Midwifery is the practice of supporting women during pregnancy, labor, and the postpartum period, a role that has existed across virtually all human cultures. The assistance of an experienced woman during childbirth is not an innovation, but rather a practice as old as human civilization itself. Because of its deep roots in unrecorded, community-based tradition, it is impossible to assign a single starting date to midwifery. However, historical records and archaeological evidence offer a clear timeline of its evolution from an ancient community role to a modern regulated profession.
Origins in Antiquity and Early Civilizations
The earliest documented evidence of formalized midwifery practices comes from ancient civilizations, where the role was already highly recognized. Midwives in Ancient Egypt, for example, were a distinct class of respected female practitioners as early as 1900 BCE. The Ebers Papyrus, one of the oldest surviving medical texts, contains references to birthing practices, and the Westcar Papyrus, dating to around 1700 BCE, provides instructions for calculating a due date and describes the use of specialized birthing chairs.
This role was a blend of practical physical assistance and spiritual guidance, where knowledge was passed down orally through generations. The Classical World saw Greek philosopher Aristotle referencing midwives in his writings. The physician Soranus of Ephesus, in the 2nd century CE, authored a comprehensive manual, Gynaecology, which detailed the qualities of an ideal midwife and provided guidance on prenatal care, labor, and newborn health.
Soranus described the ideal midwife as one who:
- Was literate and intelligent.
- Possessed a good memory.
- Was physically robust with soft hands.
This text demonstrates that in the Greco-Roman world, midwifery required both practical experience and formalized knowledge. These ancient practitioners established the core function of the midwife: managing normal births and providing continuous, supportive care.
The Role of the Midwife in Pre-Modern Europe
During the Middle Ages and Renaissance, the midwife remained the primary healthcare provider accessible to women. She was a trusted, central figure in the community, attending births in the home and relying on accumulated experience and folk traditions. This was a decentralized system where knowledge transmission primarily occurred through apprenticeship.
Formal medical education was largely reserved for men, meaning midwives generally lacked access to the anatomical and scientific texts. However, the 16th century marked a significant transition with the publication of the first printed manuals aimed at guiding these practitioners. The Birth of Mankind, first translated into English in 1540 from an earlier German work by Eucharius Rösslin, became an authoritative text for over a century.
This manual provided an understanding of obstetrics to a wider audience, including illustrations known as “birth figures” that showed different fetal positions. The text was widely used and represented an early attempt to standardize knowledge for community midwives. Despite this, the lack of formal licensing or regulation meant that the quality of practice remained highly variable throughout the period.
The Great Transition: Medicalization of Childbirth
The 17th and 18th centuries ushered in a shift away from traditional female-led midwifery toward the medicalization of childbirth. This transition was driven by the rise of the male accoucheur, who specialized in complicated deliveries. The key factor enabling this change was the invention and gradual public use of the obstetrical forceps.
The forceps were secretly developed by the Chamberlen family of barber-surgeons in the 17th century, allowing a living infant to be extracted during difficult labors. This instrument gave male practitioners a unique and powerful tool that distinguished them from traditional midwives, who were limited to hands-on techniques. The use of the forceps, which became more widespread in the 18th century through figures like William Smellie, was a catalyst for men entering the birthing room.
Wealthy women began to favor the man-midwife, viewing his association with surgical tools and scientific inquiry as a mark of superior care. Childbirth gradually moved from the home to the hospital, which was increasingly controlled by male physicians. This shift marginalized traditional female midwives, pushing them to serve only the poor or rural populations, and cemented the idea of birth as a medical event rather than a natural life process.
Modern Revival and Professionalization
The 20th century saw an effort to revive and formalize the practice of midwifery in response to high maternal and infant mortality rates in physician-controlled hospitals. In the United States, standardized education began in the 1920s. The American College of Nurse-Midwives (ACNM) was established in the 1950s, setting standards for education and certification.
This modern professionalization led to the creation of distinct, regulated roles. Certified Nurse-Midwives (CNMs) are registered nurses who complete graduate-level education in midwifery, often practicing in hospitals and birthing centers. Alongside them, the Certified Professional Midwife (CPM) credential emerged in the 1990s, formalized by the North American Registry of Midwives (NARM), to certify direct-entry midwives who specialize in out-of-hospital settings like home births.
These credentials and standardized training programs adapted the ancient practice to meet modern medical standards, focusing on evidence-based care. Today, midwifery is a recognized, regulated profession worldwide, providing a model of supportive, low-intervention care integrated within the modern healthcare system.