per cent of those who do varies among the races from 66.1 for the Poles to 1.5 for the English-speaking foreign born, a rate that falls below that of the native born. The high per cent for native-born mothers is probably explained by the fact that women of native birth employing midwives " were of Italian, Russian, or Austro-Hungarian parentage, and . . . the custom of the native country of their parents still held considerable sway." A study of mothers in New York City found 56.2 per cent using midwives; 87 per cent of those using midwives were foreign born; and 58 per cent of those foreign born were Italian. The use of midwives by Italian mothers is everywhere prevalent. In one study of two hundred and eighty-nine Italian deliveries, 91.7 per cent were attended by midwives.2 A study of three cities in California showed that "the midwifery situation. . . is very largely confined to the foreign-born population, principally Italian and Japanese."3 From Chicago, Detroit, and Pennsylvania studies come similar findings. The foreign 4 1 Jacob Soble, M.D., "Instruction and Supervision of Expectant Mothers in New York City." Reprint from New York Medical Journal, January 19, 1918, pp. 16, 17. 2 Compiled from material received from the Bureau of Educational Nursing, Association for the Improvement of the Condition of the Poor, New York City, 1918. 3 Mrs. Elwyn Stebbins, "Supplementary Report on the Midwives of Oakland, Alameda, and Berkeley," Sixth Annual Report of the American Association for the Study and Prevention of Infant Mortality, pp. 149–150. 4 Report of the Health Insurance Commission of the State of Illinois, May 1, 1920, p. 60. "How Two Thousand Detroit Mothers Were Cared for in Childbirth," Detroit Home Nursing Association, Detroit, 1917, pp. 1, 3, 6. Emma Duke, "Infant Mortality, Johnstown, Pennsylvania," Children's Bureau, United States Department of Labor, 1915, p. 60, Table IV. born mothers, especially among the Italian and Slavic peoples, have not the habit of using physicians. Were there no foreign-born mothers there would be practically no midwife problem. REASONS FOR USING THE MIDWIFE The reasons why the foreign born use midwives so extensively are easy to understand from the facts of their background and their usual circumstances in this country. One reason is the prejudice against having a man doctor. We hear much of the so-called sex prejudice of the foreign-born woman in this respect. There is no doubt that it exists to a greater or less degree, depending on the race and the individual. The husband, also, has a large part in determining whom the woman shall have and how much shall be paid. When, as is likely, he does not know any doctors, he must be brought to feel absolute confidence in a new and more expensive kind of service. He must be persuaded to let a strange man doctor render very intimate services to his wife, for he cannot usually afford a woman attendant also. There is reason to believe that the prejudice is sometimes given as an excuse for having a midwife when the real reason is economic, or simply strongly rooted custom. Another reason for using the midwife is the tradition of capability carried over from foreign countries wherein these women have recognized professional status. Throughout Europe the midwife is a highly specialized trained person. In Holland, Belgium, France, and Italy, a full two years' course of training is required before a woman may practice midwifery. In Norway, Sweden, Denmark, and England the course is one year. In Germany she gets six months' training in government clinics, under university professors. In most countries abroad, moreover, the midwives are licensed and are carefully supervised by the state.1 The mother may have already used midwives and known many of them through her friends abroad. The immigrant family has many reasons for implicit trust in the midwife. The immigrants' chief reason for using the midwife, however, is economic. The midwife costs less than the physician, both because her fee is lower and because, even when she does little housework, she renders more service to the mother and the family than the physician does. Many midwives do not only the actual obstetrical work in confinement, but a large amount of housework, thus greatly assisting the mother of a family of children to get through a very trying period. This has been, and still is, a distinct element in deciding many immigrant families in favor of the midwife as against the doctor. A good deal of evidence is accumulating, however, to the effect that the midwife is doing less housework than formerly. The head nurse of the system of supervising midwives in a large city said that the better trained the midwife was the less housework she now did. The shortage of doctors during the war undoubtedly enabled many midwives to reduce the amount of their housework and not lose clientele. 1 See "The Midwife in England,” by Miss Carolyn Van Blarcom, and "Schools for Midwives," by Dr. S. Josephine Baker, in the Proceedings of the Second Annual Meeting (1911) of the American Association for the Study and Prevention of Infant Mortality, p. 232, seq. The material gathered by the Association for the Improvement of the Condition of the Poor, covering the period 1912 to 1919, shows this tendency over a longer period, and adds considerable weight to the belief that the housework done by the midwife is decreasing. Of two hundred and eighty-nine cases having midwives, 96.2 per cent of the midwives did not do any housework. Midwives' fees are invariably lower than doctors'. The Detroit Maternity Survey, already mentioned, found that in the cases in which the doctor employs a practical nurse to visit his maternity patients he, as a rule, makes but one visit. The nurse makes on an average of six, and the common charge for the combined services is $20. The patient in such cases is left to the care of a child or a neighbor for the greater part of the time. The neighbor is often paid. Midwives' charges ranged from $7 to $10 for services at the birth and visits daily for five days or more. A few cases are recorded in which the charge was but $5. In the majority of cases the charge was $10. Doctors' charges ranged from $10 to $30. The higher figure was not as frequently found as was the charge of $15. Twentydollar or $25 fees to doctors were found in most cases.1 In California rates for midwives are found to be higher than in Detroit, but in California medical fees are also higher. Dr. Adelaide Brown, in a report2 dated 1915, found that 1"How Two Thousand Detroit Mothers Were Cared for in Childbirth," Detroit Home Nursing Association, Detroit, 1917, p. 12. 2 Dr. Adelaide Brown, "A Report of the Midwife Situation in San Francisco and Alameda Counties, California," with supplemental report by Mrs. Elwyn Stebbins, Sixth Annual Report of American Association for Study and Prevention of Infant Mortality, pp. 147-150. the average fee [was] $15 to $20, some taking $10 when they cannot get $20 or $15. . Of 33 midwives in the 1913-14 list registering 80 per cent of births recorded by midwives, only 13 record over 30 [births] each at $15 apiece. Thirty births give an annual income of $540, and $416 ($8 a week) is considered the minimum wage. The fee included daily nursing care for mother and child for from ten to fourteen days. The Association for the Improvement of the Condition of the Poor in New York City made a tabulation of two hundred and eighty-five deliveries of Italian women during the years 1912-19.1 From their data the following table was constructed: TABLE XXVII FEE RATES FOR DELIVERY OF 285 CASES, NEW YORK CITY, 1 Data furnished by the Association for the Improvement of the Condition of the Poor. |