Obstetrical authority

“It is certain that the relevant health conditions were not improving in those areas where the midwife was first being superseded. . . . Rather, the obstetricians triumphed because, before the public health programs became firmly established in the public mind, the obstetrician gained tremendous advantages from other sources. Immigration decreased significantly during the war and was afterwards reduced legally to a small fraction of the numbers experience just before the war. . . concurrently the economic problem [of competition] per se was greatly reduced. This did not occur simply because of the ‘prosperity’ of the 1920s . . . rather the secular trend towards limitation of family size accelerated to include nearly the entire population. . . . With the limitation of births, it is possible that pregnancy and anticipated delivery seemed sufficiently rare to be generally equated with major operations and worthy of great expense. The other secular shift . . . was a new, general demand for improved obstetrics. . . Also responsible was a growing public demand from women, who were becoming increasingly self-conscious about their own welfare, and who were still infected with the reforming zeal of the Progressive Era . . .” (Kobrin, 362-3).