By Jenne Erigero Alderks

Midwifery possesses a special role in the history of the Church of Jesus Christ of Latter-day Saints. The significance of the work can be seen in the description of midwives as “high priestesses in the chamber of birth” in a 1915 article in the Relief Society Magazine on the heritage and history of LDS midwives. The article declares that “As a profession, midwifery is as old as the world,” noting that women have “presided” in the office of helping their sisters give birth “until last century.”¹ By 1915, the shift away from midwifery had been both noticed and mourned by Latter-day Saint women. When the Latter-day Saint frontier midwives delivered babies, they frequently did so without the safety net of emergency obstetric services. Often their skills and expertise were called on in emergencies. But as emergency services became widely available, midwifery in the United States, and by extension among Latter-day Saints, dwindled into near extinction.

For a time, the role of midwife was an actual calling extended to Latter-day Saint women. The first midwife to be set apart and ordained by Joseph Smith in Nauvoo was Ann Carling, who was counseled to follow the principles of the Word of Wisdom in her work.² Likewise, Joseph Smith anointed Vienna Jacques and Patty Bartlett Sessions as midwives to the mothers of Zion.³

Sessions had practiced as a midwife in Maine before converting to Mormonism and joining the Saints in Missouri. After Missouri governor Lilburn Boggs issued the Extermination Order in 1838, Brigham Young and Heber C. Kimball directed Sessions to continue her work as the Saints traveled westward. She assisted in the births of children and supported women along the banks of Mississippi River. Fifty-two years old when she left Winter Quarters for the mountains of Utah, she continued assisting women in childbirth until age 85, having attended and recorded 3,977 births among Mormon women.⁴ Through all of the adversity, poverty, poor conditions, and lack of accessible emergency care, she refers to a mere “three difficult cases,” each of which could have been addressed by the advances in medicine and obstetrics today; one was likely due to rickets, a now rare nutritional deficiency causing deformity of the pelvis.

The respect afforded Latter-day Saint midwives is suggested by the fact that they were said to be “officiating at births.”⁵ They were also considered general healers, going from home to home to care for the sick and attend to the dying.⁶ Moreover they engaged in the sanctioned practices of anointing, blessing, and administering blessings of strength and healing. In this way, midwives were viewed as the female equivalent of patriarch—matriarchs whose position was cemented by being called and ordained. An example is Zina Young. Emmeline Wells said of her, “In the sickroom she was a ministering angel, having always something to suggest that would be soothing and restful; she was a natural nurse, and she invariably inspired confidence. Her strongest capabilities lay in nursing the sick. . . . No other woman knew better what to do when death came into a home. . . . Numberless instances might be cited of her administrations among the sick, when she seemed to be inspired by some higher power than her own.”⁷

In an effort to meet the medical needs of their communities, Latter-day Saints formed the Council of Health in 1848. Susannah Lippincott Richards, wife to the herbalist Willard Richards, taught classes in midwifery, childcare, and diseases of children. In 1851, the Female Council of Health was formalized under the direction of Phoebe Angell and was soon serving almost all the wards in Salt Lake City.⁸ However, though these midwives were highly adept at handling normal variations in pregnancy, there were cases that required emergency obstetric services. The infant mortality rate could not be significantly reduced without access to such services.

By the 1870s, midwives, herbalists, and physicians in the region found a solution to the limited skills and expertise they possessed. They created a maternity hospital and obstetric training center, reestablished the formerly disbanded Council of Health,⁹ and followed Brigham Young’s suggestion from 1873 that “three women from each ward in the city be chosen to form a class for studying physiology and obstetrics.”¹⁰ However, the need still existed for more advanced training. Women such as Romania B. Pratt, Ellis Reynolds Shipp, Margaret Curtis Shipp, and Martha Maria Hughes Cannon enrolled in eastern colleges, with Relief Society encouragement and financial assistance, to receive degrees in medicine.¹¹ When these doctors returned to the Salt Lake Valley, they established their own practices and taught classes in midwifery and home nursing.¹²

The 1880s brought the establishment of local hospitals throughout the Salt Lake Valley, though funding was frequently difficult to obtain. The Relief Society was instrumental in the creation of these hospitals. The intent was to provide for the medical needs of the Saints at the time. In doing so, the Relief Society became an agent of change as it combined physical and spiritual assistance with efforts to meet health needs that could not be met at home using traditional healing techniques.¹³

Community and Church leaders soon noted with regret that “sending for the doctors has become so prevalent” among the Saints.¹⁴ Brigham Young called it “‎a growing evil in our midst,” adding, “It will be so in a little time that not a woman in all Israel will dare to have a baby unless she can have a doctor by her. I will tell you what to do, you ladies, when you find you are going to have an increase, go off into some country where you cannot call for a doctor, and see if you can keep it. I guess you will have it, and I guess it will be all right, too.”¹⁵

John Whitridge Williams, a pioneer of modern obstetrics and author of the still preeminent obstetrics textbook Williams Obstetrics, expressed similar concerns regarding the inappropriate use of medical intervention, especially in normal childbearing, when he stated in 1916, “Unfortunately, history shows that advances in the practice of medicine and surgery are rarely attained in a thoroughly rational manner, but that a period of undue enthusiasm, or even of almost reckless abuse, usually precedes the establishment of the actual value of a given procedure.”¹⁶

Just as Williams predicted, the twentieth century saw the proliferation and overuse of obstetric intervention as increasing numbers of women moved from home to hospital for childbirth. In the early days of “lying-in hospitals” from the mid-nineteenth century to the early decades of the twentieth century, maternal deaths were up to three times higher than the rate for home deliveries.¹⁷ Most of these deaths were caused by puerperal fever, which is sepsis by bacterial infection. Originally, hospitals provided maternity care for indigent and homeless women and the rates of infection were far higher in the hospital compared to the documented rates for home births attended by both midwives and physicians. By the end of World War I, infection rates in the hospital were brought down through an increased understanding of antisepsis and sterilization procedures.¹⁸

Utah midwives and physicians embraced antiseptic procedure, quickly recognizing its life-saving importance. Even still, Hannah Adeline Hatch Savage in 1887 describes an early LDS maternity facility as “a poor excuse for a hospital” but is reported to have fondly remembered the healing that she experienced after a blessing at the hands of Lucy Bigelow Young.¹⁹

With the transition from home to hospital, the United States—Utah included—saw a transition from midwife to physician for pregnancy and childbirth.²⁰ Midwives in the United States were the subjects of propaganda campaigns aimed at delegitimizing their work. In 1940, 50% of American births were still taking place at home attended by either doctors or midwives. By 1955, 99 percent of babies were born in hospitals with obstetricians.²¹

As the rest of America became more modern, and as Mormons had increased interaction with the pluralistic society emerging in America, Mormons conformed to mainstream society in many ways. The abandonment of polygamy was the watershed event, but other unique Mormon cultural characteristics, such as women administering blessings of healing and men wearing long beards, slowly disappeared as Latter-day Saints assimilated into the dominant culture. As the cult of republican motherhood²² became a strong theme in American and Mormon religion, it became socially unacceptable for women to engage in professional pursuits, leaving maternity care in the hands of men. Various LDS Church leaders, including President Ezra Taft Benson, as late as 1987, have called on mothers to abandon their positions of employment and return to the home.²³

Throughout the twentieth century, pharmacological pain relief for labor pain became available to women across the country—but only through doctors, who were typically male. Doctors soon came to insist—and women to expect—that giving birth meant: administer morphine with scopolamine, then ether—a mixture resulted in a state commonly referred to as “twilight sleep.” Next cut an episiotomy; extract the infant with forceps, sew up the incision, and give more morphine/scopolamine “to prolong the narcosis for many hours postpartum, and to abolish the memory of labor as much as possible.”²⁴ Introduced in 1920 by famous obstetrician Joseph DeLee,²⁵ this birth experience became the standard in U.S. hospitals by 1938.

But this pharmacological escape from the memory of pain was hardly the removal of Eve’s curse, as some women and feminists had regarded it. Because the scopolamine often induced hallucinations and aggressive behavior, nurses took to tying women’s wrists and legs to the bed with soft lambs wool (to hide any ligature marks) and wrapping their heads in thick bandages in order to protect laboring women from harming themselves.²⁶ This experience was a far cry from being free to move around as needed, which generally allowed women to find effective methods to cope with labor pains, to eat and drink to maintain strength, and to be surrounded by supportive, familiar, and experienced women. Although scopolamine can interfere with memory creation, supposedly a boon in that women would not remember the pain of childbirth, it was not always effective. An article entitled “Cruelty in Maternity Wards” in the December 1958 Ladies’ Home Journal led to a deluge of responses of women sharing similar experiences.²⁷ Women were quoted as saying: “they give you drugs, whether you want them or not, and strap you down like an animal.” “My baby arrived after I had lain on the table in delivery position nearly four hours.” “When I asked why I couldn’t be put into a bed the nurse told me to quit bothering her so much.” “With leather cuffs strapped around my wrists and legs, I was left alone for nearly eight hours, until the actual delivery.” “My doctor had not arrived and the nurses held my legs together. She was born while he was washing his hands. I do not believe the treatment I received was intentionally cruel—just hospital routine.” A nurse stated, “I’ve seen patients with no skin on their wrists from fighting the straps.”²⁸

By the 1960s, backlashes against hospital procedures were seen on a large scale. Women insisted that their husbands be present for the births of their children; one couple went so far as to handcuff the father to the hospital bed so he could not be removed from the room.²⁹ Midwifery reemerged as a small minority of women began to demand better treatment; they resented being forced into submitting to procedures and practices governed more by convention and medical convenience than the well-being of either mother or child. Ina May Gaskin was one of the first midwives to pioneer this shift in thinking and has been a leader in American and global midwifery since 1971. She and her contemporaries have been largely responsible for the recovery of midwifery in the United States.

Knowledge of traditional midwifery had continued in the U.S. due to continued practice of midwifery in Amish and isolated communities, and because of the creation of the Frontier Nursing Service established by Mary Breckinridge in 1925, which employed nurses who were also qualified midwives. These midwives with initial nurse training were essential in making maternity care accessible to women in rural areas. Notebooks explaining midwifery procedures and practices circulated through the mail among women, reducing the need to travel in order to learn more about the practice. Women able to do so also traveled to other countries to learn from traditional midwives. Also crucial were partnerships with doctors who were sympathetic to midwives’ endeavors and goals.

Though homebirths currently account for only 1% of births in the United States, and only 8% of births are attended by midwives, medical research supports midwifery and out-of-hospital birth as safe alternatives to the typically medicalized births in hospitals. When it comes to morbidity (injury as a result of medical procedures that do not result in death), midwives and out-of-hospital birth have substantially lower rates of episiotomies, as well as complications due to infection and hemorrhage. Medical evidence also demonstrates that increased intervention beyond a certain level introduces more risk than necessary, leading to higher morbidity and mortality rates.³⁰ Many women have seen this borne out in their experience and have become wary of conventional obstetric care. Feeling these statistics and experiences are ample justification for their decision, more and more women are choosing to birth at home or in out-of-hospital birth centers with midwives. As the medical establishment continues to attempt to limit access to midwifery services, a distinctly feminist argument has emerged that it is a woman’s right to choose the setting and the attendant when she gives birth. It is also her right to pursue a profession that draws on the traditional skills supported by empirical evidence instead of common procedures rooted in impersonal protocol and the doctor’s convenience.³¹

These are among the reasons Mormon women today choose midwifery care and out-of-hospital birth, though they also have spiritual and religious reasons for their maternity care choices, including a trust in God and a belief in the divine design of the female body to give birth. Donna, an LDS blogger at Banned From Baby Showers and a childbirth educator in Texas, shared this perspective with the parents she teaches:

When we talk about why they are choosing to give birth without medication, so many of these couples will express their belief that God made their bodies to give birth. It is a gift to be able to grow a life, birth their baby, and then to feed their baby with their own body. They have so much confidence and faith in Christ, it is very inspiring. I love these answers because I feel this same way. The same is true of so many out-of-hospital midwives in this area. They feel “called” to midwifery. They pray with their clients and typically are very vocal in their faith. Faith in Christ and faith in the natural process of birth.³²

Many LDS birth bloggers have found one another on the internet and have discovered that many LDS women sense that same calling to midwifery and birth work. Like their LDS ancestors and foremothers, they feel led to working with families to have safe and satisfying birth experiences. More and more LDS women are becoming doulas, midwives, childbirth educators, and lactation consultants. They find that the work can be family friendly, allowing them to stay home with their children and work part time, sharing childcare and household duties with their husbands.

In October of 2011, the website Birthing in Zion (www.birthinginzion.com) began pulling together the LDS birth community to provide a directory of LDS birth workers throughout the Church. An LDS mother can now use the internet to find a midwife, childbirth educator, or doula who shares her religious perspective. In conjunction with the directory, LDS women and mothers are connecting with one another in a Facebook community (www.facebook.com/LDSbirthworkers) started by the creators of Birthing in Zion. Through this, LDS women today are discovering the legacy of women as primary birth attendants common in the early Church and throughout history. As the community of LDS birth workers and women interested in care provided by their Relief Society sisters grows, there may be a day when a woman will be able to find, in her own stake, an LDS midwife or other birth professional with whom she can share the spiritual dimensions of childbearing and evoke a former time when midwives were revered as female leaders and ministers of the gospel.

NOTES

1.  “Ye Ancient and Honorable Order of Midwifery.” Relief Society Magazine 2, no. 8 (August 1915):349.

2.  Margaret K. Brady, Mormon Healer and Folk Poet, Mary Susannah Fowler’s Life of Unselfish Usefulness (Logan, UT: Utah State University Press, 2000).

3.  Claire Noall, Guardians of the Hearth, Utah’s Pioneer Midwives and Women Doctors (Bountiful, UT: Horizon Publishers, 1974).

4.  Donna Smart, Mormon Midwife: The 1846–1888 Diaries of Patty Bartlett Sessions (Logan, UT: Utah State University Press, 1999).

5.  Claire Noall, “Mormon Midwives,” Utah Historical Quarterly 10 (1942): 106.

6.  Jill Mulvay Derr, Janath Russell Cannon, and Maureen Ursenbach Beecher, Women of Covenant: The Story of the Relief Society (Salt Lake City: Deseret Book Company, 1993), 66–68.

7.  Emmeline B. Wells, “Zina D. H. Young,” Improvement Era 5 (1902): 43

8.  Derr, Cannon, and Beecher, Women of Covenant.

9.  The Council of Health was originally established in 1848. As medical services in Utah territory advanced and the Saints’ health needs were met as best as possible for the time, the Council of Health disbanded due to lack of need. However, it was reestablished in 1872 when the first maternity hospitals were established in the territory and necessitated further obstetrical trainings for hospital workers.

10.      Derr, Cannon, and Beecher, Women of Covenant.

11.      Ibid.

12.      The 1915 article from the Relief Society Magazine named the Latter-day Saint female doctors above as well as Elvira S. Barney, Jane W. K. Skolfield, Emma Atkin, Jane Ivins McDonald, Mary Emma Green Van Schoonhooven, Belle Anderson Gemmel, and Elsie Ada Faust, some of whom were still practicing when the 1915 article was published.

13.      Derr, Cannon, and Beecher, Women of Covenant.

14.      Ibid.

15.      Brigham Young, in Journal of Discourses (London: Latter-day Saints’ Book Depot, 1854–86), 15: 225.

16.      John Whitridge Williams. “The Abuse of Cesarean Section,” in Surgery, Gynecology & Obstetrics 25 (July–December 1917): 194.

17.      Irvine Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800–1950 (New York: Oxford University Press, 1992), 328.

18.      Ibid

19.      Derr, Cannon, and Beecher, Women of Covenant.

20.      According to Loudon in the chapter “European Midwives” from Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800–1950 (New York: Oxford, 1993),  this was not the case in European countries where midwives were incorporated into the hospital maternity care system and managed to retain the legitimacy of their profession. The Netherlands is known today as the only European country to have continued homebirths attended by midwives who practice fully independently within a supportive framework for maternity care. Holland continues to have one of the lowest rates of maternal and perinatal mortality in the world. Sweden also continued to use midwifery services for the childbearing population and experienced the decline in maternal mortality sooner than did Britain and the U.S., likely due to increased training for midwives and the introduction of antisepsis and asepsis around 1880.

21.      Tina Cassidy, Birth (New York: Atlantic Monthly Press, 2006), 54–55.

22.      Republican motherhood is the term used to describe the American ideals of women’s roles during the eighteenth and nineteenth centuries. Women were expected to dedicate their lives to the rearing of their children to become citizens supporting the ideals of the American republic. Through their devotion to their children, they were believed to have influence in civic duties and were socially discouraged from engaging in public life. Linda Kerber originally used the term in her book Women of the Republic: Intellect and Ideology in Revolutionary America (Chapel Hill, NC: University of North Carolina Press, 1980).

23.      Ezra Taft Benson, “To the Mothers in Zion,” fireside for parents 22 February 1987, http://fc.byu.edu/jpages/ee/w_etb87.htm (accessed 23 February 2012).

24.      Joseph B. DeLee, “The Prophylactic Forceps Operation,” American Journal of Obstetrics and Gynecology 1 (1920): 34.

25.      Jennifer Block, Pushed: The Painful Truth about Childbirth and Modern Maternity Care (Cambridge MA: Da Capo Press, 2007).

26.      Ricki Lake and Abby Epstein, The Business of Being Born (DVD), New Line Home Video, 2008.

27.      Henci Goer, “Cruelty in Maternity Wards: Fifty Years Later,” The Journal of Perinatal Education 19, no. 3 (Summer 2010): 33–42.

28.      “Cruelty in the Maternity Wards,” Ladies Home Journal, December 1958.

29.      Judith Walzer Leavitt, Make Room for Daddy: The Journey from Waiting Room to Birthing Room (Chapel Hill, NC: The University of North Carolina Press, 2009).

30.      Jennifer Block, “The C-Section Epidemic,” Los Angeles Times, 27 September 2007, http://articles.latimes.com/2007/sep/24/opinion/oe-block24 (accessed 12 January 2012); Eugene DeClercq, “Birth by the Numbers.” Lamaze International Videos. http://www.lamaze.org/OnlineCommunity/LamazeVideo
Library/LamazeVideoPlayer/TabId/808/VideoId/4/Birth-By-The-Numbers.aspx (accessed 12 January 2012); A. de Jonge, B.Y. van der Goes, A.C.J. Ravelli, M.P. Amelink-Verburg, B.W. Mol, J.G. Nijhuis, J. Bennebroek Gravenhorst, and S.E. Buitendijk, “Perinatal Mortality and Morbidity in a Nationwide Cohort of 529,688 Low-risk Planned Home and Hospital Births,” BJOG: An International Journal of Obstetrics & Gynaecology 116: 1177–1184.

31.      Boucher, Debora. “Staying Home to Give Birth: Why Women in the United States Choose Home Birth.” Journal of Midwifery & Women’s Health 54, no. 2 (March–April 2009): 119–126

32.      Donna Ryan, “Religious Faith and Choosing Natural Birth,” Banned from Baby Showers, 29 March 2010, http://banned-from-baby-showers.blogspot.com/2010/03/religious-faith-and-choosing-natural.html (accessed 23 February 2012).