How white women eradicated midwifery

And what it has to do with white silence on Palestine (aka a brief and incomplete history)

I spent some time a few weeks ago going through all my Substack subscriptions and, methodically, canceling most of them. Every time I spend time protesting with tens of thousands of people, or in my little bubble on Instagram, I forget that most people in the West are, apparently, going about their lives as usual, blithely ignoring that a whole group of other people are being systematically exterminated and digging babies out of rubble with their hands. But in the moments when I am faced with the truth of this indifference — which was, that morning, as I scrolled through my Substack subscriptions, many of which were, unsurprisingly, penned by white women — I am filled with an overwhelming nausea. I do not understand how one could write about “What laser treatments are worthwhile for a 70 year old woman” or perimenopause, how one could navel gaze over what important life lessons the pictures on our phone can teach us, or — I shit you not on this last one — ask questions like “Why does society blame and disbelieve victims of abuse?” without acknowledging the ethnic cleansing happening in our midst. I cannot understand how anyone could simply be pushed to “create content as usual,” how anyone could operate under the conceit that words are valuable if they cannot be used to condemn genocide, and, especially in the case of that latter example, how anyone can write about one form of systematic oppression without acknowledging its relationship to an entire web of them, without acknowledging how islamophobia and misogyny and colonization and capitalism and violence are all linked.

As for me, I have not been able to “create content,” unless it’s to encourage people to see those links, or reassure people that it is okay to engage with the hard truths of humanity even as it hurts. I spend most of my days amplifying on the ground reports of those inside Gaza, or trying to find frameworks and history that are accessible to educate people on the history of Palestine and the way in which media has convinced us a genocide is a war. I’ve sat on the draft of this newsletter - the third portion of my series on the normalization of violence in obstetrics and the collective gaslighting about how we should be thankful for this violence because it saves us from ourselves — for well over a month now, worrying that it’s totally inappropriate to send out anything not directly about genocide during a genocide. But in unsubscribing to a bunch of white women’s newsletters I made exactly the connection I’ve been encouraging other people to make: all of these systems of oppressions are linked. The history of midwifery in the United States is related to the ongoing genocide of Palestine, because it is, fundamentally, a history of a white supremacy and colonization. At root, the systems destroyed indigenous, Black, and ethnic white midwifery in order to make room for obstetric control over birth are related to the white supremacist systems that allow Israel to operate as a violently genocidal apartheid state in plain sight while the rest of the West ties itself into knots to explain how it isn’t (even as it, itself, proudly admits it is). As Rupa Marya and Raj Patel write in the masterwork Inflamed: Deep Medicine and the Anatomy of Injustice, colonialism is

a long continuous process of consolidating and exercising power through violence and coercion and the manufacturing of consent. Colonialism is the invasion but also the subtle centuries-long dynamics of normalizing restructured relationships of power. In order to create a new normal, you need to control how society is reproduced. This is why colonialists have always held a deep concern for the institutions of that shape the consciousness and behavior of colonial subjects the school, the jail, the hospital, the workplace, and the household.

And, of course, reproduction itself.

Lots of white midwives like to cite Deirdre Cooper Owen’s work about the racist history of obstetrics when they’re making their social media content. They love to talk about the way early obstetricians killed 5x the number of birthing women that midwives did because they refused to wash their hands in between autopsying the dead and vaginally examining laboring women. They love to show films like “All My Babies” in midwifery classrooms and sigh over the loss of traditional granny midwives of the South and the loss of the knowledges those midwives could have offered. They love to complain about the way in which midwifery licensure is controlled and limited by obstetricians.

But one thing you won’t find white midwives talking about is the way in which white nurses colluded with obstetricians in this eradication, how white nurses, reformers, and suffragists themselves enacted this agenda of moving birth from the home and into the hospital, how white nurses aligned themselves with white doctors instead of Black and brown women in the hopes of gaining power and control alongside them. White midwives love to paint themselves as a victim of the obstetric takeover of birth instead of acknowledging the way in which it was precisely people like them who created the conditions for it. But while white midwives might identify more with the midwives who were eradicated rather than the nurses who eradicated them, this doesn’t make it true.

I wrote in my last post about the way in which the average consumer in the United States in 2023 is very insistent that modern medicine has saved women from almost certain death in childbirth, that the routine interventions and violences of the medical industrial complex are the price we must pay to stay alive. Though the way in which this specific narrative was built and perpetuated is not the primary theme of this piece, it is worth pausing here to point out that the data actually tells a very different story. If “modern medicine” took over birth in the United States in earnest at the turn of the 20th century — in 1900, 95% of people birthed at home with midwives; by 1935 75% of urban births and 50% of births overall took place in hospitals — this was not because it saved mothers and their babies but in spite of the fact that it killed them. In fact, infant mortality rates due to birth injuries increased 40–50% between 1915 and 1929 as hospital birthrates increased¹, and it is generally acknowledged this was because of unnecessary, and often unskilled, intervention.² One study conducted by the New York Academy of Medicine from 1930 to 1932, for example, found the septicemia death rate to be 1.67 deaths per 1000 live births in the hospital, but only 0.90 deaths per 1000 live births for infants delivered at home; a second, conducted by a subcommittee of the White House Conference on Child Health and Protection, suggested that excessive interference led to increased morbidity and mortality, “through too great a recourse to instrumental delivery;” a third, published in 1931, noted:

… there has been a gradual but constant increase in the number of women entering hospitals for delivery in the past 10 years [but] in spite of this effort, just as many women die of sepsis now as formerly, a few less from the toxemias, but actually more from operative delivery.³

A 2007 study by Melissa Thomason and Jaret Trekker using data from approximately 900 cities for the period 1928–1940, in fact, convincingly shows that “medical intervention had no positive impact on maternal mortality prior to widespread use of antibiotics” — which we know now, of course, was the single most important factor in improving both maternal and infant mortality rates in this country.

If you or your baby were more likely to die under the care of an obstetrician in a hospital than you were at home with a midwife at the turn of the 20th century, why then did people start giving birth in hospitals? Well, there were a lot of reasons, of course, and not all of them were about white women, but also: because white women.