Midwifery is a modern profession with ancient roots. Curious about the history of midwifery in nursing and how the practice of birthing care has evolved over millennia? Whether you’re a nursing student, labor and delivery nurse, nurse midwife, or just curious, below is a brief timeline of midwifery as a practice and profession.
Birthing care sits at the intersection of sometimes opposing powers. Midwives seek to care for pregnant and birthing patients, yet the culture and structures they work within often disempower women and marginalized people. Nursing and midwifery have intertwining evolutions — both began as community-based, informal care practices that have evolved into professions requiring specialized training and credentials.
If you’re interested in pursuing a career in birthing care, your skills will be in demand. The World Health Organization estimates a shortage of more than 2 million midwives and 29 million nurses by 2030. For more insights, learn more about the history of nursing and how to become a certified nurse midwife (CNM).
A History of Midwifery in the World
Prehistory to the Middle Ages
Midwifery began not as a job but as a necessity for survival. In the Paleolithic era (40,000–2000 BC), pregnant women supported themselves during labor. They used techniques like squatting, cutting umbilical cords, breastfeeding, and making safe spaces for newborns. Herbal and environmental knowledge was essential for hygiene and pain relief. It’s likely that women gained these techniques from observing others and learning within their communities.
Between 2200 and 1700 BC, also called the Biblical era, midwifery was a respected practice for women. They performed vaginal exams, managed breech births, and began the use of birthing stools — a tool that continued to be in use for 3,300 years. Midwifery was a religious and cultural practice, as well as a tool for social justice, as midwives supported women and families of lower status.
Egyptian midwives of 3500–100 BC expanded clinical knowledge. They could determine due dates, understand labor acceleration, and use herbal remedies. The Greeks of the Greco-Roman era (500 BC–400 AD) saw midwifery as a paid vocation, with skills passed down through female experts. Towards the end of this era, midwifery became more subject to oversight by male physicians.
The Byzantine era of 400–600 AD saw the first midwifery hospitals fully operated by women. But during the Middle Ages, Christianity had a heavier hand, and midwives had to be endorsed by the church to practice. Midwife training was limited or absent, and male physicians gained more power.
Women were increasingly being excluded from birthing care during this time. In the 12th–16th centuries, midwives in some areas were accused of practicing without formal training, and many were even accused of witchcraft.
The Evolution of Modern Midwifery
The 17th and 18th centuries saw the solidification of institutional medical training and birthing care. Surgical instruments were developed, and male barber surgeons were in charge of risky and dangerous births. Towards the end of this period, male midwives became increasingly common, under the title of obstetricians.
Between the 19th century and now, midwifery has transformed alongside nursing and medicine at large. Obstetrics developed as a formal medical specialty, and much of childbirth moved from the home to the hospital bed. Medical interventions were increasingly relied on, leading midwives to be marginalized in the West.
The feminist movement in the 20th century pushed for more autonomy in childbirth, and midwifery was emphasized as an essential element of holistic birthing care. Midwifery was increasingly recognized as a practice that improved both maternal and fetal outcomes, and regulations and training around midwifery grew more structured.
Today, most high-income countries require a specialized degree in midwifery in order to practice. Iceland, Sweden, the United States, and others require an undergraduate degree in nursing, as well as a postgraduate midwifery degree.
Throughout the history of midwife practice, midwives have faced marginalization and condemnation. Their position was often socially vulnerable, yet they saw a job that needed to be done and rose to the occasion for their communities. They often served as healers, nutritionists, doctors, and spiritual advisors. Some scholars even call midwifery the first holistic profession.
A History of Midwifery in America
In the United States, midwives of the 18th and 19th centuries were often enslaved women referred to as Granny midwives. They typically did not have a way to record their work, passing down practices through word-of-mouth. Their labor and expertise were used by enslavers to protect their “property.”
Granny midwives were paid only in rare cases. George Washington recorded paying his enslaved midwife $12 to $15 per year. In the same period, white midwives were paid about $10 per delivery, and the profession offered a rare means of financial independence for some women.
After the Civil War, African American communities relied on Granny midwives as a point of care. They served as spiritual leaders and healers and were deeply embedded in their communities.
As male-dominated obstetric and gynecological medicine emerged in the 19th and early 20th century, more men were involved in overseeing births, particularly in hospitals. This medical establishment rapidly passed new laws requiring licensure for midwives, painting them as uneducated and dangerous.
In the 1920s, White midwife advocates established education pathways to work in the hospital setting, but these excluded non-White midwives. Midwives of color did not gain broad access to training and education until hospitals were forced to integrate in the 1950s.
Leaders like Mary Breckinridge made strides in improving rural birthing care and training during this time. By 1958, her Frontier Nursing Service had delivered over 10,000 babies with a maternal death rate far better than the national average at the time. She also founded one of the first graduate schools for midwifery, now known as Frontier Nursing University.
The health rights movement of the latter 20th century led people to expect more autonomy in their medical care. It coincided with a push to demedicalize life events like childbirth and dying, and in the 1970s, women’s groups pushed for less hospitalization and physician supervision in birthing care unless necessary.
There was a deepening sense of crisis around birthing care in the 1980s. The American Academy of Family Physicians issued its first formal statement against midwifery, stating that midwives should only be able to work under physician supervision, and that all payments should be made to physicians only. At the same time, midwives faced barriers in securing professional liability insurance in order to practice.
In the 1990s, the first Professional Midwifery Practice Act was signed into law in New York, defining the practice of midwifery and creating a board of midwives for professional regulation. Nurse midwives gained prescriptive authority in many more jurisdictions, and federal law required all state Medicaid programs to pay for midwifery care.
In the U.S. and around the world, midwives have made great strides in evidence-based practice. Midwife-led care is associated with a lower risk of unplanned interventions, shorter hospital stays, lower infection risk, and fewer complications for newborns.
Still, birthing care is heavily politicized. Certain groups are at much more risk when giving birth than others — Black women face more than triple the mortality rate of White women. And Black midwives make up only about 7.3% of all nurse midwives in the U.S. While birthing care has certainly come a long way, the United States still has far to go to provide equitable birthing care for all.
A History of Midwifery: Timeline Overview
40,000–2000 BC: Women gave birth independently, using practices learned in their communities.
2200–1700 BC: Midwifery emerges as a respected women’s practice.
3500–100 BC: Egyptian midwives gain understanding of due dates, herbal remedies, and more.
500–400 BC: Greeks have paid midwives, with more oversight by male physicians.
40–600 AD: The first birthing hospitals are fully operated by women.
400–1400 AD: Midwives have to be endorsed by the church, with increasing medicalization and even accusations of witchcraft.
1500s: The first midwifery manuals are published.
1700s: Forceps are invented, increasing a shift towards male midwives (obstetricians).
1800s: Professional medicine is on the rise, and traditional midwifery declines.
1900s: The Midwives Act becomes law, and the Central Midwives Board is created in the UK.
1920s: White midwives in the U.S. establish formal education pathways to hospital-based work, excluding people of color.
1950s: Hospitals are forced to integrate, and Black midwives are allowed into practice.
1970s: Women’s groups in the U.S. increasingly argue for de-medicalized birthing care and more home births.
1990s: The first Midwifery Practice Act is signed into law in New York. Federal Medicaid law requires all states to pay for midwifery care.
Get Involved in the Continuing History of Midwifery
Credenza can help you find a role you’re passionate about. Whether you’re interested in postpartum care, labor and delivery, neonatal nursing, or a different specialty entirely, learn more about personalized job notifications that alert you to job opportunities that fit your interests.