What birth has done for doctors: a historical view

Historians have usually described contributions of medicine to birth as if all the benefits accrued to patients. This article explores the contributions that birth and birthing women have made to the professionalization of American medicine and to the social and economic status of doctors during the past 200 years. Birth provided doctors with some of their first valid techniques, giving them a claim to superiority over irregular practitioners and midwives; it also enabled them to become moral authorities and personal confidantes to women. Later it helped to accustom families to the use of hospitals. Finally, maternal and neonatal mortality rates provided an international standard for judging the overall quality of a nation's health care. In the United States, high maternal mortality rates led to the first self-critical investigations by the profession, the first hospital mortality review boards, and the first major specialty board, obstetrics. In the process of gaining these professional advantages in an entrepreneurial climate, American doctors transformed birth from a natural event into an occasion requiring the use of medical art.