The History and Evolution of Midwifery

Midwifery is one of the world’s oldest professions. Obstetricians did not come on the scene until the 18th and 19th centuries when male physicians began to specialize in childbirth with the belief that they could improve the field with their knowledge of anatomy. Midwifery, on the other hand, has existed since ancient civilizations and has evolved to keep up with modern times while maintaining its core roots.

Ancient Midwifery

Midwives in ancient civilizations were considered respected community healers who guided women through pregnancy and birth. They were often older women valued for their experience, wisdom, and intuition. Their knowledge was passed orally and through apprenticeship, often from mother to daughter.

Archaeological records and texts suggest that midwives were practicing as early as 1900 BC. The Ebers Papyrus, one of the oldest known medical texts, references birthing practices in Egypt and the role of the midwife. Greek philosopher Aristotle referenced midwives in his writings, and the physician Soranus of Ephesus authored a comprehensive manual on obstetrics in the 2nd century CE, offering guidance on prenatal care, labor, and newborn health.

Medieval and Early Renaissance

During the Middle Ages, there was a growing religious and political control that threw many midwives under suspicion of witchcraft and heresy. They continued to serve their communities, some officially employed by town governments, and others operating a more quiet practice.

Although there was a lack of hygiene and modern tools, the midwives’ continuity of care and close monitoring of pregnancy and birth helped many mothers and babies survive. Unfortunately, this era also saw increasing suspicion of women healers - some midwives were persecuted during witch trials, especially if they held herbal knowledge.

1600s-1800s

This era marked the beginnings of formal medicine entering the birthing scene. Male physicians started attending births in the 1700-1800s, especially among upper-class families, often using forceps and new “scientific” methods. Midwives, largely uneducated in these newer methods, were pushed to the margins in some areas, although they continued serving rural and working-class settings.

In cities, physician-attended births introduced interventions - but also infection and mortality rates from puerperal fever. Midwives often had better maternal outcomes with less interventions and risk of infection.

1900-1960s

As hospitals became the standard place to give birth, midwifery was deliberately marginalized in places like the U.S. Physicians labeled home birth as outdated and unsafe, pushing for full control of obstetrics. Formal nurse-midwifery programs emerged in Britain and parts of Europe, but midwives in many places lost legal standing.

Where midwives continued to practice - especially among Black “granny midwives” in the American South - they greatly improved infant survival rates despite limited resources. Meanwhile, hospitals introduced ether, twilight sleep, and the use of routine forceps. Over-intervention often worsened outcomes, especially before sterile techniques were widely adopted.

1970s-1990s

Midwifery saw a reemergence in response to the over-medicalization of childbirth. Homebirth movements, birth centers, and midwife-led care gained popularity once more. Education and certification grew, particularly in nurse-midwifery programs, making midwifery more regulated and recognized.

Research began to show that midwife-led care produced lower rates of intervention and comparable or better maternal and neonatal outcomes, especially in low-risk pregnancies.Countries that integrated midwives into their health systems (like the Netherlands and UK) saw consistent high satisfaction and safety rates.

Present Day

Today, midwives serve in homes, birth centers, and hospitals. Depending on their certification - Certified Nurse Midwife (CNM), Certified Professional Midwife (CPM), or traditional/lay midwife - their scope of practice varies, but the core philosophy remains: supporting physiological birth and informed choice.

Modern studies affirm that midwifery care leads to:

• Lower cesarean rates

• Reduced preterm birth and low birth weight

• Improved maternal satisfaction and breastfeeding rates

• Safe outcomes for planned home or birth center deliveries in low-risk pregnancies

When integrated into the health system, midwives fill critical gaps, especially for marginalized and rural populations. The WHO and global public health leaders now recommend midwifery as a key strategy to reduce maternal and newborn mortality worldwide.