The history of scurvy and vitamin C

In America, there were a number of praiseworthy attempts to improve the position of the midwife in the early nineteenth century, and an increase in the number of European midwives accompanied the influx of immigrants after the 1880s. Yet the midwives' position was so insecure that they nearly died out as more and more women opted for physician deliveries in hospital. Only recently, since the 1970s, has there been something of a midwife revival, split between the nurse-midwives and the "independent" midwives. The difficulties of the American midwife can be attributed largely to the absence of those very factors which strengthened her colleague in Britain. In America, there was no strong eighteenth-century tradition; no strong link with the nursing profession, although the public health nurses held out a hand in the inter-war years; there was no support from the early feminists of this century, and there was no uniform or Federal certification. Instead, there were wide disparities in the often half-hearted attempts to improve and certify midwives in different states, varying from the moderately successful at one extreme, and at the other the introduction of legislation in Massachusetts (in 1907) and Florida (in 1982) intended, directly or indirectly, to outlaw the midwife altogether. Most of all, however, the tradition of general practitioner obstetrics and deliveries conducted in the home, sank very much sooner in the USA than in Britain, almost taking the independent midwife with it. By the second world war, when only thirty-seven per cent of all deliveries in Britain took place in hospital, some eighty per cent of urban deliveries were hospital deliveries in the USA. Home deliveries were almost exclusively confined to the urban poor, especially the black population. Moreover, throughout this century there was the almost total and relentless opposition to the midwife by the American medical profession. With few exceptions, they were set on abolishing all midwife deliveries, even when statistics showed that home was safer than hospital. This is the bare bones of a complex story which is dealt with in Litoff's introduction. The rest of the book is a valuable collection of papers and reports that influenced or reflected the midwife debate. There is a 1915 paper by De Lee-the Chicago obstetrician, famous for his "prophylactic forceps operation" (1920-in which he says things about midwives that could make your hair curl. There is a paper (1927) by the marvellous Mary Breckenridge, who set …