Midwife Problems, and Solutions

(Hey! I'm trying something new here, with a series of short, interconnected posts based on research and archives I visited in the fall of 2015, relating to Swedish midwifery and comparing it to the U.S. Let me know what you think in the contact section.) 

     Hanna Karlen arrived in Boston on October 11, 1901 with four pieces of luggage. She was 36, traveling alone. On the ship's manifest, Karlen called herself a nurse, a statement that wasn't totally accurate. 

"The readers of Jordmodern might be interested in hearing something about their colleagues and our work across the Atlantic." 

     She had trained as a midwife in Sweden, and she must have already known that in the U.S., being a nurse was more respected than being a midwife. Karlen made her way to Elizabeth, New Jersey, a town just outside Newark. In the city directory, she also called herself a nurse.
     She assessed her professional situation quickly, and in 1902 wrote to the editors of the journal of the Swedish Midwives Association, Jordmodern. 

Karlen's letter to Jordemodern, 1902.

     New Jersey was one of the first states to deal with the so-called "Midwife Problem," the issue of untrained, unregulated women delivering babies. To practice, Karlen wrote that she needed to pass an oral exam from the board of health, administered twice a year in Trenton. This was radical for 1901: most states hadn't yet figured out whether midwives should be allowed to practice at all or how they should be trained and certified. Most midwives in the U.S. were over 50, and considered "ignorant, dirty, and negligent." The bias against them was a combination of reality (they hadn't been formally trained) and racism (they didn't read or write English, and came from 'undesirable' parts of Europe, like Poland, Russia, and Italy).
      Karlen wished that the regulation existed in all states, so that there would be more "order and the whole profession would be in better shape." 

One of the Midwives' homes, Spruce St., Providence, Rhode Island. Images like these were meant to illustrate the poor hygiene of midwives. Photograph by Lewis Hine for Child Welfare Exhibit 1912-13, from Library of Congress.

The type of hospital room Karlen was used to seeing at Sodra B.B., where she trained as a midwife in Stockholm. From the Stockholm City Archives.

Midwives graduating in 1899 from Södra B.B., the same school and hospital where Karlen trained. From the Stockholm City Archives.

     In Sweden, Karlen had trained at one of the midwifery schools, a two-year program regulated by the government. Her application to get into the school would have proved that she could read and write, and she would have also needed a letter from a clergymen or former employer that she was of good morals. The course of study included classes in anatomy, physiology, and hygiene. Hands-on training was done in a hospital setting. The women passed an exam to complete their study, and were employed by hospitals or local governments. This system of training and regulation had been in place for over 200 years. What Karlen saw in the U.S. was completely different, but she had arrived during a period of discussion, debate, and change on how to solve the midwife problem. 

Next: Why was there a midwife problem in the U.S.?