Education and training for midwives was a rollercoaster ride from antiquity to the Middle Ages. Rome and Greece educated and trained their midwives just as they educated and trained their other physicians. Medieval Europe…not so much.
That didn’t mean medieval Europe didn’t want or need midwives. Far from it! They just…didn’t support them as well as certain ancient societies.
Let’s take England, for example. What could you expect as an English mother if you wanted a midwife and lived in, say, the early twelfth century?
It depended on where you lived, but it could vary wildly. There were not many restrictions in place when it came to practicing medicine. These days, physicians are expected to go to school, get a degree or two, and get a license, so that we as patients know they earned a degree or two and can safely practice medicine. That wasn’t the case in Europe until the 1400s. There were universities that taught medicine, but you weren’t required to attend one to practice. If you lived in a rural area, your midwife could just be the woman in the neighborhood with the most experience having/delivering babies.
There were medical texts for women and childbirth since at least 100 – 200 AD, courtesy of the Greeks and Romans. But not everyone had access to education in medieval England, and if you were a woman, you were even less likely to be educated, unless you were in the upper classes. So not every midwife could read. And even if you could read English, you might not be able to read Greek or Latin, and a lot of those medical texts were written in Greek or Latin.
Luckily, some of those books had illustrations, and some midwives were literate. Those midwives could take on other women who wanted to learn, and in places like London they eventually formed networks to train and support each other.
If you’re saying, well that sucks for the women, but I’d just find a man to help me give birth, good luck. Male midwives were not really a thing until the 1300s, and even then you were more likely to find a physician or surgeon who dabbled in obstetrics, not a specialized midwife. Pregnancy and childbirth were regarded as an area for women. Later, male medical professionals would almost push women (including midwives) out of the European medical field entirely, but not in the beginning.
(Credit: https://www.collectmedicalantiques.com/gallery/delivery-and-obstetric-forceps)
But wait, I hear you say. If childbirth was supposed to be an area for women, why didn’t they properly educate and train women to be midwives?
Good question.
Around the 1400s, medical professionals in France, Italy, and parts of England looked around and went, wait a minute. There are a lot of uneducated, illiterate women wandering around, managing clients and delivering babies. We can’t have ignorant people practicing medicine! That’s dangerous!
Well, yes, it certainly could be. But rather than invite women into the field and offer them more opportunities for education and training, those medical professionals spread the word that women midwives were untrained, untrustworthy, and illiterate – people were better off turning to trained male practitioners instead. And for at least a couple centuries, women were steadily pushed out of medicine.
Things began to turn around in western Europe around the 1600s. But in the U.S., midwifery is a small field, almost entirely overshadowed by hospitals and private ob/gyn practices. Which is problematic, because midwives could do quite a bit to help the overburdened healthcare system in the U.S.
According to a recent report, 49% of 3,143 U.S. counties lack a single ob-gyn, mostly because those counties don’t have hospitals that offer ob-gyn services. That’s more than 10 million women who may not have access to reproductive healthcare, including maternity care. The report also states, “Medical needs of the U.S. adult female population during the next decade cannot be met by ob-gyns, family physicians, and general internists alone…the addition of qualified nonphysician health care professionals, working in concert with physicians, should help meet those needs while potentially reducing the cost of care and the need for additional health care professionals.”
In other words, midwives could become a larger part of healthcare teams and healthcare services, especially in smaller/rural areas, and it would help ease the strain on other medical staff and provide affordable alternatives for pregnant women. And unlike medieval England, we now have programs to train and certify midwives and nurse-midwives. The U.S. model of healthcare may see a stronger movement toward midwifery in the coming decades.
Further Reading:
Monica Green, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology (2008).
Doreen Evenden, The Midwives of Seventeenth-Century London (2000).
Costanza Dopfel, Alessandra Foscati, and Charles Burnett, Pregnancy and Childbirth in the Premodern World (2019).
Medieval Midwives 