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Midwives, Nurses, & OBGYN's (Oh My!)

A history of the over-medicalization of birth and the female body.

Society often paints midwives as spiritual, non-academic women, who are ill-equipped for the real dangers of childbirth. From sitcoms, to celebrity reporting, having a midwife or doula present for your birth can be seen as ‘woo woo.’ With the rise of western medicine, midwifery received the reputation of being unsafe for mothers, unsafe for baby, and something only elite women take part in. You should want to see a doctor, instead of seeing a woman who carries on a tradition of guiding women through their births, right? I’m going to walk you through the history of midwifery and why societal preferences for doctors above midwives can be misguided.  You’ll learn how, over generations, midwifery in the U.S. turned from a practical practice, to a discredited one with the development of modern medicine and rampant sexism resulting in the overmedicalization of the female body.

During colonial times, midwives solely performed deliveries for all women. They brought this tradition over from England, where midwifery is still widely respected. In fact, in countries like Japan, Sweden, and the United Kingdom, midwives attend most births and outnumber obstetricians. In the 1700s, society viewed childbirth as a social rite performed by women for women. They respected a woman’s natural process of giving birth, and trusted midwives to guide this process. However, in 1751, a large push for professionalism in medicine led to sexist views on the profession of the midwife. Women were deemed too emotional and incapable of learning new obstetric methods. With these attitudes being spread, wealthy women didn’t want midwives attending their births, but physicians instead. Midwifery soon became the best access to healthcare that lower class women and women of color could afford for their births.

Social influence slowly pushed women out of the medical field, claiming that once married, women should only have domestic roles. Even as Midwife training programs appeared across the country, the primary students were men. In the late 1800s, the American College of Obstetrics and Gynecology was formed, and doctors became more integrated into the middle and upper classes. With the downfall of Midwifery in America, came the rise of gynecology and obstetrics.  

19th century American Gynecologist J. Marion Sims is widely known as the father of modern gynecology. Lesser known is that he performed his first experiments on slave women without anesthesia. Anesthesia being difficult to obtain during the time was Sims excuse for foregoing it. He also carried a cruel and racist belief that black women have a higher pain tolerance than white women. With this being the basis of modern gynecology, it's no surprise that obstetrics and gynecology carry a long history of mistreating women, especially black women. By 1900, physicians were present at half the births in the nation, Midwives still making up for the other half while taking care of lower-class women and women of color. In 1914 the invention of “twilight sleep” allowed women to not feel the pain of childbirth. In fact, they didn’t feel it at all. Women would seemingly go to sleep and wake up with no recollection of the birth. “Twilight sleep” was viewed as a sign of medical progress even though mothers were completely removed from the birth experience and often the anesthesia negatively affected the newborns. However, the serious problems associated with “twilight sleep” were ignored for years and the practice continued into the 1970s.

After the invention of twilight sleep, in 1915 Dr. Joseph DeLee described birth as a pathological process, one that wasn’t a normal function for women, and therefore, midwives had no business in it.

Sit with that one a minute. Can you imagine telling a modern mother that her birth is a ‘pathological process’?!

It’s astounding to see the lying propaganda peddled in the medical community and blindly accepted as truth.  Obviously, a woman’s body has evolved for the process of pregnancy, birth, and post-partum, and yet false theories to the contrary would persist until the 1950s.  

In 1952 the midwifery section of the National organization for Public Health Nursing affirmed that pregnancy was in fact a natural process, and a family centered event (gee really? Thanks!) With this attitude change, more women began entering the medical field as nurses, midwives, and OBGYNs. By the 1970s women accounted for only 9 percent of medical students, but this would jump to 25 percent by the end of the decade. During this time, women’s groups began learning how to care for their own vulvas, and shortly after these groups called for medical care to be demystified and for the female body to be de-medicalized. They argued that since birth was a natural process, there wasn’t a need for births to take place in hospitals over the constant supervision of obstetricians. Furthermore, in the 1980s, the medical community came under fire, while women’s groups demanded the same access to medical care for all women. The disparity in medical care started becoming obvious to women of color, who were far more likely to have limited access to effective care. With this in mind, midwifery started to be viewed as a profession again, and one that should be standardized and regulated. In 1994 the North American Registry of Midwives offered its first written examination to certify midwives. Sadly however, midwifery is still illegal in many states as of 2020, and regulations on what’s required to become a certified midwife varies from state to state.  

Today, the majority of births still occur in a hospital. Even with midwives and doulas becoming more widely accepted, there’s still a mistrust of the profession. But when you look at the history, it’s clear to see midwifery decreased in popularity because of sexist, racist, and classist views. Midwives were discredited by the medical community for being women, lower-class, and women of color, even though they carried on long-standing and effective traditions.  

As a vagina superhero, I believe medical birth practices and midwifery can come together, each with the unique and vital value they provide. In fact, the word obstetrics, is actually the Latin word for midwife, and is taken from the root word obstare, meaning to stand before, because attendants stood in front of the mother to “catch” the baby.

The two professions don’t have to be at odds with each other, they can agree to be on a shared mission, to help mother’s deliver their babies to the world. For example, training programs at UCSF now place both midwife students and OBGYN residents together during a vital part of their learning, in order to build a foundation of respect between the two professions.

UCSF charges forward with this new initiative in the wake of covid-19 causing shut-downs of maternal wards, especially in low-income and rural communities. Integrating midwives into maternal healthcare is necessary to ensure every mother gets the best care.

The history of these two professions should be examined while noting that quality medical access is still less accessible to women of color and lower-class women. In turn, midwives, even today, can help fill that gap in healthcare.

While I am hopeful to see institutions like UCSF work hard to create an understanding between these two professions, there is no doubt that the U.S. overall needs to step up in providing equal care across the board which should include more readily available and highly trained midwives.

Integrating advocates for mothers into the medical system that inherently trusts in the female body’s process can be part of much needed reform and a movement towards healthy birth opportunities for all women.

          An Open Letter to Politicians and any concerned that video games add drastically to the number of incidents of gun violence and mass shootings.

          I watched a video from The Daily Show. In it, Trevor Noah responded to a tweet from Neil DeGrasse Tyson. The tweet came in the wake of a pair of mass shootings, drawing the ire of the collective internet. In the video, Trevor Noah pointed out that in all the events in which there are statistically more deaths than mass shootings, we as a society have many mitigating factors in an effort to ensure the health and safety of the populace. From medical errors, illness, car accidents, suicide and homicide, he went down the list of how we as a society try to stave off a mounting death toll.

          After the video, my mind turned to the blame that violence in video games was recieving once more. Is there a some valid history here? I think so. I have heard of times in which shooters used games and their engines to make mock ups of the grounds they aimed to terrorize and essentially practice their runs. I am also willing to admit that “you are what you eat”, and as such have to be mindful about what you consume. But in the vein of Trevor Noah’s segment, I began giving focused thought on what the gaming industry could do to police itself, more than lip service or pandering. To do something with the aim of quelling violence. After solid consideration there is only one thing that could be done: Rate games more harshly, namely rating more games as Adult Only rather than Mature.

          Back before the 90s, video games were seen solely as a medium of entertainment for children. The game series Mortal Kombat, still in its infancy, gained a lot of attention for bucking that trend and playing to an older audience. The gratuitous death animations and the over-the-top blood sprays on every hit gained the attention of the American government, leading to creation of the ESRB (Entertainment Software Ratings Board). Since then, all video games, and many other form of computer software and electronic media, have been subject to a division akin to movies and books. These are…

Everyone (E) Everyone 10+ (E10) Teen (T)- Geared towards ages 13 and up Mature (M)- 17 and up Adults only (AO)- 18 and up

          I am of the opinion that the rating system is not all that useful as it is not accurately utilized. For starters, I have always found it quirky how closely spaced the ages in the latter ratings are. Next, brick and mortar salesman were savvy gatekeepers when such was the only way to purchase games. The staff were, and still can, recognize if a T title is appropriate for younger audiences. Beyond that, in cases where an obvious child strolls up with a Mature game or one for Teens more on the Mature side, a parent is normally not too far away. They are likely to see their child as being “mature enough to handle it” and support the purchase. In this vein it has always been an adult, not the rating system, that has barred my access to a game. If you pull aside an adult gamer and ask them to assemble a collection of their most adult games and you will likely see that they are all rated as Mature. This rating is “as bad as it gets”. Thus I doubt you’ll see any Adult Only games. Why?

Cue my Social Cynic for the answer: Money.

          The video game industry generates billions of dollars worth of annual revenue. Amongst that is Grand Theft Auto Online, an extension to GTA V, which is the most lucrative entertainment property of all time. Not most valuable video game. Highest earning entertainment outlet in history. More than Avengers: Endgame or Avatar. More than Harry Potter, Game of Thrones, or any other popular book series.

I repeat: Grand Theft Auto Online is THE highest grossing entertainment property of all time. And, as it is ongoing, its revenue will only continue to grow.

          So how is this possible? The first answer on the board is microtransactions, which are gaining a number of articles from me and the internet abroad as it stands. But in relation to this article, availability. The difference between a Mature and Adults Only rating is where they are sold. With the former it is virtually everywhere, and it is virtually nowhere with the latter. In the pre-internet age, making a game Adults Only would have killed any chance of it turning a profit. And, while removing a title from retailers shelves may seem major even now, the people that want the game will purchase it online and get a download key or the like. If they want a physical disc instead, they can order it from the company, and will likely be given a key while they wait. In fact, an Adults Only rating would only serve as free publicity.

          I have seen games earn the Adults Only rating. I have watched as they were banned from sale in Wal-Marts, Gamestops, and many digital marketplaces. The fact that they were officially deemed heinous by the ESRB was not taken lightly. But any other game earning a lesser rating that does not gain national news attention for one reason or another? ‘Eh… must not be so bad’ echo the thoughts of most people. This acceptance assures that any game can be easily accessed by anyone. Even though I have gamed most of my life and view video games as a burgeoning artistic medium, there is a part of my brain that is conditioned to think of them as “just toys for kids”. And the games’ industry benefits from this social perception, both from myself, other gamers, and the world at large.

          To illustrate, there were children that I cared for that I allowed to play Saints Row IV, a game series much like GTA. It holds a rating of Mature. Why, if the content was not suitable for them, did I allow them to play it? Because I knew which part of the game they would play. I got their file to a free roaming sandbox portion, showed them how to access a garage for vehicles, change their load outs, and where to shop for clothes and even five years out that’s what they think Saint’s Row is. A fun game to dress up, drive around, and use super powers in. They never got into the story, character development, dialogue, and the bulk of what makes the game mature. They had similar play habits in similar, yet more kid-friendly, titles such as the Lego video games.

          But let us say that one finds my actions with the children appalling. That my supervision was not enough. That my foreknowledge of the the game itself and the playing behaviors of the children was negligent. That I was not a dutiful parental figure. And so we make our Grand Theft Auto, Fortnite, Call of Duty, and other questionably violent game series Adult Only. If your aim is to limit access to the games, it does nothing. It just means that sales of these games migrate from physical to online.

          If re-rating games would do no good, why not take other measures? Perhaps ban games like GTA from being brought to completion in the first place? On the one hand, the Video Game Lobby would push to counter these efforts. As I pointed out, it generates too much money to be written off. On the other, remember the digital marketplaces I mentioned? Even now independent creators make games and post them without ESRB sanctioning. Some companies and platform holders (e.g. Nintendo, Microsoft, Sony)are more exacting when it comes to quality control. Without an ESRB rating, these companies will not allow games to be sold on, through, and for their platform(s). And while the PC market has checks and balances, they are comparatively lax. Some of the most heinous “games” (a term I am using very loosely here) I have ever seen exist in the gutters of Steam. And much like society at large, they thrive in numerous pockets. You take down one and, not only will more just like it take its place, but the original game is likely to be taken down and uploaded again as something else. It’s a whack-a-mole that cannot be won unless you want to take drastic action.

          Now… do I want to see this happen? Do I want more games to be bumped up from Mature to Adults Only? I personally do not care. I am old enough to buy whatever games I wish. But you know what? As ineffectual as I think it would be, and as much evidence as I have seen showing that video games and shootings are unrelated on the whole, I would be willing to abide by a more stringent rating system.

          That said, my abdication comes with one single ongoing condition:

Blame whatever you want, but if you identify a problem, fix the problem.

          I’ve informed you what can be done about video games. If this is where you want to place the fault today… okay. Let’s make games with realistic and gruesomely violent conent harder to access for people who do not have enough external real life experience to contextualize what they are playing. (Ignoring for now how video games aided me in being able to contextualize so much of real life. A discussion for another time.) If, in the wake of another/the next shooter, you are going to point the finger at mental health? Vote for robust healthcare so people get the help they need. Enable that medications are affordable to help keep brain chemistry in check. Improve the quality of life of people so they aren’t driven to violent and deadly outbursts, or perhaps so much medical care to begin with. An ounce of prevention being worth a pound of cure and all. Want to blame them being an outlier, racial supremacist and other radical ideologue? Then figure out what lawful measures there are to eliminate them wholly, from the fruit back down to the root. Don’t just denounce them and then tolerate them as they continue to spread hatred and foment terror. Peter denied Jesus Christ three times, but we still regard him as a faithful apostle. Don’t continue to pay lip service by pointing to a problem. Something has to be done at this point, and sooner than later.

As I was finishing up, Facebook reloaded and this was front and center.

          In answer to the question “Do video games increase the potential of violence/mass shooting?” thirty years worth of science and study says no. Additionally, counties that have a larger population of gamers than the United States do not suffer from widespread gun violence. We may not be able to prove the mental soundness of each individual shooter. And things like manifestos and social media profiles can be spoofed if you want to give all sides their due.

          All of these incidents have one common element beyond the shadow of a doubt. All of these killings were perpetrated by people with guns fine tuned to kill a multitude. Even with the current safeguards and measures we have in place, gun violence is still all too common. As what we are doing is not enough, more must be done. Referring back to Trevor Noah, we have to try something. If today it’s my turn with games, that is fine. If, after cutting at every other factor, gun-driven violence is still a problem will it then be time make compromises regarding firearms?

I am willing to Try, Do, and abide to something different in my life and industry to make the America safer.

Are you?

Is there any action that can be taken on video games to mitigate gun violence?           An Open Letter to Politicians and any concerned that video games add drastically to the number of incidents of gun violence and mass shootings.