Since members of the medical profession engaged in the field of childbirth, divergent views on the birth process fueled the fundamental conflict between midwives and (traditionally exclusively male) medical doctors. It is safe to say that in no other socially important area the opposing standpoints of two professional groups and the two genders collide as hard as in the field of our present birth culture. This is still true even if the number of female gynecologists is rising since a few decades.

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The American pediatrician Marsden Wagner, head of the WHO European bureau of maternal and child health for 15 years, describes the overall impact on the present birth culture as follows:
“Uterine contractions and the birthing process follow the stimuli through the autonomous nervous system, which makes them uncontrollable through conscious decisions. In principle, this results in two approaches for birth care, namely the humanized birth and the medical assisted birth. The approach of humanized birth means cooperating with the mother and easing her autonomous reactions.

In contrast, the medical assisted birth readily neglects and even superimposes the natural processes through additional medication and surgery.” (1)
In the current German health system, the professional group of midwives has no influence. In the hospital, the midwife is formally responsible for the birth, but in fact she works under the supervision and command of medical doctors. Many experienced midwives quit their jobs in the hospital, exhausted from the nerve wrecking unsolvable conflict between male birth medicine and female midwifery. The younger colleagues who then replaced them are more willing to come to terms with these structures. The advantages of regular working hours and a fixed salary mean a lot at a younger age.

The midwives could not prevent the increasing mechanization and medicalization of hospital births, but outside of the clinic, protests grew. In 1985, the first German hospital-independent birth center (Geburtshaus) was founded in the city of Giessen, exclusively managed by midwives. Since then, at least 140 more independent birth centers were established.
Since the beginning of this century, we observed some positive changes developing for the midwives:
- Starting in 2008, around 140 existing birth centers receive financial funding to cover their operating costs. Until then, the parents had to cover these costs through additional payments.
- Midwives and female social scientists developed a set of tools to document and evaluate out-of-hospital births. Their comprehensive pilot study covers 42,154 out-of-hospital births over a five-year period. It is available through www.quag.de.
- More and more parents make use of alternatives to the classical hospital birth. They decide for delivery rooms managed by midwives or for outpatient hospital births.
- The first German professional association for home obstetrics was founded in 2008.
At the same time, the efforts of the midwives encounter serious obstacles and they coincide with opposing developments:
- In September 2008, the liability insurance fee for a home birth midwife rose out of proportion. It increased more than tenfold from 130 EUR to 2,400 EUR per year, no matter how many births she attends. This endangers a midwive’s existence and is a sign of political fight against a female profession.
- The use of technology and medication has infiltrated obstetric medicine for about 40 years. Since then, for example, births have been controlled systematically and often routinely. Between 1995 and 2005, the caesarean section rate rose 10 % to unprecedented height.
- German midwife schools are still dependent and always affiliated with a hospital. As a consequence, the midwife students are mainly trained in the use of technical equipment, according to the requirements of the hospital’s birth procedures.
- The caesarean section rates in the hospitals continued to rise. Since there has been competition from independent birth centers, the premises in hospitals were decorated a little more colorful, birth stools and bathtubs were installed – but the concept of birth remained unchanged.
- The maternity pass became a control instrument for the surveillance of the pregnancy without any participation of the midwives. Until 1970, two passport-sized pages were sufficient to document the regular preventive medical check-ups. Now the new maternity pass lists an extensive compilation of all sorts of medical services, and no woman can judge whether these are preventive medical check-ups or additional offers of the medical market. Most pregnant women agree to complete the whole battery of tests, exams, and documentations. This ties them to the fixed appointment structure of the doctor’s offices throughout the pregnancy. According to scientific studies, this is how almost 75% of the pregnant women become risk patients by definition.(2) Feeling at risk, however, might overshadow the pregnancy, and an undisturbed growth of the child and a serene expectation of the forthcoming birth might become less and less possible.

In the medical field around birthing support, we witness a collision of structural and professional views, and in addition, of male and female positions (perspectives). Men, who hold positions of power at many levels of the health care system, lack the women’s experiential knowledge regarding the birth of children. Women with their empirical (practical) knowledge who additionally acquire medical knowledge would in fact be predestined for this field, but this insight has no public relevance.
We from GreenBirth do not know of any quick solution to the problem. But we think that parents should know about the backgrounds that can affect them and their child. Parents who are aware of the natural processes of pregnancy and birth and who take part in careful prenatal care in a measured and self-determined manner are simply better off.

(1) Beate Schücking (ed.): Self-determination of Women in Gynecology and Obstetrics. Published by Vandenhoeck &Ruprecht, Göttigen,2003, p.48 f.
(2) Friederike zu Sayn-Wittgenstein (ed.): New Thinking in Obstetrics. Published by Huber, Bern, 2007, p.60 ff.