Across the Atlantic

Midwife Problems, and Solutions, Part 2

This is part 2 of a series on the history of midwifery in the U.S. and Sweden. Click here to read part 1. 

     Like Hannah Karlen, Rosa Fineberg was alone when she had arrived in Baltimore in the 1890s. Fineberg had also been a midwife in her previous home, Russia, and planned to continued her work in the predominantly Jewish neighborhood of Jonestown.  
     Almost daily, she stepped out of her house carrying a large black leather bag. She walked by kosher meat markets and a butcher (who much to the dismay of the city health officials sometimes kept chickens in the basement), a kosher grocery store that advertised wares in Yiddish, and the Russische Shul where she attended temple. Every week, sometimes twice a week, and sometimes even twice in a single day she was called to deliver a baby. Her patients called her Tante Rosa and trusted her.  

Rosa Fineberg around the turn of the 20th century, courtesy Jewish Museum of Maryland.

Kosher butcher in Jonestown, with the basement chickens, from Janet Kemp's Housing Conditions in Baltimore, 1907.

Rosa's daughter Sarah with her husband, Max Siegel in 1899, courtesy Jewish Museum of Maryland.

     Fineberg's daughter Sarah thought her mother had a special, healing power, that was at times unexplainable. When Sarah went into labor in 1901, she called her mother to deliver the baby. And if her mother hadn't been a midwife, she probably would have called another midwife and not a doctor. A midwife’s delivery fee was five to ten dollars, much less than a hospital or private doctor would ask for, and in a time before medical schools were regulated, being a doctor didn't necessarily mean anything. 

      In Baltimore city, over 150 midwives delivered over 4,000 babies a year, and in every city and town in the U.S., you could find a woman delivering a baby, calling herself a midwife. But just like there were no regulations for doctors, there were no regulations for midwives. Why didn't the U.S. regulate the medical profession? And what did that mean for the health and safety of babies and mothers? 

Delivering babies has been women's work for all of human history, until recently. This 1583 engraving from the Wellcome Library shows a woman on a birthing stool attended to by a midwife.

Engraving of a Dutch man comforting his wife after labor while the baby is taken care of by the midwife.

     Midwives were respected in the early years of the colonies in North America. Towns in New England provided a house or rent-free lot to a midwife, as long as she responded when a woman called. The Dutch West Indian Company gave midwives salaries and free houses, again under the condition that they respond to the poor. In French Louisiana, midwives received pay until 1756 and physicians examined the quality of their practice. 

    But in the middle of the 1700s, the American colonies had no medical schools or hospitals, and the medical profession itself was not professionalized in any way. Louisiana and Florida still belonged to France and Spain, respectively, and American colonies under British control were independent, mostly self-governing. While American colonies did use British law as an example, it wasn't until 1901 that England had an official policy on the training and regulation of midwives, so the colonies had no example to look towards. In what became the United States, a lack of laws and regulations meant a lack of schools and training, and left the definitions of doctor and midwife nebulous. 

"The Man- Mid Wife," a commentary on the perception of doctors versus midwives, 1793, from The Wellcome Library.

     At the end of the 18th century, the U.S. only had four medical schools that offered no standard course work and no minimum amount of study. Students might not have practiced on actual patients, and they might not even have completed high school. Basically anyone could call themselves a doctor, and soon, diploma mill medical schools started creating a glut of doctors, who work. 
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     Regardless of what a doctor actually knew or what training he received, women in the U.S. increasingly called on him to help deliver babies. As “professionals,” they could charge more than a midwife, and were happy to do so. ​

     The Association of American Medical Colleges was formed in 1876 by twenty-two medical schools in an attempt to standardize what a diploma of medicine meant. Some schools, like Johns Hopkins University, had strict entry requirements and rigorous course work, but those places were in the minority. Many doctors in the U.S. were not using the new techniques of antisepsis and aspesis to prevent the spread of germs and disease.

The first class of residents at the Johns Hopkins Hospital, 1899. Hopkins was the model for the 3-year, post-secondary medical school we know of today. And, although this photograph is clearly missing women, Hopkins was one of the only medical schools to accept female students. Image from Johns Hopkins History of Medicine.

     Schools for midwives were nonexistent. An American midwife might not have known that washing her hands could prevent the spread of childbed fever. She might not have know that cleaning a baby’s eyes at birth could prevent blindness. She might not have known what birth complication would need more knowledge and tools than she had. She might have simply been bad at her job. With no regulation about who could practice, babies and women were those who suffered. In 1910, the United States recorded that one mother died for every 154 babies born alive, a staggering rate and almost three times higher than Sweden. 

So what did Sweden do right to have such a low maternal mortality rate? Next time: a brief history of Swedish midwifery. 

For more information about the history of midwifery in the United States, check out:  Lying-In: A History of Childbirth in America; American Midwives: 1860 to the Present; Witches, Midwives and Nurses: A History of Women Healers, and Brought to Bed: Childbearing in America, 1750-1950.