Medicine: Rebirth for Midwifery

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Rising costs and feminism bring back an ancient art

For most of the human species' existence, the delivery of babies has been the exclusive prerogative of women. It was only at the turn of this century that U.S. physicians, most of them then male, decided to put the delivery business into masculine hands.

The move was not sexist. It was simply part of the notion that all life's problems could best be corrected through technology. In difficult births, a midwife was clearly no match for a trained obstetrician, often backed by hospital facilities. In the U.S. at least, a steady shift to doctor, and then doctor-plus-hospital deliveries soon threatened to turn midwifery into a lost art, and in many states an outlawed one. Old-fashioned "granny" midwifery is still in decline. But delivery by professional nurses and trained lay midwives is now becoming more popular in the U.S., though the practice remains less common than in such countries as Sweden, Britain and The Netherlands.

As medical costs skyrocket and more American women choose natural childbirth, often at home, over the impersonal facilities offered by many hospitals, it seems likely that the trend will accelerate. A bill, currently pending in Congress—sponsored by Senator Daniel Inouye of Hawaii—would authorize Medicaid payment of fees to nurse midwives. Next week the California assembly will consider a bill, backed by Governor Jerry Brown, legalizing the practice of mid wifery by adequately trained people whether or not they are also registered nurses.

Touching as it does matters of love and money, health and deep feminist feeling, the question of midwifery has stirred strong argument, with more to come: an incredible patchwork of wildly inconsistent state laws now govern, ignore or tacitly condone various kinds of midwifery. Setting adequate licensing and training standards, therefore, will not be easy.

Much of the organized medical profession, including the American Academy of Family Physicians, has opposed most midwifery for a variety of reasons. Among them: the difficulty in regulating midwife procedures, the belief that women get better basic care in hospitals and the fact that many deliveries may require aid that few midwives can provide in the home. Examples: anesthesia; delivery by cesarean section; forceps delivery; episiotomy, a surgical procedure in which an incision is made from the vulva through the perineum to widen the birth canal.

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