According to my father (born and raised in Harlan, KY) who was delievered by a midwife, and his mom had one for almost everyone of her births...
In most rural communtites there were no doctors, or they were considered unaffordable, and alot of women passed with there first child. Usually older girls of the family were ones to become midwives as they helped either there mother birth siblings, or there mother/grandmother taught them how to "heal". So despite what alot of people may believe most of them weren't trained anywhere other than at home or at a neighbors house.
Like stated in one of the before posts. Most often midwives were paid with goods "garden vegtables, meat, milk, ect", most were not paid with money.
The midwife that came to deliver my father, was said to have arrived 3 days early, and stayed with the family until labor "came upon" my gmother.
Also my dad says that "cutting the pain" was just like an episiotomy these days. When the woman wouldn't stretch far enough she was cut instead of letting her rip. Making healing time alot easier on the woman.
Hope this helps this isn't from any source on the net, this is strictly from my father. If you want to know more just send me an email.