The History of Midwifery and Gynecology/Obstetrics

Happy Women's History Month!

In honor of Women's History Month, we will be talking about the history of women's reproductive healthcare through the fields of gynecology and midwifery in this blog post. Today in the United States, most births occur within a hospital setting, the majority of which are attended by a physician such as an obstetrician/gynecologist. However, this was not always the case! Throughout the 1800's and early 1900's, midwives attended the majority of births in the United States and the field of midwifery was dominated by women, such as Margaret Charles Smith. Margaret Charles Smith was an African-American midwife from 1949-1984 who assisted over 3000 poor and African-American women in childbirth. During her career, none of the mothers she assisted died in childbirth or from labor complications, an astonishing feat considering the high rates of maternal mortality among African-American women during this time period.

Most midwives during the antebellum period in the South were African-American enslaved women, who provided care for both black and white women during pregnancy and labor. Black women continued to be transformative figures in the field of midwifery and women's health post-emancipation. Check out this cool video about the history of black midwives in the U.S.!

It was not until the late 1800's that medical institutions began to professionalize and streamline obstetric care. This led to competition between the fields of midwifery and medicine in regards to the care of women during the pre- and postpartum periods. Solely in order to improve physician training in obstetrics, medical reports recommended that all labor and delivery take place in a hospital setting. Obstetricians helped to create a medical narrative of labor and childbirth that designated pregnancy as a pathology and led to the creation and widespread implementation of medical interventions such as medicinal pain relief, episiotomies, and forceps. Additionally, medical institutions at this time argued that midwives were untrained and incompetent, furthering the demise of midwifery as a profession. By 1935, less than 15% of births were attended by midwives.

Midwifery began its slow rebirth in the form of nurse-midwifery in the 1950s. Despite being a small field, nurse-midwives remained influential in advocating for family-centered maternity care and against the medicalization of pregnancy and childbirth. Today, most midwives practice in hospital settings and they attend around 8-12% of all births in the United States. Competition between medical and holistic models of pregnancy care still exists today. More and more we are seeing the benefits of midwifery (and doula) care during pregnancy and labor. For more information, check out this awesome review:

Although, obstetrics and gynecology exist as a cohesive field within medicine today, they had different origins. J. Marion Sims, a physician during the 1800's, is regarded and revered as the founder of modern gynecology. Sims is responsible for developing and perfecting the treatment for vesicovaginal fistulas (an abnormal lesion between the vagina and the urinary tract that can develop from a prolonged and obstructed labor). He invented many gynecological instruments such as the speculum that are still used today. Additionally, he helped to open the first hospital in the world that exclusively catered to women's health needs in 1855. Sims is highly respected within the medical community for his accomplishments and contributions to the field of women's health and monuments of him stand in both Central Park and Lancaster, South Carolina.

However, Sims' legacy is not without controversy. Sims' accomplishments and discoveries came from his unethical experimentation on fourteen enslaved women between 1844-1849. Not only were the experiments and surgeries that Sims performed on these women done without consent, they were also performed without anesthesia. Many of the women on whom Sims operated remain unknown but we do have the names of three of these enslaved women: Lucy, Betsey, and Anarcha.

Sims is revered for his benevolence and devotion to the amelioration of female suffering but the nature of his practice suggests otherwise. He exploited black enslaved women and experimented on them in an attempt to perfect his surgical techniques. In doing so, he was able to publish his findings and become a world-renowned physician/surgeon and then he used his discoveries to service and benefit white upper-class women. Monuments to Sims espouse that he was "The first surgeon of the ages in ministry to women, treating alike empress and slave". However, it would appear that his treatment of enslaved black women vastly differed from his treatment of white upper-class women.

If you're interested in learning more about the controversy surrounding Sims and the legacy of Lucy, Betsey, and Anarcha, check out this podcast by NPR:

As we celebrate Women's History Month, it is important to celebrate the accomplishments and contributions of women to the fields of midwifery, gynecology, and obstetrics. Whether this means remembering the contributions of Lucy, Betsey, and Anarcha, learning more about the female-dominated field of women's health and midwifery, or by celebrating the accomplishments of the women and mothers in your life, we should all take a moment to celebrate the contributions of our foremothers!

In addition to celebrating the wonderful accomplishments of women throughout our history, this month we are also celebrating the Southeast Michigan Doula Project's third birthday. Founded in March of 2014, we are so excited to see how much the organization has grown since then and we are optimistic about our future prospects!

Who are you celebrating this month? Let us know in the comments!

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