Indigenous communities on all continents have been practicing birth care for centuries. Most midwives believe that childbirth is normal and inherently within the domain of female competence, and rarely seek formal training, especially from men. Few women have access to learning and most cannot afford schools. Additionally, the Puritan philosophy does not encourage education for women. Shippen begins the masculinization of midwifery by bringing men into the field and lifting male-defined science as the standard.