History of Midwifery

What is the history of midwifery in the United States?

Midwives and birth attendants have a long and rich history in the US. Before colonization, native birth practices were strong and families were often attended by a family or community member, or by these skilled healers during their births. During colonization, midwives came from the United Kingdom or were brought as slaves from West Africa to attend births for all families. The black midwives were called “granny midwives” and continued to serve both black and white families in the south well into the 1950s.

In the US, the majority of births took place in the home until the early 20th century. The rise of physicians and physician led care began in the early 1900’s, and by this time midwives attended about half of all births in the US. This number dwindled to less than 20% by 1935 and has yet to grow to such levels again. The most recent US data shows midwife attendance at 10.7% of US births in 2019, with 1% of US births taking place at home. 

During the 1920’s nurse-midwifery in the US began, gaining momentum and recognition with the majority of midwives attending births at home through the 1950s. By the 1970s, there were around 1000 certified nurse-midwives (CNMs) practicing in the US, national standards for education and certification had been established, and CNMs had moved from a primarily community-based practice to a primarily hospital based model. CNMs are recognized through licensure in all 50 states and territories in the US, and they work in hospital, clinic, birth center, and home birth settings. Discover more about CNMs here.

During the rise of nurse-midwifery, other midwives were being marginalized and oppressed. Many granny midwives were forced out of their practices and criminalized through institutionalized racism. Japanese-immigrant midwives, including those in Hawaii, were all but eliminated through the placement in internment camps and curfews imposed during World War II. 

In the 1970s, there was a small birth revolution among middle-class white women that led to them using midwives and having more home births. This group of women often used ‘lay’ midwives, or informally trained midwives, to attend their births. This brought attention to home birth and direct-entry (non-nurse) midwifery in the US. From this movement, the certified professional midwife credential grew.

The National Association of Certified Professional Midwives (NACPM) writes:

“Midwives continued to practice in certain populations that actively chose to maintain their traditions of midwifery for religious or cultural reasons and in those communities that were denied access to medical institutions and physician care because of segregation laws. In some instances, the midwives were exempted from restrictive laws and in others they were careful not to reveal their practice. Anti-immigration laws reduced the number of new immigrant midwives and the assimilation of second and third generation women further contributed to the decline of midwifery. In the case of Japanese-American midwives, internment during the Second World War virtually ended their service. African-American and Hispanic midwives served their ethnic communities and some white women well into mid-century. In 1950, while midwives attended less than 5% of all births in the U.S., they still attended one-fourth of all non-white births.

By 1975, the number of midwife-attended births reached its lowest point at less than 1% of births overall and 2.4% of non-white births. The few remaining traditional midwives were being forcibly retired and the legacy of race, gender and class injustice surrounding midwifery was deeply embedded in the dominant American cultural beliefs about birth and midwifery.”