The changing times of midwifery

Throughout history, midwives have been challenged by doctors and the medical profession. Over time the education of midwives have been enhanced, however the care that midwives show has never waivered.

In an article published by the Southern Cross University- an Australian history of subordination of midwifery, by Kathleen Fahy, it pointed out the struggle midwives had in proving their ability to be a proven profession to deliver a child. (Fahy, 2007)

Since the beginning of white colonisation, midwives had provided the majority of maternity care. Women had control over their own birthing, with the support of a midwife, and was largely unchallenged in Australia until the late 1800s.

In her article, it stated that midwives were working class, mainly uneducated women. Being unable to read and write, created a huge power differential when it came to challenging medicine's claims that they were safer practitioners than midwives.

As the number of GPs expanded midwives were increasingly seen as a problem. Writing in the Australian Medical Journal, doctors informed each other that the fastest way to build up a general practice was to establish a relationship with the woman during pregnancy; build up her trust and then become the doctor for the whole family.

For many years, however, midwives provided stiff competition for doctors. They were known within the community and were generally held in high regard. Midwives charged much lower fees than doctors. (Fahy, 2007) The community generally thought midwives were as effective as medicine or even more so. (E, 1983)

In order to wrest the childbearing women away from the midwives GPs had to find a way to justify their involvement in all labours and births, not just the complicated ones. The basis for the initial medical insurgence into the birth room was the development of the obstetrical forceps by the Chamberlain family of barber-surgeons in the 17th century. In Australia as in Britain, barber-surgeons were called to pull out the babies in cases where the labour was blocked. (Fahy, 2007)

During 1886Ð1928, medicine forged an alliance with nursing and achieved both legal and disciplinary control of midwifery. (Fahy, 2007)

The tide of medical domination is turning. The state health departments have heard of the safety, satisfaction and cost-effectiveness of midwifery led care.

Midwives and women are asking for woman centred birthing and they are being heard on radio, television and read in the newspapers. In the context of an Australia-wide shortage of obstetricians and GP obstetricians, governments are motivated to provide maternity services close to where the voters live.

Kathleen Fahey pointed out that there is a synergy of interests between maternity consumers, midwives and government. In the state of New South Wales, Australia, the government has committed to extending midwifery-led models of care; including publicly funded homebirth.

A homebirth model was established at St George Hospital in 2005. This was the first publicly funded homebirth model in NSW. The model was established to address inequities in access to services for women who choose homebirth. Two years of planning was undertaken before the model was fully operational. The homebirth model operated out of the existing Birth Centre at St George Hospital. (Homer & Caplice, 2007)

Thus, at the state and national level the struggle over maternity services continues. Thanks to feminism, women and midwives are more powerful than they were 100 years ago. Thanks to government decisions to provide university education for midwives we now have a voice that is being heard. Midwives and women can now challenge anti-midwife ideology by countering with research.

References
E, Willis (1983). Medical dominance: The division of labour in Australian health care. Sydney: Allen & Unwin.
Fahy, K. (2007). An Australian history of the subordination of midwifery. Women and Birth, 25-29.
Homer, C., & Caplice, S. (2007). Evaluation of the publicly-funded homebirth program in South East Sydney Illawarra Area Health Service. Sydney: Univeristy of Techonology Sydney .