Objections to such procedures sparked the growth of the natural childbirth movement during the 1960s and 1970s and forced numerous changes in obstetric practices. Most hospitals, for example, now offer natural childbirth classes. Critics, however, argue that the real purpose of these classes is to make women patients more compliant and convince them that they have had a natural childbirth as long as they remain conscious even if their doctors use drugs, surgery, or forceps.

By the late 1960s, many women had concluded that hospitals would never offer truly natural childbirth. As a result, a tiny but growing number of women chose to give birth at home. For assistance, they turned to sympathetic doctors and to female friends and relatives, some of whom were nurses. Over time, women who gained experience in this fashion might find themselves identified within their communities as midwives. This new genera- tion of direct-entry midwives who attend almost solely home births reflects the broader revolt against medicalized birth.

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Working as a direct-entry midwife means long and uncertain hours with little pay. Most midwives, however, are motivated by humanitarian and philosophical concerns rather than by financial gain. Although midwives recognize the need for obstetricians to manage the complications that occur in around 10% of births, they fear the physical and emotional dangers that arise when obstetricians use interventionist practices that were developed for the rare pathological case during all births. Like nurse–midwives, direct-entry midwives strongly believe in the general normalcy of pregnancy and childbirth and in the benefits of individualized, holistic maternity care in which midwife and client work as partners.


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