With great developments in medicine and obstetrics – none of which was being integrated into the practice of midwifery – the upper classes began to gravitate towards more physician-assisted births, while the lower classes had little option but to rely on the more traditional (and far cheaper) the midwife.
[In America] 'In state after state, new, tough licensing laws sealed the doctor's monopoly on medical practice. All that was left was to drive out the last holdouts of the old people's medicine—the midwives. In 1910, about 50 percent of all babies were delivered by midwives—most were blacks or working class immigrants. It was an intolerable situation to the newly emerging obstetrical specialty: For one thing, every poor woman who went to a midwife was one more case lost to academic teaching and research. America's vast lower class resources of obstetrical "teaching material" were being wasted on ignorant midwives. Besides which, poor women were spending an estimated $5 million a year on midwives—$5 million which could have been going to "professionals."'
Although what became known as the 'midwifery problem' seems to have been at its worst in the United States, it stands to reason that it would have had echoes throughout the rest of Europe.
'The homeopathic remedies and traditions practiced by generations of midwives began to appear in stark contrast to more "modern" remedies suggested by physicians. Obstetricians began to identify a difference not only in the practices of the two professionals, but also in the neonatal/maternal outcomes between births attended by physicians and those by midwives. Statistics regarding maternal deaths and neonatal deaths which were available, demonstrated that midwifery attended births often (although not in all studies) had poorer statistical outcomes than physician attended deliveries. It must be noted that this discrepancy may have been influenced by other factors. For example, as physicians became the provider of choice for the affluent woman, midwives cared for an increasing number of poor women. These midwifery clients usually lived either in rural areas of the country, or in immigrant areas of large urban cities where poor nutrition and poor sanitation were the norm.'