STRENGHTS OF MALE MIDWIVES IN INTRAPARTAL CLIENT CARE

Chapter 1
THE PROBLEM AND ITS BACKGROUND

Introduction

In ancient Egypt, midwifery was a recognized female occupation, as attested by

the Ebers Papyrus which dates from 1900 to 1550 BCE. Bas reliefs in the royal
birth rooms at Luxor and other temples also attest to the heavy presence of
midwifery in this culture (Jean, 1986). Midwifery in Greco-Roman antiquity
covered a wide range of women. It included old women who continued folk
medical traditions in the villages of the Roman Empire. ibid). Midwives are also
mentioned in the Old Testament: in Exodus, Chapter 1. The Bible describes how
the Egyptians became fearful because Israel (Hebrews) multiplied greatly.
Pharaoh, therefore, commanded the Hebrew midwives (named Shiphrah and
Puah) to kill all male babies delivered to the Hebrew women..“As such God dealt
well with the midwives” (Exodus, Chap. 1, verse 20).

The ancient occupation of midwifery was the exclusive domain of women. During
the time of Hippocrates (460 to 410 BC), it was thought that midwives in Athens
should be required by law to have had children themselves (Nicopoullus, 2003).

However, there were certain characteristics desired in a ‘good’ midwife. As

described by the physician Soranus of Ephesus in the 2nd century, he states in
Gynaecology that, “a suitable person will be literate, with her wits about her,
possessed of a good memory, loving work, respectable and generally not unduly
handicapped as regards her senses. The midwife be of sympathetic disposition
(although she need not have borne a child herself) and that she keep her hands
soft for the comfort of both mother and child” (Valerie, 1986).

There appears to have been three ‘grades’ of midwives present in ancient times.
The first was technically proficient; the second may have read some of the texts
on obstetrics and gynaecology; but the third was highly trained and reasonably
considered a medical specialist with a concentration in midwifery (Ralph, 1988).
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Historical Midwifery

However, not much is known about individual English midwives before the
fifteenth century, but mention is made in the Parliamentary Rolls for 1469 of an
annual pension of £10 (then a substantial sum) granted to Margaret Cobbe,
midwife to Elizabeth, Edward IV’s Queen. The midwife’s duties were
incorporated into the oath in England. Midwives swore under the licensing system
operated through the Church under an Act of 1512. As the sixteenth century
progressed, so the new Renaissance spirit of enquiry was applied by leading
surgeons to the anatomy of childbirth. Eminent among these pioneers was
AmbroiseParé (1510- 1590), a surgeon to four French kings and notable for his
use of podalic version. The fame of men like Paré, spread through the printed
word, in the vernacular rather than the traditional Latin, was to encourage male
attendance in childbirth, first in ‘extraordinary’ cases and later in routine ones
(Samuel, 1793).

This development gradually spread throughout Europe. It was boosted further

from the 1720s by the availability of the new midwifery forceps introduced in
England 3 by the Chamberlain brothers. Like other surgical instruments, they
belonged officially to the surgeon (Lewis, 1991). William Smellie, born in
Scotland in 1697, is credited with innovations on the shape of the forceps. He
delivered women fully draped, unable to see his own actions beneath the cloth,
and he encouraged his male students to wear dresses to births so to look like
women (Casssidy, 2006).

Men who were interested in attending childbirth became obstetricians. However,

there are clear accounts that man-midwives went to great extremes to respect
modesty and reduce embarrassment by all. Female childbirth attendants remained
practicing empirical midwifery. This is because traditionally, women were
excluded from educational institutions and thereby prohibited from using surgical
instruments.
 3

. This brought about new designations ‘Man-midwife’ in English, ‘Accoucheur’

in French, to refer to men who were usually surgeons and added midwifery to
their practice. This divided midwifery and obstetrics along gender and
philosophical lines for many years to follow (ibid). Many midwives of the time
bitterly opposed the involvement of men in childbirth. Some male practitioners
also opposed the involvement of medical men like themselves in midwifery, and
even went as far as to say that men-midwives only undertook midwifery solely for
perverse erotic satisfaction (ibid). Samuel Gregory cited in “Man-Midwifery
Exposed and Corrected, Boston, 1848,” states that, “Man-midwifery, with other
'indecencies,' is a great system of fashionable prostitution; a primary school of
infamy as the fashionable hotel and parlour wine

Midwifery began to change from a female art into a male occupation in the early
modern period. The shift was not a smooth one, it began in 1522, when Dr. Wertt
of Hamburg dressed up as a woman in order to observe midwives and learn about
childbirth. When he was discovered to be a man, Wertt was burned alive. Later in
the mid-sixteenth century, however, the renowned surgeon Pare laid a more solid
foundation for men’s work in the birthing room. He aided in delivering babies
during difficult birth by pulling them out of the womb by their feet. A major
contributing factor in this shift of gender roles was Louis XIV. He used male
midwives to deliver his illegitimate children. As men delivered babies of his
mistresses, male midwives gained more popularity. More especially, there was a
rapid population boom in Europe around this time which encouraged these social
changes. As the population grew, universities increased the study of reproduction
and anatomy. Childbirth not only became medicalized but also a masculinized
domain. Case studies, rather than oral tradition, became the preferred method for
educating individuals about childbirth (Schnorrenberg, 1981).

Workplaces are key sites which inform and influence social constructions of
gender. Although jobs are not dependent on the gender of a worker, perceived
notions of ‘women’s work’ like Teachers, or ‘men’s work’ like Engineer, and
Police that continue to prevail in work environments. Midwifery is a case in point
(Panopio, 2006). The nature of midwifery as a caring occupation has produced its
constant association with women. Gendered assumptions of the division of labor
significantly segregate the labor market (Cross and Bagilhole, 2002) and for
midwifery, it has translated into the fact that women make up the majority of
midwives in all countries.
 4

According to an article (Philippine Charrier 2011) study shows that of

19,208 midwives polled in France in 2010, 349 were men. Male midwives assert
their masculinity by seeking autonomy in their work. They are able to work
around the obstacle of showing empathy to female patients, typically considered a
gendered predisposition. The case of male midwives shows the dynamics of
masculinization when taking into account socio-professional contexts.

According to Sherrod(Sherrod and Rasch, 2006), there is a need to explore

why midwifery has yet to break the gender barriers that other professions have
been successful at addressing.

Background of the Study

In a gendered work division of society caring and child birth delivery is

often performed by women. (Elwer, 2013) Kari Waerness (1983) has explored
caring from the horizon of rationality. She argues that responsibility for caring
and birth delivery ascribed on the basis of gender and is intertwined with the
formation of “femininity”. Contrasting to the rationality of caring is the scientific
rationality which is emotionally neutral, formal and aimed at curing or improving
the health of the patient.

Presence of men in midwifery has been conceptualized in very different

ways in theories that go beyond perceptions of identity and the social construction
of gender. In keeping with the belief that domination is central, Williams (1989)
shows substantial benefits of this situation for men, notably with respect to
internal hierarchy. She defends the notion of the “glass escalator.” Men guarantee
themselves a high profitability in their career advancements, which leads in turn
to holding dominant positions in these careers. This dynamic entails side-benefits
for men that have traditionally feminine careers. One observes a two-fold
advantage: men work in fields of specialization that plays to their strengths, and
are also typically better financially compensated.

The situation of men in healthcare professions has been well-researched in

France, as in Anglo-Saxon countries. Studies of male midwives are all but
nonexistent. Only Bagihole and Cross (2000) address the case of the male
midwife. The authors, concentrating on obstacles encountered by the gender
minority, put the male midwife in a “mixed” category. The male midwife
positions himself in competition with his female colleagues, which is proof that
 5

he has not totally relinquished their masculine power, all the while keeping a
distance from definitive masculine traits. Nevertheless, this might be generalizing
the situation. Despite of undoubted significance, these theoretical patterns are
limited when taking into consideration the presence of men and the
masculinization of the midwife profession, indeed for two reasons. On the one
hand, men entered into the field after professional evolutions that affected all
French midwives. Most of the studies referenced here do not take into
consideration the professional dimension; their arguments start from the point of
view of men issued from professional heterogeneous backgrounds. On the other
hand, this masculinization importantly refers to the concept of empathy, as a
supposed handicap. Female midwives have always claimed to have a
predisposition or specific ability to “put themselves in the place of the women in
labor,” because they are female. They supposedly know best how to accompany
women through the birthing experience. Empathy is a veritable “gender capacity”
(Schweyer, 1996), a capacity acquired though feminine socialization and the lived
experience of giving birth. This empathy is presumed despite the fact that many
midwives, especially the youngest ones, practice without having given birth
themselves. The latter essentially occupy the same position as male midwives,
except that they are attributed a maternal power (Jacques, 2007). Empathy must
also be understood as a widespread social representation, historically tying
women to the role of accompaniment (Gélis, 1984, 1988; Knibiehler& Fouquet,
1977). The capacity for empathy, then, remains a criterion in the evaluation of the
work of midwives, even where not explicitly discussed.

The researchers, who were used to work in a lying- in clinic, have noticed
the presence of male midwives in the clinic. In this case, it proves that patients
and some sectors accepted the work of male midwives. However, some sectors
including conservative families, upon inquiry, do not incline and subscribe to the
acceptance of male in midwifery profession. Despite of such negative comments,
these sectors openly agree to the high leadership and skills of male midwives
which we, researchers, also subscribed to.

The researchers want to explore and learn deeper the strengths of male
midwives on their individual qualities that makes them effective as midwives.
Understanding these individual strengths manifested by male midwives will
provide opportunities to build on and develop.
 6

Theoretical Framework of the Study

Kanter Theory on Tokenism

Tokenism is the policy and practice of making a perfunctory gesture

towards the inclusion of members of minority groups. The effort of including a
token employee to a workforce usually is intended to create the appearance of
social inclusiveness and diversity (racial, religious, sexual, etc.), and so deflect
accusations of social discrimination. Typical examples of tokenism are purposely
hiring a black man or woman in an occupation usually dominated by white
people, or hiring a woman in a profession usually dominated by men.

In her work on tokenism and gender, Kanter said that in occupations

traditionally viewed as female-dominated, men have been shown to be affected by
their status as tokens. In a study of a hospital with both male midwives and female
physicians as minority groups, both experienced the effects of being
tokens. However, male midwives reported more positive effects than did female
physicians, indicating that proportions alone are not responsible for the negative
aspects of being a token. While male midwives’ experience heightened visibility,
they are more often mistaken for physicians or nurses than are female midwives,
despite wearing a midwife uniform. Male midwives are also considered to be
more knowledgeable on the mechanics of the body than female midwives are, and
are more often assigned leadership roles that they are not qualified for.

In addition to this, Kanter explained three perceptual tendencies of

tokenism, namely heightened visibility, contrast and assimilation. Heightened
visibility can be described as occurrences wherein a token might stand out from
the dominant group. The author stressed that increase visibility can result in
greater notice either of mistake or accomplishment of token (either for both
gender). Another, contrast perceptual tendencies usually occurred when the
dominant group members exaggerate their similarities with one another and their
differences with the token group. Social ties or social isolation of either both
gender may be experienced in relative to this context. Contrast also pointed out
equality issue between male and female staff midwives. Interaction process for
contrast tendency either may lead to increase career opportunity while hindering
the other’s gender career. Lastly, assimilation is defined as the assignment of
gender-specific traits to a token. Stereotype regarding to general expectation on
either gender can be associated to a better worker or a more competent one.
Differences between male midwife characteristics versus female midwife
characteristics have different consequences on each gender role. For example,
male midwives can be seen as better worker as the peers, supervisors and patients
 7

perceived them as with authority, more competent and good leadership. Though
midwife is a ‘female occupation’, less emphasis were given to female expected
traits such as: nurturance. Aside from this, no specific expectation characteristics
were established for female midwives. To this end, the power of tokenism is that
the three perceptual tendencies accentuate the influence of status characteristics
on gender over individual characteristics. This is much likely to happen; if the
importance of expectation on each gender is much stressed.

Statement of the Problem

The main objective of this study is to determine the leadership and

communication skills of male and female midwives.
Specifically, it sought answers to the following questions:

1. What are the self-assessed leadership skills of male and female midwives
respondents?
2. What is the assessment of the patient respondents on the leadership skills
of the male and female midwives respondents?
3. Is there a significant difference on the leadership skills of male and female
midwives respondents?
4. Is there a significant difference on the self-assessed leadership skill of
male and female midwives respondents, the assessment of patients on their
leadership skills of the male and female midwives?
5. What are the self-assessed communication skills of male and female
midwives respondents?
6. What is the assessment of the patient respondents on the communication
skills of the male and female midwives respondents?
7. Is there a significant difference on the communication skills of male and
female midwives respondents?
8. Is there a significant difference on the self-assessed communication skill of
male and female midwives respondents, the assessment of patients
respondents on their communication skills of the male and female
midwives?
9. Based from the result of the study what paradigm shift can be proposed?
 8

Research Hypotheses
1. There is no significant difference on the self-assessed leadership skills of
male and female midwives respondents.
2. There is no significant difference on the self-assessed leadership skill of
male and female midwives respondents, the assessment of patients
respondents on their leadership skills of the male and female midwives.
3. There is no significant difference on the self-assessed communication
skills of male and female midwives respondents.
4. There is no significant difference on the self-assessed communication skill
of male and female staff nurses respondents, the assessment of patients
and head nurses respondents on their communication skills of the male and
female midwives.
5. There is no significant difference on the self-assessed work fidelity of male
and female midwives respondents.
6. There is no significant difference on the self-assessed work fidelity of male
and female midwives respondents, the assessment of patients respondents
on their work fidelity of the male and female midwives.

Significance of the Study

This study is significant for several reasons. To begin with, similar studies have
been done by some researchers before mostly with the medical background and
from the medical point of view. The problem is gender based hence the need for a
gender expert to exhume the notorious confounders of the problem for mitigation.
From the standpoint of traditional power it calls for the application of critical
epistemology. Carspecken (1996) described critical epistemology as an
understanding of the relationship between power and thought as well as power
and 7 truth claims (Kincheloe& McLaren, 2003). To achieve an understanding
between power, thought, and truth claims, there is need to examine the traditional
value orientations (Kincheloe& McLaren, 2003)

Most of the researchers concentrated in interviewing mainly women and in some

instances where men were interviewed, they were very few. Leaving out men in
this kind of a study is tantamount to leaving out leaders of social institutions who
mainly happen to be men

This study has identified entry points in institutions for bringing about change. It
has shown that the attitude is based on the perceptions of institutional culture and
bought out awareness to change agents that solutions to this problem require
institutional changes. It has also shown that gender sensitization and training that
 9

is reinforcing factors in institutions will bring about changes in the attitudes of the
rural communities towards male midwives. This study is justified in the sense that
it has brought out data that will be used to

Male midwives are being discriminated upon from performing the work of their
profession based on their sex. The study outcomes will add to the pool of
knowledge in gender.

The intention of this study is to determine the leadership and

communication skills and work fidelity of male and female midwife.

The finding of this research is addressed to the following sectors:

Male Midwives: understanding the research study; they will be motivated to

strive more as male midwife/tocologist in dedicating themselves in the
midwifery profession do so for strategic purposes and in the likelihood of
obtaining many advantages.

Female Midwives: this research will provide them understanding and

acknowledgement male midwifes in terms of their leadership and
communication skills.

Midwifery Schools: through the finding of this research, midwifery school would
be fair in accepting enrollees of both male and female midwives student.

Midwifery Students: this research will provide midwives student awareness and
inspire them to pursue their career in midwifery. Giving their time to
understand this study, they will appreciate the concept of value of male
midwives in midwifery profession.

Patients/Clients: through this research they will learn to appreciate male

midwives as a healthcare provider.

Future Researcher: the result of this study will serve as a basis in their future
related studies.
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Scope and Delimitations

The main objective of this study is to determine the leadership and

communication skills of male and female midwives and their work fidelity in the
midwifery profession. The study is guided by Kanter’s theory of Tokenism.
Questionnaires are based on the related literatures and made by researcher for
midwives on leadership and communication skills and work fidelity. The study
has 3 respondent’s namely male midwives, female midwives and patients. Male
midwives will have their self-assessment and will be evaluated by patients.
Purposive sampling will be used to determine the sample. The study will covers
selected tertiary hospitals and lying- in in NCR. There would be 10 male
midwives and 10 female midwives to each hospital and lying-in from the age
group 20 years old up, to 50 years old with three years working experience and 20
patients under the care of the male and female midwives. Gathering of data will
be done through questionnaire. Statistical Analyses of the study will be based on
statistical treatment of data. The study will be conducted within one to two
months of the Academic Year 2018-2019.

Definition of Terms

Communication – exchange of thoughts and ideas, gather information and used

to establish relationship.
Empathy – means putting yourself in another person’s place.
Leader – A person that motivate, inspire, support and influence others towards
clear goals.
Leadership – Is commonly defined as a process of influence wherby the leader
influences others towards goal achievement
Motivation – is the force within the individual that influences or directs behavior.
Work Fidelity – commitment to duties and responsibilities to work.
Tocology– Male midwife
Tokenism - is the practice of making only a perfunctory or symbolic effort to be
inclusive to members of minority groups
Patient - a sick individual that needs medical attention under the care of
healthcare providers
Stereotype – A widely held but fixed and oversimplified image or idea of a
particular type of person or thing.
Attitude - The way community regards male midwives Community: The people
living in a particular area or location.
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Gender - Refers to those social, cultural, and psychological traits linked to males
and females through particular social contexts.

Gender roles - The expected attitudes and behaviors a society associates with
each sex.

Midwife - A person educated, trained and certified to care for pregnant mothers
during pregnancy, labor and after delivery.

Knowledge - The information that pregnant women have on the activities of a

male midwife. Traditional beliefs: A strong feeling about what customs say.
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Chapter II: Literature Review

Introduction

The chapter focuses on the review of readily available researched information in

the past, relevant to the current study. The need for further research arises due to
gaps revealed in the previous researches. The studies under review are the history
and modern midwifery; unique contributions, facing rejection and steps to
success. The global perspective of midwifery outside Africa is also reviewed by
looking at the United Kingdom, the United States of America, Japan, Canada,
China and Australia. The African perspective is as well reviewed by focusing on
Cameroon, Ghana, Liberia and South-Sudan. The regional perspective is reviewed
under The East, Central and Southern African Health Community (ECSA-HC) by
looking at Uganda and Zimbabwe. The national perspective takes in both
substantive and research reports from all over the country Zambia.

History

History tells us that the ancient occupation of midwifery was the exclusive
domain of women.Women have helped each other in childbirth from time
immemorial; indeed, until relatively recently such attendance remained a female
domain in which men very rarely played a part. Generally the midwife was the
senior woman in the community. She was commonly a married woman or a
widow who had herself given birth. With the gradual development of towns and
cities came the specialisation of occupations, including midwifery, and with this
the professional midwife. These women would acquire their skills over years as
apprentices to older midwives. During the time of Hippocrates (460 to 410 BC), it
was thought that midwives in Athens should be required by law to have had
children themselves (Nicopoullus, 2003). During the seventeenth and eighteenth
centuries, the advent of surgical instruments and institutional medical training
brought many changes to midwifery and medicine in general. Initially, barber-
surgeons, who carried with them destructive surgical instruments, were called to
attend to difficult births by midwives in a desperate attempt to save the life of the
birthing woman (Bynum, 1983; Cassidy, 2006).
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This role evolved in seventeenth-century Europe into what was termed the
‘manmidwife,’ the predecessor of the obstetrician. These doctors who attended
births were controversial from the onset. Their motives were questioned and they
were often viewed as deviant, improper, and scandalous. Some men were
certainly curious about birth; most men had never witnessed one. However, there
are clear accounts that man-midwives went to great extremes to respect modesty
and reduce embarrassment by all (Cassidy, 2006). When a man midwife was
called to a birth, he would often drape the woman, tying the long cloth around his
own neck, so that his eyes couldn’t see what his hands were doing. There are
some accounts of man-midwives sneaking into a room, completing a difficult
birth, and then exiting without ever being noticed by the laboring woman
(Bynum, 1983; Cassidy, 2006). Other anecdotes suggest that the male birth
attendant should be unsightly himself, in order to offset any jealousy by a husband
or improper thoughts by the laboring woman (Nicopoullus, 2003).

The motivation of any man to attend a birth was often questioned, and the
opportunity for a man to witness a birth was rare, if at all. Despite the controversy
during this time, prominent men were making great strides to further the science
of midwifery and what would later become the practice of obstetrics. At the
HotelDieu in Paris, men were being book-trained in midwifery and the use of
surgical instruments for delivery (Cassidy, 2006). William Smellie, born in
Scotland in1697, is credited with innovations on the shape of the forceps
(Schuilling et al., 2005). He delivered women fully draped, unable to see his own
actions beneath the cloth, and he encouraged his male students to wear dresses to
births. The disguise reduced suspicion and controversy, but also provided ample
room to hide instruments, such as forceps, which were experimental and ill-
favored (Cassidy, 2006).

As midwifery began to develop so did the profession of obstetrics near the end of
the century. Childbirth was no longer unjustifiably despised by the medical
community as it once had been at the beginning of the century. But the specialty
was still behind in its development stages in comparison to other medical
specialities, and remained a generality in this era. Many male physicians would
deliver children but very few would have referred to themselves as obstetricians.
 14

The end of the 19th century did mark a significant accomplishment in the
profession with the advancements in asepsis and anaesthesia which paved the way
for the mainstream introduction and later success of the Caesarean Section where
pregnant women with complicated births are attended to (Caplan, 1995).

By the late 19th century the foundation of modern day obstetrics and midwifery
began to be laid. The delivery of babies by doctors became popular and readily
accepted but midwives also continued to play a role in childbirth. Midwifery also
changed during this era due to increased regulation and the eventual need for
midwives to become certified. By the late 19th century many European countries
were monitoring the training of midwives and issued main article certification
based on competency. This means that midwives were no longer uneducated in
the formal sense (Bryte, 2002).

The increasing use and development of surgical instruments during this time
marks the beginning of obstetrics as we know it today. It also coincides with
developments in anesthesia, and the propagation of exclusively male educational
institutions. Men who were interested in attending childbirth became
obstetricians. Female childbirth attendants, largely excluded from educational
institutions (and thereby prohibited from using surgical instruments), would
remain practicing empirical midwifery. Hence, midwifery and obstetrics would be
divided along gender and philosophical lines for many years to come (Bynum,
1983; Schuilling et al., 2005; Cassidy, 2006).

Modern day midwifery

However, midwifery still remains a female territory, largely due to the commonly
held belief that in essence, midwifery is about a female relationship. It is believed
is that women seek out a midwife in the hopes of building a close and trusting
relationship with another woman. Midwives themselves have stated that
midwifery is about ‘woman-to-woman’ care. People have asked, ‘What would a
male midwife be called, amid husband?’ This woman-to-woman relationship is
characterized as nurturing, intuitive, patient, sensitive, and understanding.
Midwifery care focuses on the intimate, intensely personal aspects of pregnancy
and childbirth, along with well-woman care. Intimate care should be understood
as 13 providing physical care that invades the client’s personal space and requires
the removal of some parts of their clothing or entailed a procedure that touched
the client’s genital area. Many believe that a man would not be able to bond with
a woman in this way as he could not cultivate this relationship. This is partly
 15

because as a man he could never understand what a woman was going through.
As such, many find men’s motivations suspect. Questions are asked, why would
any man want to be a midwife? Could the interest be sexual in nature? The male
presence would be off-putting or embarrassing to a woman. The woman’s partner
may be intimidated or jealous of the bond between her and the male midwife. The
underlying assumption is that socially it is simply inappropriate for a man to
identify himself as a midwife. Midwives themselves are some of the most
vehement proponents of this view (Kennedy, 2006).

Midwives, more than ever, are serving women and families from diverse
backgrounds, socioeconomic levels, race and ethnicities, and sexual preferences
(Barger, 2005). Midwives aim to serve the needs of these women and families
with personalized, attentive care. Truly achieving this goal requires a diverse,
culturally competent population of midwives. In recent decades, women have
overcome many barriers to practicing medicine and now make up a large
proportion of obstetricians. It’s generally socially acceptable for either male or
female obstetricians to attend births. The same can’t be said for midwifery, which
until this day has largely remained the exclusive terrain of women (Bynum, 1983;
Schuilling et al., 2005).

The issue isn’t so much about men in childbirth, as it was in the seventeenth
century, but of men in midwifery. Midwifery remains female territory, largely due
to the commonly held belief that midwifery, in essence, is about a female
relationship. The belief is that women seek out a midwife in the hopes of building
a close, trusting relationship with another woman. Midwives themselves have
stated that midwifery is about “woman-to-woman” care (Kennedy et al., 2006).
Much of the public believes that a midwife by definition is a female provider.
People have asked, “What would a male midwife be called, a mid-husband?” This
woman-towoman relationship is characterized as nurturing, intuitive, patient,
sensitive, and understanding.

Midwifery care focuses on the intimate, intensely personal aspects of pregnancy

and childbirth, along with well-woman care. Many believe that a man would be
unable to bond with a woman in this way. He could never understand what a
woman was going through. A man couldn’t cultivate this relationship (Bynum,
1983). As was the case centuries ago, some find men’s motivations suspect. Why
would any man want to be a midwife? Could the interest be sexual in nature? The
male presence would be off-putting or embarrassing to a woman. The woman’s
partner may be intimidated or jealous of the bond between her and the male
midwife. The underlying assumption is that men’s involvement in midwifery is
questionable and problematic. And that it’s simply socially inappropriate for a
 16

man to identify himself as a midwife. Midwives themselves are some of the most
vehement proponents of this view (Kennedy et al., 2006). There are few
professional spheres where one can continue to voice such harsh sentiments based
entirely upon sexual stereotype and bias.

Recent articles and Web-based discussions have documented the experiences of

male midwives. Despite the theoretical opposition described, many encounters
that these men describe are remarkably positive. Repeatedly, male midwives and
the women they serve described the quality of care given, and not the gender of
the provider (Kennedy et al., 2006). One male midwife succinctly stated that
“gender is very rarely an issue for clients (Armstrong, 2008). Many women
reported being initially hesitant about having a male midwife, but once rapport
was developed; gender was no longer a consideration. Furthermore, one woman
reported that her male midwife was “much more caring and sympathetic” than her
female midwives (The Mid-Person, 2008).

Men’s motivations for choosing midwifery are also discussed. One man reported
a long family history of involvement in midwifery; as a result, caring for pregnant
15 women came naturally to him. Others choose the profession precisely because
of the relationship it allows the provider to form with the patient: the patient-
provider rapport, continuity of care, and the opportunities for teaching
(Armstrong, 2002; UK Midwifery Archives, 2008). In addition, evidence suggests
that men in nursing tend to specialize in areas of high acuity (Armstrong, 2002).
Some men may simply enjoy the critical care aspect of labor and delivery.
Clearly, the motivations are multiple and varied just as they are among female
midwives.

Unique contributions

Male midwives may not only possess the essential qualities of a midwife, but may
also offer unique attributes to the childbearing family’s experience precisely
because they’re male. Women appreciated and in some cases preferred a male
midwife because of his “open” approach to pregnancy and childbirth. They shared
encounters where male midwives displayed less “emotional baggage” than some
of their female colleagues. These women recognized that male midwives lack
preconceived ideas based on their own childbirth experiences (Kennedy et al.,
2006; The Mid-Person, 2008). Additionally, rather than feeling jealous or
intimidated, husbands and partners were instead relieved to have another man in
the room (Bynum, 1983; Armstrong, 2002; UK Midwifery Archives, 2008). One
 17

male midwife found that most men “seem to find his presence comforting”. It was
suggested that the male midwife may explain things differently and relate to men
more “on their level” (Armstrong, 2002; UK Midwifery Archives, 2008). Male
midwives may also showcase the quality of gentleness that impacts how fathers
view their role in the context of the new family (Kennedy et al., 2006; The
MidPerson, 2008). Rather than being problematic, some qualities of being male
were viewed as distinctive attributes.

Global perspective of midwifery outside Africa

In the United Kingdom, men were legally prohibited from practicing midwifery
until a legislation abolishing sexual discriminations was passed in 1983. The legal
battle for men to enter midwifery faced much opposition. Men presently make up
slightly less than 1% of the midwifery workforce in the United Kingdom (The
Mid-Person, 2008).

In the United States, there has been no legal prohibition to exclude men from
midwifery, yet the percentage of male midwives is comparably low. The
overwhelming presence of men in obstetrics demonstrates the social acceptance of
men in childbirth. According to the most recent survey of certified nurse
midwives (CNMs), the American College of Nurse Midwives (ACNM) found that
0.6% of its members are men (Schuilling et al., 2005). Although this number is
reflective of members of the college, one can easily see that men account for a
miniscule number of CNMs nationwide. The percentage of male student nurse-
midwives is even lower. Diversity in American midwifery is limited on many
fronts. Nearly 90% of CNMs are white females (Kennedy et al., 2006).
Recognizing this 18 homogeneity, attention has recently been devoted to
understanding why there’s such a lack of diversity, and what can be done to
remedy it. The midwifery model of care holds that all women of all backgrounds
deserve safe, effective, satisfying care throughout their lifetime. A guiding
philosophy is respect for diversity, human dignity, and individuality (ACNM,
2005).

In Japan, midwifery was first regulated in 1868. Today midwives in Japan are
regulated under the Act of Public Health Nurse, Midwife and Nurse (No. 203)
established in 1948. Japanese only had female midwives but up to until March 1,
2003 men have been admitted to the career by law (http://www.midwifery.Org).

Despite the gains the midwifery profession has made in Canada over the past 10
years, it still faces many challenges. In the past, men have been excluded from
 18

maternity care due to the influence of traditional culture, and a number of factors
centred on health service delivery issues. Involving men in the maternity care of
their pregnant partners has become important because of the realisation that men’s
behaviour can significantly affect the health outcomes of the women and babies.
Men have increasingly become aware of their critical role in reproductive health
care. First Nations and Inuit midwives still face great challenges around training
and regulation (http://wwwmenstuff.org).

In China there are a growing number of men who are taking up jobs previously
seen as the exclusive preserve of women. China's first male midwife Li, says that
in some ways a man is well-suited to providing postnatal care, as it is a physically
demanding job. Many members of the public are still unsure about a man carrying
out a job that has traditionally been done by women. Formerly a university
lecturer with a master's degree in public management, Li quit his job and decided
to train as a postnatal caregiver, feeling the profession offers brighter prospects.
Professional caregivers are in high demand and command good prices for their
services. Li says he understands that some may be opposed but he will stay the
course and try to make a success of his new chosen career. (CAN Vol. pg. 23,
2012).

In Australia, there are 337,807 nurses and of those only 33,891 are male (2012
statistics from NCAH). This is roughly a tenth. That may not sound like a lot, but
is the result of a major increase in recent decades and demonstrates considerable
19 growth and changes in social expectations around gender categories and
behaviours. However, the same cannot be said for midwifery. In Australia there
are just nine male registered midwives. This is nothing unique to Australia as 2%
of midwives in the USA are men, 1 % of midwives in the UK are men There is
nothing actually standing in the way of men training to be midwives, it is just
uncommon and for various reasons. While there may still be a taboo for some,
particularly people with strong religious convictions, there are men working in
maternity wards and they’re working extra hard to change the way people feel
about male midwives (Dar P. et al. 2012).

The African Perspective

A shortage of doctors and midwives in Cameroon has drawn more men into
midwifery in recent years. While many Christian men and women say they prefer
male midwives for their attentiveness, Muslim men and women say that it goes
against their religion for a male to attend to a woman during labour. The
government introduced the country’s first official midwife training programme in
order to ensure the availability of skilled midwives regardless of sex. Women are
 19

unfazed when they find a man in the labour room attending to them, especially
young girls who are having their first babies, are uncomfortable with male
midwives. However, most women prefer male midwives. Generally, women
prefer male midwives, but the problem is that there are very few male midwives
in Cameroon. Women want male midwives because of that cordial relationship
that exists between men and women. There is that natural flow or soft link
between the man and the woman, so a man will always want to care for the
woman.

Cameroon has never offered exclusive training for midwives, according to the
Ministry of Health’s delegation in the Southwest region. Keukam says that
midwifery education has instead been available as a post-nursing program, and
prerequisites included at least two years of experience as a nurse to both men and
women (Scheffler, 2008)

The Ministry of Health in collaboration with the Ghana Health Services has begun
training males as midwives in selected midwifery training schools in the country
come 2013/14 academic year.

The ministry described the move as part of efforts to promote gender equality to
provide additional support for maternal health in Ghana. The decision was arrived
at after consultation with its stakeholders to implement the policy through a pilot
basis approach with a very competitive written examination and an oral interview
to select qualified candidates to pursue the programme.

Addressing the matriculation ceremony of the Garden City University College

(GCUC), the Offinso Municipal Director of Health Services, Mrs Beatrice Appah,
said the training of males to offer services to women in labour would address the
posting of personnel to rural communities.

The first batch of males starts training this academic year for the pilot programme
at Pantang, Goaso and Asante-Mampong, Post Basic Midwifery training Schools
in the Eastern and greater Accra region respectively. They would be awarded
diplomas in midwifery after training. The programme is currently opened to
community health nurses or health assistants who have completed a 3-year
working experience. Explaining, she said many female midwives often refused
postings to rural communities after their training, a situation that greatly
undermined the quest to reduce maternal mortality in the country.

“With the training of males as midwives, the incident of high maternal mortality
in the country will be greatly reduced because most female midwives have
refused to accept posting to rural communities, leading to a high incidence of
 20

maternal mortality cases. The training of males as midwives will also fill the
yawning gap that has been left behind, following the retirement of many
midwives in the country,” she added.

Ghana currently has about 4,035 midwives, approximately 1 midwife to 6,155

patient ratio which is still yet to meet WHO’s recommendation of 1 midwife to a
1,000 patients (Ghana Daily Graphic, 14th March, 2013).

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It’s true that up until 1975, midwifery was seen as a female profession in the eyes
of the law, and men were prevented from training. But times have changed,
attitudes must follow.

Interestingly it was midwives themselves who opposed the idea of male midwives
and the Royal Collage of Midwives fought back against proposed legislative
changes in 1951 that would allow male midwives on three grounds:
1. Midwives give intimate care and most of the public and the birthing woman
would not accept this care from a male midwife.
2. The depth of intimate care required for psychological support during a
woman’s pregnancy is best given by another female.
3. And the very fact that a midwife is a woman is vital in her function
Ultimately, The Royal College of Midwives defined midwifery as a relationship
between pregnant women and female midwives, making an assumption that
women would feel more comfortable with a female midwife.
Janet Davis, Chief Executive and General Secretary for the RCN (Royal College
of Nursing), too admits that: “Nursing and midwifery began as a mainly female
profession and the RCN itself did not admit male members until the 1960s.’
Men, they believed, could not provide this type of care. This philosophy was
challenged by various research.* Women who were cared for by men (male
midwives) described them as gentle, calm, sympathetic and more understanding
than some female midwives. Of note was that some women preferred the care of a
male, while 10% of women actually requested a male midwife. It became clear
that male midwives had a role to play in midwifery and were a valuable asset to
the profession even in the early days of men entering the profession.
The Royal College of Midwives did later realize however, the part men had to
play in the midwifery industry, and in 1982 there is a change in attitudes
Men have now been working as midwives for the past three decades in the UK.
A great example of this progress, can be seen from the experience of Stuart
 21

Hislop, Scotland’s first male midwife. Training as a male midwife in the 80’s was
a different experience to what it is now, according to Stuart.
“There was a considerable amount of ‘hype’ around the inclusion of males in
midwifery,” says the now 65 year old, who trained and practiced midwifery from
1980 – 1982, and continued to teach nursing and midwifery thereafter.
Recommended that midwifery should be open to men.

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