates as a measure of success, then the substitution of male doctors for female midwives was a failure.
For example, in early 20th century Sweden, “highly competent midwives” managed deliveries in the woman’s home. The maternal mortality rate was one-third of that in the United States.
In The Netherlands, Norway, and Sweden, low maternal mortality rates were reported by the early 20th century and were believed to be a result of an extensive collaboration between physicians and highly competent, locally available midwives.
Writing in Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950, Irvine Loudon points out that in early 20th century America:
… rich women were more likely to die in childbirth than poor women… For almost any other cause of death, the poor were more likely to die than the rich. But for childbirth, poor women could afford only midwives. Rich women could afford doctors. Doctors in turn had to justify their fees and distinguish themselves from lowly midwives by providing new tools and techniques.
Slate journalist Laura Helmuth advises pregnant women: “do not read this book.“
As late as 1933, only one-third of all births took place in a hospital. However by 1955, that figure was 95% although only about two-thirds of the population lived in urban centers.
As noted in current news reports about the U.S. Supreme Court, as men began pushing out midwives around the time of the Civil War, abortion would become “a controversial issue.”
The world does not have enough midwives, according to the UN.
Midwives can meet about 90 percent of the need for essential sexual, reproductive, maternal, newborn and adolescent health interventions.
In the United States today, “states that have integrated midwives into their health care systems are also those states with better maternal and infant outcomes.”