The culture war between doctors and midwives, explained

Summary

The video script explores the ongoing cultural and racial conflict between doctors and midwives in the U.S., particularly around childbirth. It highlights how midwifery, which is widely practiced in other industrialized countries, faces resistance in America, often rooted in historical and racial tensions. The script delves into the history of midwifery, its professionalization, and its modern resurgence, especially among white women in the 1970s. It also emphasizes the role of midwives of color in addressing racial disparities in maternal health. Despite growing support, the cultural divide between doctors and midwives persists, affecting maternal and infant health outcomes.

Takeaways

• 😀 The conflict between doctors and midwives, often rooted in race and class, has a long history in the U.S.
• 😀 Midwifery is a common and effective practice in countries like the UK, Sweden, Denmark, and France, where it contributes to lower maternal mortality rates compared to the U.S.
• 😀 In the U.S., midwives participate in less than 10% of births, while other industrialized nations rely on them more frequently.
• 😀 Maternal mortality in the U.S. has risen while it has decreased in other countries with higher midwifery integration.
• 😀 Midwives have historically been an integral part of childbirth across cultures, including among indigenous and immigrant groups in the U.S.
• 😀 The professionalization of medicine in the late 1800s led to the marginalization of midwives, especially in the South, where racial dynamics played a significant role.
• 😀 Midwives were unfairly blamed for maternal and infant deaths, contributing to their removal from the birthing process.
• 😀 Despite the history of midwifery in the U.S., the practice has faced racial prejudice, with black midwives being denigrated as 'unqualified' or 'superstitious'.
• 😀 The midwifery profession began to rise again in the 1970s, largely driven by middle-class white women seeking more control over their maternity care.
• 😀 There is a significant underrepresentation of midwives of color in the U.S., with only about 5% of midwives being women of color, despite the positive impact they have on maternal health outcomes, especially for black mothers.
• 😀 Studies suggest that in states where midwifery is more integrated into the healthcare system, there are better outcomes in terms of premature births, neonatal mortality, and C-sections.
• 😀 Recent efforts by organizations like the American Congress of Obstetricians and Gynecologists show a shift toward welcoming licensed midwives, though the cultural divide between doctors and midwives remains.

Q & A

Why is there a cultural conflict between doctors and midwives in the U.S.?

The cultural conflict stems from historical, racial, and class-based differences. Historically, male doctors took control of childbirth from female midwives, and much of the attack on midwifery was rooted in racial bias, particularly in the South.

How are midwives viewed in other countries compared to the U.S.?

In countries like the UK, Sweden, Denmark, and France, midwives are highly involved in childbirth, handling a significant portion of births. In the U.S., however, midwifery is much less common, with midwives attending fewer than 10% of births.

What historical role did midwives play in American society?

Midwives were integral to childbirth in the U.S., especially within indigenous and immigrant communities. In the South, they were known as 'granny midwives' and provided crucial care during a time when access to hospitals was limited for black and poor white women.

Why did midwifery decline in the U.S. in the 19th century?

Midwifery declined due to the professionalization of medicine. Male doctors took control of childbirth, pushing midwives out of the field. Many midwives were blamed for maternal and infant deaths, even though their practices were often rooted in long-standing traditions.

What was Joseph DeLee's view on midwifery?

Joseph DeLee, an influential OB-GYN in the early 20th century, referred to midwives as 'relics of barbarism' and believed they hindered the advancement of obstetrics.

How did race affect the development of midwifery in the South?

In the South, race played a significant role, with many black midwives caring for both black and poor white women. These midwives were often subjected to racist views, which contributed to the stigmatization and regulation of midwifery.

What led to the resurgence of midwifery in the 1970s?

The resurgence of midwifery in the 1970s was driven by middle-class white women seeking more control over their maternity care. This movement resulted in a rise in the number of midwives, although they were predominantly white.

What is the current racial disparity among midwives in the U.S.?

The midwifery profession in the U.S. is overwhelmingly white, with only about 5% of midwives being women of color, despite the fact that midwives of color can provide essential cultural and linguistic support in underserved communities.

How can midwifery improve maternal and infant health outcomes?

Research suggests that midwives, especially those from marginalized communities, can help improve outcomes by offering personalized care, particularly for black women, who face higher rates of maternal mortality. States with greater integration of midwives tend to have better health outcomes.

What role do midwives and doctors play in improving maternal health together?

Midwives and doctors can collaborate to improve maternal health. While they have different approaches, a collaborative relationship allows for the complementary strengths of both professions to address the diverse needs of pregnant women.