Medicine: Second Oldest Profession

Into Rome’s grandiose Palazzo dei Congressi one day last week poured 1,400 purposeful women from 41 nations. Blonde-tressed Norwegians in embroidered blue skirts mingled with black-haired Ghanaians in flowing brown and gold robes. Swiss Frauen sported delicate lace caps, and Icelanders regally balanced gold diadems with trailing white veils. Here and there through the colorful throng could be seen the somber black habit of a nun. Remarkably little feminine chatter disturbed the solemnity of the occasion: the twelfth International Congress of Midwives.

Reduced Role. Midwifery may be the world’s second oldest ‘ profession, once ranked among its most respected. Plato made no distinction between mother and midwife, used the same word (maia) for both. An old Norwegian proverb advised: “The greatest joy is to become a mother; the second greatest is to be a midwife.” But since 1648, when male doctors—at Paris’ Hôtel-Dieu—were first permitted to attend a mother during a normal delivery, the role of the midwife throughout much of the world has been reduced to that of a mere birth attendant, patronized mostly by the poor and ignorant.

In nations like the U.S. (where there are only 400 trained midwives) and Canada (where there are none), the midwife is often regarded as a sort of medieval social curiosity, on a par with the fortuneteller. In U.S. obstetrical argot, a clumsy delivery is a “midwife’s job.” This loss of stature was partly deserved. A generation ago, for example, all Moroccan births were handled by the tribal midwife (habla), whose actions were inspired more by superstition than by science. If the newborn Moroccan infant cried too loudly, the habla sliced the child’s thorax “to let the bad blood out.” About 80% of the noisy infants died.

Strictly Regulated. The practice of midwifery is now strictly regulated in most nations, and a ‘worldwide shortage of physicians and nurses has given the ancient profession new life. Japan alone has 40,000 midwives, many of whom staff the 143 community health centers to which rural housewives go to give birth. Swedish midwives examine each expectant mother ten times during the course of her pregnancy, lecture her on female anatomy and sexual relations, conduct classes in calisthenics, explain delivery procedure, counsel expectant fathers, even help fit contraceptive devices. When they have completed a three-year course, prospective Greek midwives must intern for a year in a maternity hospital, then serve for another three years in rural regions where trained medical help is short.

Opposition from doctors, who believe resorting to assistance of midwives (even trained ones) is a step backward, has hampered efforts to expand the profession in the U.S. and some other nations. Brazil once had 15 midwifery schools, now has only two—and 80% of all deliveries are unattended. Chile has only 640 midwives for a population of 7,000,000.

At last week’s congress in Rome, attentive delegates plugged in United Nations-type earphones, scribbled notes as speeches were broadcast in five languages. Among the speakers: U.S. Midwife Carolyn A. Banghart, dean of Kentucky’s Frontier Graduate School of Midwifery. Afterward the midwives adjourned to a reception in the ancient Baths of Diocletian, where they downed martinis, danced spiritedly with one another, and scaled a low wall to stage playful mass dashes at food-bearing Italian waiters.