The following are excerpts from a pamphlet by a physician originally published more than 150 years ago. It attests to the common belief of medical professionals at the time of publication (1820) concerning midwifery. In particular, these quotes reveal their objections to women being formally trained as midwives.  This rejection of women as "practitioners" was based on a series of erroneous and/or self-serving   ideas --

1) That women were intellectually incapable of being educated

2) That the emotional nature of women would make then incapable of being able to respond rationally in an emergency

3) That even if it was possible to sufficiently educate women the indelicate nature of medical knowledge would corrupt their morals

4) That while labor and birth was of itself "simple", the potential for systemic complications makes childbirth a medical event which should only be attended by fully "qualified" physicians

5) That if midwives were educated and formally trained, these educated women practitioners would be preferred by the better classes of women (who could pay) as it would be considered "indelicate and vulgar to suffer the attendance of a physician"

6)  And the real argument  -- that providing maternity care was the  key to a successful general medical practice as the gratitude of the mother resulted in loyalty to the physician, thus generating "return business" for other kinds of medical care for herself and family members

"Women seldom forget a practitioner who has conducted them tenderly and safely through parturition. . ."

"It is principally on this account that the practice of midwifery becomes desirable to physicians. It is this which ensures to them the permanency and security of all their other business."

The pamphlet ends by congratulating "distinguished individuals" in the medical profession for being so successful in excluding midwives from the practice of midwifery.

"It is one of the first and happiest fruits of improved medical education in America, that they were excluded from the practice; and it was only by the united and persevering exertions of some of the most distinguished individuals our profession has been able to boast, that this was effected."

"Remarks on the Employment of Females as Practitioners in Midwifery"

"Objections founded rather upon nature of their moral qualities, than of the powers of their minds, . . ."

"Where the responsibility in scenes of distress and danger does not fall upon them, when there is some one on whom they can lean, in whose skill and judgment they have entire confidence, they retain their collection and presence of mind; but where they become the principal agents, the feelings of sympathy are too powerful for the cool exercise of judgment."

"The profession of medicine does not afford a field for the display and indulgence of those finer feelings, which would be naturally called into operation by the circumstances in which a practitioner is placed."

"The nature and progress of the mechanical part of a simple natural labour can be easily explained, and may be comprehended by the most limited understanding. Where then is the danger of trusting these cases, which form allowedly a very large proportion, to the hands of an intelligent and well educated woman? I answer, that it is wrong to look on labour as a mere mechanical process, it is a process in which every part of the system more or less partakes."

And therefore, since he regards labour as a medical event, he goes on to address the issue of educational standards and training that only a practicing physician could attain.

"No one can thoroughly understand the nature and treatment of labour, who does not understand thoroughly the profession of medicine as a whole."

". . . we cannot expect them (female accoucheurs) to be possessed of this essential part of their education. . . . it is obvious that we cannot instruct women as we do men in the science of medicine; we cannot carry them into the dissecting room and the hospital; many of our more delicate feelings, much of our refined sensibility must be subdued, before we can submit to the sort of discipline required in the study of medicine; in females they must be destroyed; and I venture to say that a female could scarce pass through the course of education requisite to prepare her, as she ought to be prepared, for the practice of midwifery, without destroying those moral qualities of character, which are essential to the office."

"Heretofore, where midwifery has been in the hands of women, they have only practised among the poorer and lower classes of people; the richer and better informed preferring to employ physicians, and this has been the reason why it has not become universal; but if it is again introduced among the rich and influential, it will become fashionable; it will be considered as indelicate and vulgar to employ as physician, and the custom will become general."

He then goes on to discuss that knowledge is not acquired merely through textbooks, etc. but rather practical tact.

"A man must be a universal practitioner in midwifery, before he is qualified for a practitioner in difficult cases."

"It is sufficiently obvious if the employment of female practitioners becomes fashionable, that it will create a fastidious nicety of feeling, which will make it be thought indelicate to suffer the attendance of a physician in any of these complaints."

"Women seldom forget a practitioner who has conducted them tenderly and safely through parturition. . ."

"It is principally on this account that the practice of midwifery becomes desirable to physicians. It is this which ensures to them the permanency and security of all their other business."

It would appear then, that even during this period, the practice of obstetrics was seen as a profitable profession and midwives were seen as a threat to their pocketbooks.

"It was one of the first and happiest fruits of improved medical education in America, that they were excluded from the practice; and it was only by the united and persevering exertions of some of the most distinguished individuals our profession has been able to boast, that this was effected."

Excerpts from this historical document came to us courtsey of  Linda Green who is doing a midwifery related research paper, using birth certificates filed in the late 1800s. For additional information on this publication, please contact her via her email address: lingreen@internet-95.com.