Sustaining midwifery in an ever changing world
It would make sense to begin this chapter by considering the obstacles that currently stand in the way of a sustainable midwifery profession around the globe. We know that it is possible for the profession – a profession so vital to the health and well-being of mothers, babies, families and society in general – to be marginalized, or even obliterated and erased from the memory of a particular culture. A century ago, this dramatic change is exactly what took place in North America, largely because the newly-established profession of obstetrics desperately wanted access to women for teaching material and because the professionalization of medicine itself was still in its infancy (Borst 1998). The US obstetric profession of the early twentieth century lacked the boundaries that existed in most European countries, where medical societies had historically developed codes of behaviour and scopes of practice that included an assumption that midwives were a necessary component of any rational system of maternity care (Radosh 1986). When significant numbers of births were beginning to occur in hospitals in the US, midwifery was being made illegal in some states. A virulent anti-midwife campaign managed to convince large numbers of people that hospital birth was a sign of upward social mobility (Barrett 1978). Midwives belonged primarily to the lower socio-economic classes, so no mother in her right mind, as a result of the message rather successfully promoted by the campaign, would choose the midwife if she could afford to pay a doctor to attend her birth.