With Wisconsin Women: Midwives in the Badger State
- About the Exhibition
- Mary Gerrard
- Regulations & Licensing
- Midwifery in 20th Century Wisconsin
- Professional Designations
- About the Curator
About the Exhibition
From April 23 to July 31, 2007, "With Wisconsin Women: Midwives in the Badger State, Late 1800s to the Present" was on display in the Historical Reading Room of Ebling Library. A complement to the Smithsonian exhibit "Reclaiming Midwives: Stills from 'All My Babies,'" "With Wisconsin Women" highlighted significant events in local midwifery practice. The exhibit featured artifacts, photographs, and government documents generously loaned from the Wisconsin State Historical Society, Ebling Library, and from private collections.
This online exhibit is a small representation of the history, artifacts, and lives of Wisconsin midwives during the past one hundred years.
Exhibition developed and arranged by guest curator, Kala R. Kluender.
The word "midwife," in Old English, means "with woman." Traditionally, the label is applied to those who assist women during childbirth. A more contemporary use of the term describes midwives as healthcare providers who focus on women's health before, during and after healthy pregnancies.
The 1909 Midwife Practice Act was the first legislation to officially regulate midwives statewide. It required all midwives to apply and test for professional licensure from the Wisconsin Board of Medical Examiners. Subsequent years saw a rise in the social authority and professional status of medical practitioners, and physicians began to replace midwives as childbirth attendants. The prevalence of midwifery practice continued to decline throughout the early twentieth century, and in 1953, the law that allowed for new midwife license acquisition was repealed.
Recent renewal of interest in midwifery has been attributed to a combination of social and political movements in the late 1950s and 1960s, along with heightened awareness of increasing healthcare costs. Wisconsin legislature enacted a law in 1979 that again permitted the certification of nurse-midwives. On April 10, 2006, Governor Jim Doyle signed the Midwife Licensing Act 292, establishing a second means to midwifery licensure in Wisconsin that does not require training as a nurse.
In the late 1800s, Wisconsin midwives attended births much as they had throughout history. Valuable knowledge of the birthing process was gained largely from experience due to remote or isolated settlements. The birth log of one particular midwife, however exceptional her practice, provides a glimpse of midwifery at the time.
Mary Gerrard was born in Luxembourg, Germany and emigrated to the U.S. in 1872. She attended a three-month training course at the Northwestern Academy of Midwifery in Chicago and practiced midwifery in the St. Joseph's Ridge, WI area before moving to La Crosse with her husband and five children in 1884.
Courtesy of UW - La Crosse, Murphy Library
Notice sign advertising midwife services.
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Gerrard's Birth Log
In her birth log - a rare surviving record in the field - Gerrard noted the name of the baby's father, the date, and the amount she was paid by the family from 1878 to 1912.
Her very active, full-time practice was unusual at that time as midwifery was not typically the primary source of income for most families. An analysis of the birth log reveals between 1878 and 1883, she attended an average of 28 births per year. In 1894, however, she achieved a career high of 202 births in the La Crosse area. She received about $3 per birth, although the amount fluctuated considerably throughout her career.
Gerrard's Birth Log.
Courtesy of the Wisconsin Historical Society, La Crosse, SC 28: WHi-48154
Regulations & Licensing
The 1909 Midwife Practice Act required midwives in Wisconsin to obtain professional licensure from the Medical Board of Examiners. The applications illustrate the various educational and ethnic backgrounds as well as geographic locations of midwives in Wisconsin.
Midwives seeking certification after 1909 needed to graduate from a formal school of midwifery and had to pass an exam administered by the Medical Board of Examiners.
The examination presented problems for prospective, non-English speaking immigrant midwives. Several applicants provided documentation of midwife certification from their country of origin. An important exception to the Act allowed midwives already in practice to be exempt from the educational requirements and exam - they received their licenses for a $5 fee if their application was approved.
In 1923, new Wisconsin midwifery laws prohibited practice without registration. Applicants for licensure had to fulfill the same requirements as outlined in the 1909 Act, receive approval from six members of the State Board of Medical Examiners, and register in their respective county of practice. Certification as a midwife under this law disallowed the use of any instruments and also did not permit midwives to grant medical or death certificates.
The Milwaukee School of Midwifery was founded in 1879 by Wilhelmine Stein, a German immigrant who trained at the Midwifery School at Anstedt, as well as doctors Alphonse F. Kalckhoff and Charles Betzell. The school appealed to the substantial German-speaking community in Milwaukee and appeared to emphasize experiential learning.
Early applications for registration with the State listed attendance at this school for four to six months, though within a few years nine month program durations were more common.
The Wisconsin College of Midwifery opened in 1885 under the direction of three physicians. It also offered classes in both German and English languages, and was later under the administrative direction of midwife Mary Klaes. The school was re-named in 1889 as the "Wisconsin College of Midwifery and Lying-In Hospital," and in 1901 began to be referred to as "St. Mary's Private Sanitarium."
Both the Milwaukee School of Midwifery and the Wisconsin College of Midwifery were in operation for about 20 years, and together were responsible for the majority of the training cited by midwives during their registration in the late nineteenth century.
Midwifery in 20th Century Wisconsin
Midwives continued to be licensed in Wisconsin until 1953, when certification of new midwives was discontinued. A new law in 1979 stated that certification as a midwife required training as a nurse, fee payment, and practice in a healthcare facility or under a formal written agreement with a physician supervisor. Non-nurse midwives unsuccessfully attempted to establish self-accreditation in the 1980s by writing a "Program for Certification" and granting certificates of Lay Midwifery.
In 1983, the first Midwives Alliance of North America (MANA) conference was held in Milwaukee, WI.
In 2002, Wisconsin Assembly Bill 725 changed the definition and standards of practice of a "nurse-midwife" to those used by the American College of Nurse-Midwives (ACNM). Under this bill, certified nurse-midwives were granted prescriptive privileges, given insurance requirements, and defined to work in collaboration with - versus under the supervision of - physicians.
Most recently, on April 10, 2006, Wisconsin Governor Jim Doyle signed the Midwife Licensing Act 292 into law. In addition to Certified Nurse-Midwives (CNMs) and effective May 1, 2007, this law established a second means of obtaining midwifery licensure in Wisconsin: as a Certified Professional Midwife (CPM).
Certified Nurse-Midwife (CNM): requires a nursing degree, additional training in midwifery, and passing a national certification exam. Certified by the American Midwifery Certification Board, CNM's are currently licensed in all fifty states.
Certified Professional Midwife (CPM): requires that candidates meet the standards of knowledge and skill established by the North American Registry of Midwives. CPMs must also pass a national certification exam. A CPM is the only credential recognized internationally that requires experience in out-of-hospital settings. CPMs generally do not have backgrounds in nursing.
Direct-Entry Midwife (DEM): requires midwifery experience via self-study, apprenticeship, a midwifery school or a college/university-based program separate from that of nursing. DEMs are independent practitioners who usually provide care to healthy women and infants outside of hospital locations. They are also referred to as Lay Midwives, Traditional Midwives/Birth Attendants, Granny Midwives, and Independent Midwives.
Licensed Midwife (LM): can include any of the classifications listed above as licensed in a given state. In Wisconsin, this term describes CNMs and CPMs that are licensed under Act 292.
Doula: trained and experienced in childbirth, doulas provide continuous emotional and physical support to a laboring woman before, during and just after childbirth. The word "doula" comes from ancient Greek, meaning "woman's servant."
Midwives may use a number of different tools to monitor the fetal heartbeat and development. In the first half of pregnancy, modern midwives often use Doppler ultrasound. After 18-20 weeks gestation, a pinard horn may be reliably employed to assess the heartbeat and position of the fetus. The pinard horn has been used by midwives for centuries.
Made of wood, plastic, or aluminum, a pinard horn has a hollow core about the diameter of a pencil. It is through this opening that the sound of the fetal heartbeat travels from pregnant abdomen to naked ear. The flat end with a smaller opening is applied to the ear, while the wider, open end is placed on the abdomen. As the heartbeat sounds travel up through the cone, the flat opening at the top amplifies them. The sound of a fetal heartbeat through this instrument has been described as subtle, like a vibration felt with the ear.
(Artifact courtesy of Jane Crawford Peterson)
Today, many midwives continue to use the pinard horn in the second half of pregnancy in addition to the fetoscope. Similar to a stethoscope, the bell of a fetoscope is pressed firmly onto the pregnant abdomen, and the flat bar is held against the forehead of the person listening. The heartbeat is heard most clearly over the fetus' back. For this reason, the pinard horn and fetoscope, unlike Doppler ultrasound, can assist the midwife in determining the fetal lie and position. While the Doppler probe can trace a fetal heart echo from most positions on the abdomen, the pinard horn and fetoscope directly transmit the heartbeat. The sound quality and position of these tools indicate the direction the fetus is facing and whether it is vertex (head down) or breech (head up).
(Artifact courtesy of Ingrid Anderson)
Applications and Photographs
Applications and photographs of licensed Wisconsin Midwives can be found at the Wisconsin Historical Society Archives. The collection title is "Applications for midwifery licenses, 1909-1934," Series 1611.
For additional information, please contact the Archives Reference and Information Services.
While we cannot endorse any program or organization, additional information regarding midwifery training and organizations may be found on the following websites:
- American College of Nurse-Midwives (ACNM)
- Citizens for Midwifery (CfM)
- Midwives Alliance of North America (MANA)
- North American Registry of Midwifes (NARM)
- Wisconsin Guild of Midwives (WGOM)
- Borst, Charlotte G. "Catching Babies: The Professionalization of Childbirth, 1870-1920." Harvard University Press, 1995. MadCat
- Fiorenza, Mary. "Midwifery and the Law in Illinois and Wisconsin." Unpublished Univeristy of Wisconsin M.A. Thesis, 1985. MadCat
- Leavitt, Judith Walzer. "Brought to Bed: Childbearing in America, 1750 - 1950." Oxford University Press, 1986. eBook
"With Wisconsin Women" in the News:
- "State's Midwives Finally Get Their Day." Susan Lampert Smith. Wisconsin State Journal: A1. May 1, 2007.
- "Writer's Choice: Students use art, history to sharpen practical skills." Barbara Wolf. Wisconsin Week, May 9, 2007 (see p.13).
- Midwife Licensing Act 292
- "With Wisconsin Women" brochure
About the Curator - Kala R. Kluender
I approached Judith Walzer Leavitt (to whom I am deeply indebted for her continuous patience, advice, and mentorship) with a heightened interest in women's health history while enrolled in her course, "Childbirth in the United States," in the Spring of 2006. Ebling Library had just secured the Smithsonian traveling exhibit "Reclaiming Midwives" by Linda Janet Holmes for installation in April 2007. Professor Leavitt and I decided to create a complementary display of the history of midwifery in Wisconsin. Under the guidance and leadership of Micaela Sullivan-Fowler and Mary Hitchcock, Curator of the Historical Services Unit and Historical Services Librarian, respectively, the project evolved into an incredible interdisciplinary learning experience.
My research began and followed the work of Charlotte G. Borst. Her book, "Catching Babies," led me to the Wisconsin State Historical Society, where I gained access to century-old applications for licensure, Mary Gerrard's birth log, and other items I had not known existed on this subject. Selection of materials and the "science" of museum exhibit installation were also new to me, and I was grateful for the guidance of Sullivan-Fowler and Hitchcock. Their insight to human traffic flow, lighting, and aesthetic appeal of the space we worked with was integral. Given the subject matter and recent legislative decisions, we sought a balance between the presentation of accurate information and political neutrality. I was constantly aware of the significance of the exhibit's display within a building almost entirely devoted to the field of medicine. I felt the heavy responsibility of presentation to the public; historical and explanatory text, artifact descriptions, and background information had the potential to give first and lasting impressions to those who haven't had the opportunity to study the subject extensively, as well as receive criticism from others who have.
I am deeply thankful to Ingrid Andersson (CNM, MS), for her input, advice, as well as assistance in promotional efforts. Further thanks are extended to: Jane Crawford Peterson (CPM, LM), Ginnie Priest (CPM, LM), Gretchen Spicer (CPM, LM), Aszani Kunkler (CNM, MS), and Julie Olson Simani (MS, RN, CBE) for the items and information they provided.
I will graduate from the University of Wisconsin Madison in May, 2008 with a B.S. in Kinesiology, a second major in the History of Science, and a Certificate in Women's Studies. Largely due to my work with this exhibition, I have decided to pursue a career as a midwife and would ultimately like to practice, teach, and research within an academic setting.