MIDWIFERY. Midwifery has a long history in Texas. Midwife-attended delivery was the custom among most indigenous Indian and Mexican populations. Throughout the nineteenth century Anglo and black women also depended upon local midwives or neighbor women for care during childbirth and the postpartum period. As late as 1900 more than half of all births in Texas were attended by midwives. In 1924 a State Bureau of Child Hygiene survey estimated that at least 4,000 midwives were practicing in Texas. They were usually older women who learned their craft through apprenticeship with other midwives. Most served rural populations, especially in the eastern and southern part of the state. In some counties midwives attended as many as two-thirds of all births. One black midwife in Harrison County attended 1,000 births in her twenty years of practice. The Bureau of Child Hygiene survey recognized that, despite some serious problems, midwives provided necessary services in many communities. Midwife practice was traditionally a combination of "letting nature take its course" and assisting the mother with emotional support and a variety of home remedies and herbals. For example, lavender tea or wasp-nest tea was sometimes used to strengthen uterine contractions; tourniquets were used to stop hemorrhages; mescal or pepper tea was given for "after pains"; and sometimes an ax was placed under the woman's bed to "cut the pain" of childbirth.
As more Texans moved to urban centers and as physician-attended hospital births became common practice, the number of births attended by midwives decreased drastically, especially among black and Anglo populations. A concerted effort to eliminate "the midwife problem" occurred between 1910 and 1930, as physicians attempted to standardize practice and to raise the status of obstetricians. Although research revealed the reverse to be true in the early 1930s, many physicians and increasing numbers of the general public believed that infant and maternal mortality rates were higher for midwife than physician attended births. But some public health officials believed that properly trained midwives could help reduce mortality rates. Supporters contributed to the passage of the Sheppard-Towner Maternity and Infancy Protection Act of 1921, which mandated that hygiene training for midwives be conducted by public health nurses and other health professionals, but the act expired in 1929 without being renewed. By the early 1970s fewer than 1 percent of recorded births in the United States were attended by midwives. In Texas in 1970, 1,500 registered midwives delivered only 2.3 percent of all live births. Parteras, Mexican-American midwives, still attended a significant percentage of all births in Hispanic communities, especially in the lower Rio Grande valley and in El Paso County. In 1978 two-thirds of the 7,500 midwife-attended deliveries in Texas were of Spanish-surnamed women.
Midwifery in Texas changed in the 1970s. Certified nurse midwives, registered nurses with special training in normal childbirth, certified by the American College of Nurse Midwives, began to provide maternity services for certain indigent groups. The first CNM maternity service in Texas was established by Sister Angela Murdaugh in 1972 at Su Clínica Familiar-an outpatient migrant clinic in Raymondville. Soon the clinic attended 80 percent of all births in Willacy County and dramatically improved the health of hundreds of mothers and babies. The success at Su Clínica Familiar was followed by the establishment of other CNM clinics and several hospital midwifery services. In 1985 the Midwifery Section of Baylor College of Medicine, which serves women at Jefferson Davis Hospital, opened the first nurse-midwifery training program in the state. Texas midwives have established two professional organizations: the Consortium of Certified Nurse Midwives and the Association of Texas Midwives. Another development since the early 1970s has been the reappearance of empirically trained lay midwives among the non-Hispanic white population. New midwives organized midwifery practices in both rural and urban areas, for example with the Austin Lay Midwives Association in 1974. They attend home births, provide childbirth education, and train prospective midwives.
Midwife practice has always been legal in Texas. In 1956 midwifery received sanction in case law when the Texas Court of Criminal Appeals ruled that the practice of midwifery did not constitute the practice of medicine without a license. The court reasoned that assistance with childbirth, a "normal function of womanhood," was not included in the states' statutory definition of medical practice as the treatment of a "disease, disorder, or deformity." Two subsequent decisions of the attorney general have reaffirmed the legitimacy of midwife practice. Certified nurse midwives are regulated by the Board of Nurse Examiners under the Nurse Practice Act. In 1983 the Sixty-eighth Legislature enacted the state's first lay-midwifery regulation bill, which requires the health department to offer voluntary training to lay midwives and specifies certain aspects of lay-midwifery practice. Brownsville and El Paso passed municipal ordinances in 1977 and 1979, respectively, which require training and certification of the local parteras. In 1984 CNMs attended 3,906 births or 1.3 percent of the total live births in the state, and lay midwives attended 8,164 or 2.7 percent of all live births.
Raymond G. DeVries, Regulating Birth: Midwives, Medicine, and the Law (Philadelphia: Temple University Press, 1985). Judy Barrett Litoff, The American Midwife Debate: A Sourcebook on Its Modern Origins (New York: Greenwood, 1986). Judy Barrett Litoff, American Midwives: 1860 to the Present (Westport, Connecticut: Greenwood, 1987). Stephanie Ortman-Glick, "A Look at Lay-Midwifery in Austin, Texas," Journal of Nurse-Midwifery 22 (Winter 1978). Janet M. Schreiber and Loralee Philpott, "Who Is a Legitimate Health Care Professional?" in Modern Medicine and Medical Anthropology in the United States-Mexico Border Population, ed. Boris Velimirovic (Washington: Pan American Health Organization, 1978).