Regulating the Midwife: Power, Public Health, and the Decline of Traditional Midwifery in West Virginia, 1881-1929.

This historical policy analysis centers on how early maternal and child health (MCH) efforts affected the practice and decline of traditional midwifery in West Virginia. From the emergence of official government action in MCH with the establishment of the West Virginia Board of Health in 1881, through the federal Sheppard-Towner Maternity and Infancy Act of the 1920s-the nation's first large-scale attempt at making the provision and improvement of MCH issues a national priority-West Virginia transformed childbirth practices by increasingly regulating, professionalizing, and ultimately marginalizing traditional midwives. As the West Virginia case shows, the intersection of state and federal public policy and professional power attempted to improve maternal and infant outcomes, which often led to policies reducing autonomy and numbers of midwives. The West Virginia experience reflects wider US trends in the early twentieth century, showing that public health programs and physician-led campaigns combined to reform who was authorized to attend births. West Virginia's history exemplifies the dual nature of MCH legislation in the early 1900s, bringing much-needed resources and attention to maternal and infant health, but accelerating the decline of midwifery through regulatory oversight and the medicalization of birth, frequently leaving communities without skilled expertise in pregnancy-related care.