week 9 - midwifery

which university was the first to offer a program in midwifery?

mcmaster

what is midwifery?

a health science profession involving trained midwives

in canada, midwifery is…

regulated and publicly funded by provinces and territories

midwifery is an ancient practice long recognized as who’s responsibility?

women’s

in latin, “midwife” means what?

with women

midwives, lay-midwives, family, friends, and neighbours are a range of female actors involved in assisting what?

women in labour

in upper canada (ontario), midwifery involved what?

neighbourhood networks of women

the management of childbirth is almost exclusively the domain of ________

women

midwives are regarded as experts in ___________ obgyn care

uncomplicated

worldwide, midwives deliver approximately ___% of all infants

85

even though, worldwide, midwives deliver majority of all infants, the situation in north america is different. why?

canada and US were the only industrialized countries to make midwifery illegal

prior to the 1930s, majority of births occurred where?

in the home

what is the role of the contemporary midwife?

to prepare women for and aid women in the birthing process

midwives aid women from which periods

perinatal to postpartum

what are examples of abnormal conditions in mother and child a midwife could detect?

breech positioning of fetus, high blood pressure

examples of how midwives procure medical assistance if necessary

consult with doctors, admit to hospitals in emergencies

what is another form of healthcare also offered by midwives?

preventative health measures

examples of preventative health measures

nutrition, counselling, sexual and reproductive education

births used to be a community-centred event but now they are a…..

medicalized and industrialized event

the WHO endorses midwives as an option to deliver babies BUT they also state that….

traditional beliefs and practices are not always safe

the WHO states that there is a need for modern knowledge and training to ensure what?

safe birthing practices and outcomes

true or false: the WHO favours a biomedical model and medicalized approach to brighting and pregnancy

true

the WHO considers pregnancy and childbirth as what type of event?

risky and potentially dangerous

since the beginning of the rise of modern medicine circa 1600 europe, what have midwives fought for?

access to medical training

midwives were denies access to medical knowledge and institutions by who?

male doctors and surgeons

in late 19th century, regular doctors were successful in doing what?

taking over midwifery

in canada, regular doctors established a monopoly over midwifery that lasted until when?

1980s

did formal training and regulation exist for midwifery in early cultures?

yes

in ancient greece, what were midwives required by law to have?

their own children

in ancient rome, women had to be ______ to get access to obstetrical knowledge

literate

medieval period of midwifery:

which country was the first european country to mandate midwifery laws?

germany

germany guaranteed what to every woman giving birth?

a midwife

in Germany during the medieval period, childbirth and its management was almost exclusively a domain of ______

women

in germany in the medieval period, how did practitioners learn skills?

as craft from friends and family

in Germany during the medieval period, midwives served communities in what type of capacity?

semiofficial

true or false: in germany in the medieval period, some midwives were so valued they were prohibited from leaving town

true

in Germany in the medieval period, what privileges did midwives enjoy?

pension, tax exemptions

during the medieval period, what fraction of all female medical healers did midwives comprise?

1/3

during the medieval period, did many men deliver infants?

no

why were there strong norms against men delivering infants in the medieval period?

because men touching women’s bodies provoked scandal and gossip, it was undignified for men to care for pregnant women

in the medieval period, most things associated with women and women’s work were ______

devalued

in the medieval period, there was a christian belief that pregnancy is the result of what?

original sin, eve is the cause of all problems

in the medieval period, what was considered punishment for eve and her original sin?

the pain of childbirth

in the medieval period, what were midwives and female healers accused of during religious inquisitions?

witchcraft

what did men value most during the medieval period?

intellectual pursuits like medicine

during the medieval period, why were surgeons contemptuous of women’s obstetrical monopoly?

because its a field dominated by women

when was the beginning of early scientific medicine? and the practice of midwifery changing?

1600s - 1700s

in the 1600s-1700s, doctors made claims to scientific knowledge and methods so they could expand their scope of practice into what?

birthing

in the 1600s-1700s, care from doctors became what?

a symbol of wealth and status

in the 1600s-1700s, what tool in france was introduced?

forceps

proper use of forceps did what?

reduce number of deaths

in the 1600s-1700s, who was allowed to use forceps?

doctors and male midwives

true or false, it was illegal for female midwives to use forceps

true

1600s-1700s marked the early beginning of _________ of childbirth

medicalization

in the 1800s, why did most midwives remain poor, illiterate, and uneducated?

because they were denied access to medical knowledge and medical institutions

how were midwives characterized by doctors in the 1800s?

as meddlesome and unscientific

in the 1800s, hospitals began to shift into being a place to what?

care for the wealthy ill

in the 1800s, the wealthy began to use hospitals for childbirth, but where did the working class give birth?

still at home

in the 1800s, midwives are the primary maternal care providers for what demographic of women?

working class and poor

in the 1800s, there was an increasing availability for what drug?

effective anaesthetics

in the 1800s, anaesthetics were much desired by women but only administered by who?

doctors

in the 1800s, increasing availability of anesthetics led to more doctor-attended births for who?

those who could pay

in late 1800s England, what became available to middle class midwives?

education and training programs

in late 1800s England, midwives had come to align themselves with _________

medicine

in late 1800s England, middle class midwives who were aligned with medicine had little in common with who?

working class lay midwives

in 1881 england, the royal college of midwives was established to improve what?

status and recognition of midwives

is the royal college of midwives the oldest existing midwifery association?

yes

in late 1800s England, ___ % of births are midwife-attended in some capacity

75

in late 1800s england, despite professional dominance of medical profession, there is still a strong what in europe?

midwife tradition

in 1600s-1800s upper and lower canada, who dominated birthing in the days of early settlements?

midwives

why did midwives play an important role in the days of early settlements in 1600-1800s upper and lower canada?

because settlers coming over had to give birth

during 1600s-1800s upper and lower canada, were all women formally trained as midwives?

no, only a few

what was a popular birth culture dominant in upper canada that was established by women during 1600s-1800s?

supportive networks, neighbourhood midwives

what is a supportive network/neighbourhood midwives composed of?

systems of women helping other women during labour, delivery, and post partum period

what were the strengths of supportive networks/neighbourhood midwives?

material aid: provided cooked meals, housework, making quilts

true or false: in the 1600s-1800s upper and lower canada, there was a cultural expectation of helping your neighbour when your neighbour was in need

true

were the neighbourhood midwives paid for their services?

rarely, but they often received gifts

what was a negative about the supportive networks/neighbourhood midwives?

care was sporadic and uneven due to distance between neighbours

who also cared for women during birth? (especially if midwife couldn’t get there in time)

husbands and family members

why did the knowledge in these supportive networks/neighbourhood midwives vary?

because some had formal midwifery or nursing training while others possessed special skills but were not certified midwives

could women earn community recognition as a midwife without being formally trained?

yes

how was most maternity knowledge transmitted during 1600s-1800s upper and lower canada?

informally, learned via apprenticeship or experience

in 1600s-1800s upper and lower canada, trained midwives were brought over to do what?

provide maternity care to female colonists

what group was also relied on to aid in colonialist births?

indigenous midwives

how were midwives (and the practice of midwifery) viewed in the period of 1600s-1800s upper and lower canada?

as respected among doctors, highly sought after, regarded as skilled and knowledgable practitioners

where were midwives particularly respected among doctors during 1600s-1800s upper and lower canada?

quebec

what started to decline at the end of the 19th century in 1600s-1800s upper and lower canada?

female social networks of birthing care

where did female social networks of birthing care persist? (at end of 19th century)

in outpost areas and among cultural groups

what period did the series of events leading to the demise of traditional midwifery in canada occur in?

late 1800s - early 1900s

the demise of the traditional role of midwives was not caused by a single factor, it was a congruence of…

economic, social, and political factors

did the timing and rate of the demise of midwifery differ across canada?

yes

did the demise of midwifery affect groups of midwives differently?

yes

how did market forces contribute to the demise of midwifery?

there was competition in maternity care services due to an oversupply of doctors in urban areas, which resulted in intense battle for clients

doctors used scientific medicine to make which claim?

that they are better suited to care for babies and mothers than midwives are

why did doctors want to take over midwifery?

because pregnancy and childbirth became a new economic opportunity

what speciality did doctors create in medical education?

obstetrics

what were the lying-in wards and hospitals for pregnant women that doctors established?

hospitals where women could go for a week to get some rest and then go home

did doctors allow midwives to have access to obstetrics and lying-in wards?

no

the propaganda campaigns by doctors to discredit midwifery claimed what…

midwives lacked formal knowledge and training, midwifery knowledge was folk medicine

to discredit midwives, doctors invoked what type of theories?

pseudo-scientific theories of women’s inferiority