Preserving Midwifery
The professionalization of obstetrics in the early 20th century led to the marginalization and, in some cases, the eradication of traditional midwives, particularly impacting African American communities in the South. These midwives, often the primary birth workers in their communities, were systematically displaced by emerging medical regulations and licensure requirements that favored formally trained physicians.
The push for modernization introduced expensive credentialing processes, creating barriers for traditional midwives who lacked formal education but possessed extensive practical experience. This shift not only sidelined seasoned practitioners but also replaced them with younger professionals who may have lacked the cultural competence and community trust that traditional midwives had established over generations.
In Pennsylvania, the legal framework is clear about licensed categories: Pennsylvania licenses nurse-midwives and, as of Act 14 of 2026, certified midwives. Cardinal Birth is not in those licensed categories. Traditional midwives are not licensed by Pennsylvania, and families who hire them are choosing this model with that disclosed.
Advocates argue that preserving traditional midwifery is essential for accessible and culturally sensitive care, especially in underserved communities. They contend that the current framework should be reconsidered to support families who choose traditional midwifery, recognizing its historical and community value.
The intersection of modern obstetrics and traditional midwifery has led to the marginalization of community birth work through stringent licensure requirements and the prioritization of formal medical credentials. The lack of a licensure pathway for traditional midwives presents legal challenges that merit consideration.
The commercialization of midwifery has fundamentally altered its craft, shifting it from a community-based, holistic practice to a more clinical and transactional profession. Historically, midwifery was deeply rooted in tradition, community trust, and lived experience. The midwife was often a respected elder with years of accumulated knowledge passed down generationally. This approach centered on the natural processes of childbirth and the physical, emotional, and spiritual well-being of the mother and baby.
IMPACT OF COMMERCIALIZATION
Shift Toward Medicalization:
Modern midwives are increasingly trained within frameworks that prioritize interventions, often mimicking the practices of obstetricians (OBs). Traditional tools, such as herbs and massage, have been replaced with technology-heavy practices. The result is a loss of the essence of midwifery as a gentle, patient-centered craft, as it becomes more aligned with the efficiency-driven model of hospital obstetrics.
Loss of Personal Connection:
Where midwives once served communities over decades, building trust and deep cultural competence, the emphasis on credentials and licensing has created a transient workforce. The reliance on formal training often devalues lived experience and the importance of cultural traditions in caregiving.
Exclusion of Traditional Midwives:
The commercialization process systematically excludes older or traditional midwives who cannot afford expensive credentialing processes or conform to standardized medicalized practices.
CHALLENGES OF YOUNG MIDWIVES IN TRADITIONAL ROLES
Lack of Life Experience:
Midwifery is more than a technical skill—it requires intuition, maturity, and emotional resilience developed over time. Young, newly credentialed midwives may excel in technical knowledge but lack the seasoned judgment and empathy needed for traditional midwifery's nuanced and intimate role.
Ego and Misalignment with Tradition:
Some younger midwives, influenced by competitive training environments, may prioritize professional advancement over the relational aspects of care. This mindset contrasts sharply with the humility and patience central to traditional midwifery.
Adopting Obstetric Practices:
The pressure to align with obstetrics can lead young midwives to rely on interventions and frequent attempts at controlling labor, diluting the naturalistic essence of midwifery.
TRANSFORMATION OF TRADITIONAL PRACTICES
From Holistic to Procedural:
Practices such as honoring the laboring mother's natural rhythms, using natural pain-management techniques, and engaging the family unit have been sidelined. In some cases, midwives are indistinguishable from OBs in their approach to time management and delivery goals.
Institutional Constraints:
Midwives operating within hospitals are often subject to policies that limit their autonomy, forcing them to adhere to institutional protocols rather than individualized care.
WHY THIS MATTERS
The commercialization and professionalization of midwifery, while bringing certain advancements in safety and accessibility, risk eroding the heart of the practice. The shift to an OB-like model and the focus on credentialing exclude traditional wisdom and lead to a loss of diversity in care approaches. Midwifery needs experienced, intuitive practitioners who see birth as a holistic event rather than a clinical task. Re-centering the craft around its traditional roots, while integrating safe modern practices, is essential for preserving its integrity.
REGULATORY CONTEXT
Pennsylvania licenses nurse-midwives and, as of Act 14 of 2026, certified midwives. Cardinal Birth is not in those licensed categories. Traditional midwives are not licensed by Pennsylvania, and families who hire them are choosing this model with that disclosed.
WHAT CAN BE DONE
Families can choose their own support system, learn from traditional birth knowledge, invite trusted individuals into their birth space, practice their faith and traditions in pregnancy and birth, and take responsibility for their decisions outside the licensed system.
Advocacy: Communities, particularly in rural or underserved areas, can advocate for transparent and inclusive policies that respect families and traditional birth work.
Midwifery is not just a medical profession; it is also a cultural and community-centered craft that deserves protection from erasure caused by overmedicalization and strict credentialing.
BOOKS
In the Way of Our Grandmothers: A Cultural View of Twentieth-Century Midwifery in Florida by Debra Anne Susie, University of Georgia Press.
This book details the cultural and historical significance of midwifery in African American communities in Florida, including the impacts of medicalization and licensure on traditional midwives.
Birth as an American Rite of Passage by Robbie E. Davis-Floyd, University of California Press.
Granny Midwives and Black Women Writers: Double-Dutched Readings by Valerie Lee, Routledge.
A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812 by Laurel Thatcher Ulrich, Vintage Books.
CITATIONS
Susie, Debra Anne. In the Way of Our Grandmothers: A Cultural View of Twentieth-Century Midwifery in Florida. University of Georgia Press.
Davis-Floyd, Robbie E. Birth as an American Rite of Passage. University of California Press, 1992.
Lee, Valerie. Granny Midwives and Black Women Writers: Double-Dutched Readings. Routledge, 1996.
Ulrich, Laurel Thatcher. A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812. Vintage Books, 1991.