The word midwife is early English for “with woman.” The French term for midwife, sage femme (wise woman), goes back thousands of years, as do the words in Danish, jordmor (earth mother), and in Icelandic, ljosmodir (mother of light). In the fifth century B.C. Hippocrates formalized a midwifery training program in Greece. Phaenarete, the mother of Socrates, was a midwife. In the Bible, the Book of Exodus recognized the strength and independence of midwives who defied the pharaoh’s command that they kill all sons born to Hebrew women. The first law to regulate midwifery in Europe was passed in Germany in 1452 and required that a midwife attend all births. Since then, every little girl in Europe has grown up with the understanding that if she has a baby, a midwife will assist her. When Europeans migrated to the New World, midwives were among them. Midwives were a valued part of the developing health care system in colonial times, and by the mid-1880s they were teaching medical students in at least one university. As the number of physicians increased in the United States, medical doctors attempted to monopolize health care through state medical practice acts that defined health care parameters, including who can practice. By the end of the 19th century, it was common for midwives to be accused of witchcraft and tried in court, and midwifery practice began to disappear. The case of Hanna Porn was one of the most famous and had far-reaching consequences. In Gardner, Massachusetts, in 1909, a judge sentenced Porn to three months in prison. Her crime? She was a practicing midwife. Fewer than half as many of the babies whose births she attended died as babies whose births were attended by local physicians. But the Massachusetts Supreme Judicial Court used her case to rule that midwifery was illegal in Massachusetts, based on the testimony of physicians who said that midwives were incompetent. Other states followed suit and made midwifery illegal, and it remained illegal in nearly all states for more than 50 years, until nurse-midwifery began to be legalized. Despite this attempt to dismantle the profession in the United States and Canada, midwifery continued to thrive in Europe and other parts of the world. And while the profession was severely hampered in the United States for decades, it was not stamped out. Throughout history, every attempt at ending the practice has failed. It seems that there will always be women who want to be midwives and women who want midwives to attend them when they give birth. When officially sanctioned midwifery was attacked in the United States, midwives went underground. Women who became known as “granny midwives” (because they tended to be older) continued to practice, especially in poor communities. In the 1920s Mary Breckinridge, a public health nurse and midwife, formed the Frontier Nursing Service to provide maternity care to families in rural areas of Appalachia. Some of the staff members formed an organization that later became the American Association of Nurse-Midwives, as well as the Frontier School of Midwifery and Family Nursing, which trained hundreds of women in what became a new profession in America, nurse-midwifery. The number of nurse-midwives grew, and by 1977 the profession was licensed in every state. After nursing school, a nurse can elect to go on to midwifery school for about two years and become a nurse-midwife. This is not the same as becoming a labor and delivery nurse, a nursing specialization that has no training requirement and usually involves about six weeks of on-the-job training. Women can also train as “direct-entry” midwives, going directly to midwifery school without training first in nursing. Direct-entry midwives have grown steadily in numbers and recognition.

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