Astonishingly adequate, though, the one area in which men doctors played a little role was in helping woman in childbirth. Childbirth was traditionally attended by wise and knowledgeable woman, midwives, who had achieved a respected status in this role, in England licensed by the Church until the eighteenth century. It was the one areas in which woman were to keep a monopoly role in medical practice until the passing of the Sex Discrimination Act of 1975.
The move violently to sustain the role of woman in midwifery simply succeeded, though, because the woman working as midwives were prepared to compromise, accepting outside controls over their activities. They were to create their professional identity in the twentieth century under the shadow of established medicine as next class medical practitioners. The complexities of this long drawn out process owed very small to scientific medical knowledge and much to do with the educational framework within which it took place. History and tradition played more than a minor role.
At first, attendance at childbirth was not rated as an important part of medical carry out or knowledge. Obstetrics and gynecology were just made part of medical training of doctors in 1886 and even then, such studies were not rated as an important part of a medical education. The extremely fact that midwifery was seen as woman’s work downgraded it in the eyes of the medical practitioner and there was a general disregard in the medical profession of the skills needed for what was seen as a perfectly “natural” process. Pregnant woman were not ill and childbirth was an all day occurrence. Eventually however, the medical general practitioners realized that attending births could be a remunerative business and they begin to encroach on the territory of the women midwife. a few GPs went as far as trying to eliminate the midwife as a threat to their incomes. This competition lasted until after the Second World War and the transitory of the National Health Act.
There was another threat to midwives from the end of the nineteenth century and this is the public health campaign to lower humanity. Every age group in the population had enjoyed a significant decrease in mortality rates since the 1870s, except for one: infants between the ages of O-1. The increasing regulation of public health matter had become a concern of the state since the enlargement of large towns in the early on Victorian era had forced state action. The problem of infant mortality though was dissimilar. It continued to be high. It was not amenable to improvements in the public stadium such as clean water supplies and a water-borne drainage system. Babies died because of their person circumstances. From the point of vision of trained Medical Officers of Health in large towns (every men) the reason for this was obvious. It was the poor excellence of care for mothers and babies at birth and the lack on knowledge shown by mothers in caring for their babies. The regulations of midwifery therefore become a matter for state regulation.
In fact many middle class woman had developed the practice of calling in the men doctor during their confinements. Since the mid century, just doctors were allowed to administer analgesics such as chloroform to effortlessness birth pain and doctors had also developed surgical instruments, especially different kinds of tongs, to aid in difficult deliveries. Unfortunately, the latter were used without knowledge of sepsis (discovered by Lister at the end of the century but not widely known about until the First World War) and a lot of woman were to die unnecessarily of puerperal fever. The use of science and technology, however, made midwifery a medical activity and doctors were increasingly called to difficult births. As late as 1933, when doctors were trying to find more woman to have their babies in hospital instead of at home, 60% of births attended by doctors involved the use of tongs. The Registrar-General speculated in 1916, that woman just had relief from such attentions as doctors were needed for the troops!
The key get through in childbirth was the application of knowledge of septicemia. Only state action could cut through the inertia surrounding dissemination and the breaking down of age old practices. In America, the aggressive marketing of medicine and the lack of an established and widely upheld tradition and culture of women midwifery had resulted in the elimination of the women midwife. American woman were to suffer as a result, one of the highest rates of maternal mortality (often caused by sepsis) in the industrialized world. In Britain, the initial Act regulating the practice of midwifery was passed in 1902. It was designed to train and control midwifery by establishing a register of practitioners. In the early on days, demand far outstripped supply of trained midwives and the “untrained” practitioners, relying on their experience as their expert guide, were given license to practice. The number of untaught midwives slowly declined and by the interwar years the trained midwife constituted a large proportion of those in practice. However as late as the 1930s, the practice of the illegal uncertified “handy” woman sustained in a lot of areas.
The distance end to end on time required for training extended from 3 months in 1902 to two years in the interwar period. By that time, the line of work of midwife was beginning to attract woman who had had a few formal education and midwives were also recruited from the nursing profession. The 1936 Midwives Act shaped salaried midwives working by local authorities.This brought better training and the extension of midwives work into ante-natal care. The professionalization of midwifery thus become state sponsored but the form it took was determined by its initial inferior status to the medical profession. In every act since 1902 (for e.g. 1918, 1936) midwives were encouraged to name on the doctor in difficult cases and a measure of a good midwife was confirmed as being related to the number of times she did this. The doctor was to be paid by the restricted authority for his services if the confined woman could not afford a doctor. In a lot of places, the doctor could maximize his earnings by using forceps, as their use occasioned an additional fee. The main measure of a good midwife in the 1920s was seen in terms of the number of times in which she called the doctor. Promoting greater public authority involvement in medical care was to nourish the men medical profession as it took authority and responsibility away from the foemen midwives. The growth in the hospitalization of births was to complete the process.