Beginning in the mid-19th century, doctors’ desire to obtain a monopoly on childbirth care led them to voice opposition to midwives. These attacks escalated substantially in the early 20th century. Recent waves of immigrants had swelled the ranks of midwives and made them more visible and threatening to doctors, whose status, especially in obstetrics, remained low. Moreover, doctors now needed the business of poor women as well as wealth- ier women because the rise in scientific medical education had created a need for poor women patients who could serve as both research subjects and training material.
To expand their clientele, doctors attempted through speeches and publications to convince women that childbirth was inherently and unpredictably dan- gerous and therefore required medical assistance. In addition, doctors played on contemporary prejudices against immigrants, African Americans, and women to argue that midwives were ignorant, uneducable, and a threat to American values and that midwifery should therefore be outlawed. For example, writing in the Southern Medical Journal, Dr. Felix J. Underwood, the director of the Mississippi Bureau of Child Hygiene, described African American midwives as “filthy and ignorant and not far removed from the jungles of Africa, with its atmosphere of weird superstition and voodooism”.