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158 Medicine as Culture
Childbirth and the struggle for control
The changing nature of childbirth over the past two centuries demonstrates
the increasing control of the medical profession over women’s
bodies. Up until the close of the seventeenth century, attendance at childbirth
had always been the preserve of women. Midwives assisted women
in labour, while the labouring woman’s close women friends and relatives
attended and assisted. Their experience and knowledge about birthing
was passed from one generation of women to the next. Throughout the
eighteenth century a struggle took place between female midwives and
the emerging male-dominated medical profession over the control of
intervention in the birth process. The use of forceps, which enabled the
delivery of live infants in cases where previously either mother or child
would have died, became the exclusive domain of physicians and surgeons,
and was associated with the emerging (male-dominated) profession
of medicine. The introduction of the forceps gave these men the edge
over female midwives who were adept at the manual delivery of babies
and who had all the practical knowledge about birth and birthing
(Wilson, 1985; Moscucci, 1990; Wajcman, 1991: Ch. 3). According to custom,
midwives were not allowed to use instruments as an accepted part
of their practice. Therefore, if the birth was obstructed, a male practitioner
was sent for: ‘The task of the midwife was to deliver a living child, the task
of the male practitioner was to deliver a dead one’ (Wilson, 1985: 137,
emphasis in the original).
Midwifery resisted the pressure of the male medical profession for
many years, but became vulnerable with the rise of scientific medicine
during the nineteenth century. Due to increasing medical regulations and
municipal ordinances designed at excluding women from obstetrics, from
the early Middle Ages women were forced out of attending births. Female
midwives were discredited and marginalized. Attempts to professionalize
medicine led to competitiveness amongst physicians, surgeons, barbers
and midwives to establish control over fields of medical practice.
Scientific knowledge became valorized over experiential knowledge, and
women midwives were denied access to medical training. Midwifery
became associated with superstition and witchcraft (Ehrenreich and
English, 1973; Brighton Women and Science Group, 1980; Wertz and
Wertz, 1981; Oakley, 1987; Blumenfeld-Kosinski, 1990: Ch. 3). The ‘man
midwife’ came into being in the middle decades of the eighteenth century,
and treatises of midwifery began to be written for male practitioners,
which, from 1750 onwards, criticized the female-dominated ceremony of
childbirth (Wilson, 1985: 140).
Because of its technological and surgical nature, caesarean birth was
among the first obstetrical procedures to be lost to the control of midwives
and placed under the aegis of male practitioners. Blumenfeld-Kosinski
(1990: 90) notes an increasing presence of male attendants at caesarean