............Historical Perspectives Series Economic issues $$$--
Arguments by Physicians
Against Independent Midwives
Ø Do ophthalmologists favor a school for the instruction of optometrists...? Why not train the chiropractor and Christian Scientists also? [1915-C; DeLeeMD p. 115] ^41
Ø What has been done to take the midwife’s place? In the larger cities, Boston, NY, Philadelphia, Baltimore, Pittsburgh, Chicago, substitute agencies are supplanting her and what is still more hopeful, even the poor foreigner is becoming enlightened as to the value of medical attendance and is demanding it. [1915-C; DeLeeMD p. 120] ^42
Ø But another encouraging and very practical feature has been that these 2,007 patients voluntarily contributed to the support of the hospital the some of $2,571 or, on the average, $1.28 contribute by each patient and the total expenses of the out-patient department were $1,763, leaving a net gain of $807. [1911-C, p. 211] ^43
Ø We feel that some such scheme as this can be carried out in every medical center where medical schools are near at hand. In the smaller cities ... the young doctor, the visiting nurses' association and a few beds in the hospital give a very excellent substitute for the more elaborate system. [1911-C, p. 211] Thus the young practitioner gains experience and may even acquire patients for his future practice. [1911-C, p. 221] ^44
Ø (H)owever, to entirely eliminate the midwife, it will be necessary for the government to substitute some cheap service at the time of birth. A women will employ a midwife who will render such services as she can at the time of birth and attend to the women for a certain period after birth, giving many ministrations to the mother and child that no doctor will undertake to furnish. The only way to eliminate the midwife is to furnish some proficient and at least equally cheap service. [1915-H] ^58
Ø ...that the sensible thing to do is to train the physician until he is capable of doing good obstetrics and then make it financially possible for him to do it by eliminating the midwife and giving him such other support as may be necessary. [1912-B, p. 222] ^59
Ø Urge the extension of obstetrical charities---free hospital and out-patient services for the poor, and proper semi-charity hospital accommodations for those in moderate circumstances.
g. Greater development of visiting obstetrical nurses, and of helpers trained to work under them.
h. Gradual abolition of midwives in large cities and their replacement by obstetrical charities. [1911-B; WilliamsMD] ^60
Ø Since poverty is given for the cause of the perpetuation of the midwife, let us see if there be not some way to eliminate poverty at least as far as childbirth as concerned.[1915-C; DeLeeMD, p. 121] ^61
Ø The free maternity hospitals take away a certain number ... growing each year. The number of beds in hospitals for women of moderate means is also increasing rapidly. The free dispensaries --- or out-clinics are now caring for a very large percentage of the cases.... I would guess that in Chicago, about 1/5 of the births are cared for by institutions of the dispensary type. [1915-C; DeLeeMD] ^62
Ø It is quite within the bounds of possibility that the extension of maternity hospitals as well as further development and increase of our outdoor [i.e. domiciliary] maternity services will in time render the existence of the midwife unnecessary. A rough estimate recently made of the number of patients cared for by maternity hospitals and dispensaries in the borough of Manhattan, alone shows, that about 10,000 ere last year confined in maternity hospitals as charity patients and 7,000 in their own home, a total of 17,000 FREE confinements.
Ø A study of birth returns for the City of New York during the past ten years is instructive. For 1905, 1906, 1907, 1908, the percentage of births reported by midwives is about the same, namely in the neighborhood of 43%. But in the past 6 years there has been a gradual but persistent decline in the births reported by midwives until in 1914 it reaches 37.6 %...[1915-A; EdgarMD p. 93] ^63
Ø Many of the doctors we sent out from medical schools do conscientious work for a time, but they soon learn that they cannot keep it up and prosper financially. 1922-A, p.407] ^152