The growth of man-midwifery in Philadelphia and its environs, 1765--184

During the middle of eighteenth century male physicians attempted to displace female midwives and clinical instruction in midwifery played a crucial role in the growth of the field. William Shippen, Jr. started the first American course for midwifery instruction and utilized poor women as clinical training objects. He also served as the first chairman of the department of anatomy, surgery, and midwifery for the newly established medical school in Philadelphia.;The 1790s marked a turning point for the growth of man-midwifery in Philadelphia and the decline in republican civic humanism. Physicians and other elite white men made self-interested decisions that were contrary to the interests of poor pregnant women. Thomas James convinced the board of the Philadelphia Almshouse to allow him to utilize almshouse residents as clinical subjects for his private midwifery course. After the almshouse established a lying-in ward, the Pennsylvania Hospital followed with its lying-in ward. James took charge of both lying-in wards and his subsequent appointment as chairman of the newly independent department of midwifery at the medical school represented the most significant step in growth of midwifery instruction.;In 1813 the medical school made midwifery instruction mandatory for its medical degree. The number of physicians practicing midwifery doubled in Philadelphia and promoted the spread of man-midwifery to its environs. As the need for clinical subjects increased, the Philadelphia Dispensary established an obstetrical department and appointed Joseph Warrington as chief of the department to attend to the poor pregnant women in their own homes. Warrington took this opportunity to start his classes in man-midwifery. He also established the first school of nursing for the instruction of women as obstetrical assistants. Warrington exemplified the self-interested individualism of the 1830s and reinforced the trend towards using women as assistants rather than as active participants in normal deliveries.;Poor pregnant women were largely powerless once they agreed to the services provided in the institutions for the poor. As a result of racism, poor African American women had even fewer options in their parturient care and in infanticide cases. Race, gender, and class were important factors in the growth of man-midwifery.