September 17, 2011

Midwifery is the second oldest profession for women in the world. The practice of midwifery is documented in the Old Testament. The derivation of the word midwife means “with woman,” giving credence to the most enduring hallmark of midwifery which connotes a human presence during birth.

Exclusive of the North American continent, midwifery care for women has maintained a congruent path throughout history. Organized schools of midwifery have flourished across Europe through the centuries as far back as the 5th century BC when Hippocrates founded the first formal midwifery program. Countries across the world continue to recognize midwives as the caregivers of women, especially during parturition. Today’s midwife is very different from the one who counseled Moses’ mother to set him adrift in a basket upon the Nile, but her/his role in counseling women remains undaunted.

Midwifery came to America with the first colonists, although birth attendants existed among the Native Americans long before the continent was “discovered.” This new midwife initially had been trained in Europe or was indigenously apprenticed in America. It was Mary Breckinridge who, having been educated in England, brought the nurse midwife to the United States in the early 1920s to care for Appalachian women and their families in the state of Kentucky. In 1925, she opened the Frontier Nursing Service with nurse midwives who had also been educated in England. These British-trained nurse midwives were the first to practice in the United States.

In 1931, the first nurse midwifery educational program in the United States opened in New York City. It was called the Lobenstine Midwifery School and continues today as the State University of New York (SUNY) Downstate educational program. Currently there are over 40 nurse midwifery educational programs, and nurse midwives practice in all the 50 states. The number of graduates fluctuates each year, but usually over 400 graduate yearly. Currently, there are over 10,000 Certified Nurse Midwives in the United States, and over 7,000 belong to the American College of Nurse Midwives (ACNM). Ninety-five percent are women, and the majority practice in urban and suburban communities.

The American College of Nurse Midwifery was formed in 1955 and changed its name to ACNM when it merged with the Kentucky Association of Nurse Midwives in 1969. The ACNM sets the Standards for nurse midwifery/midwifery practice in the United States. Through the Division of Accreditation, the ACNM accredits its educational programs to ensure a single standard of education; the Certification Council provides the venue for national certification. Within the last decade, the ACNM has expanded its educational horizon and accredited a nonnurse midwifery educational route to practice. Individuals who select the nonnurse route to midwifery must possess a Bachelor of Science degree to be considered for admission. After acceptance they must successfully complete a bridge option which includes basic fundamentals of health care and the trends and ethics of today’s health care delivery system. These students then attend and complete the same accredited midwifery education program as their fellow registered nurse students.

There are different routes to midwifery education and care in the United States today. As a future practitioner, it is important for an individual to choose the educational route consistent with his/her philosophy of practice. As a consumer, it is important for a woman to make an informed decision about the practice of midwifery, before entrusting herself and her baby to the birth attendant.

The Certified Nurse Midwife (CNM) and Certified Midwife (CM) are licensed providers who have been educated in programs accredited by the ACNM Division of Accreditation and nationally certified by the ACNM Certification Council. State regulations and/or legislation are promulgated to set the perimeters of the scope of practice.

Direct entry into midwifery education and practice are prospering in its own venue. Midwives’ Alliance of North America (MANA) is the official professional organization. Accreditation standards for educational programs and certification of its graduates have been established through the Midwifery Education Accreditation Council (MEAC) and the North American Registry of Midwives (NARM).

Certified Nurse Midwives/Certified Midwives, referred to hereafter as “midwives,” provide primary care to women throughout the life cycle. Today, midwives are not just provider of care during pregnancy and childbirth; they provide care that emphasizes well woman care incorporating health promotion and education through the woman’s lifetime. Pregnancy and childbirth, however, remain a focal point of midwifery care, since pregnancy is often a healthy woman’s first entry into the health care system. Midwives attend about 9% of births nationally each year.

Midwives focus on pregnancy as a normal event, and they inspire women to have confidence and to trust their bodies. Their basic approach is to empower the woman and her family to take an active role in her health care. Midwives respect technology and use it appropriately; they educate women to make informed decisions about childbirth, and they provide the knowhow and environment necessary to achieve a safe and satisfying birthing experience.

Increasingly, today’s families are choosing midwives, as evidenced by a 118% increase in births attended by midwives in the last decade. However, many legislative, political, economic, and social challenges confront the profession and women’s health care. Among them are:

  1. High liability premiums
  2. Barriers to home birth and trial of labor after cesarean
  3. Increasing use of epidurals and induction of labor
  4. Emergence of elective cesarean sections
  5. Inequitable reimbursement for nurse midwifery services
  6. Decrease in scholarship funds for students

In order to sustain and promote the growth in the practice of midwifery observed in the last decade, midwives must educate the public that they are skilled and knowledgeable practitioners who care for women over their lifetimes, rather than only during pregnancy and childbirth.

SEE ALSO: History of Women’s Health, Women in the Health Professions, Labor and delivery, Nurse practitioner, Nursing, Pregnancy, Prenatal care

Suggested Reading

  • Rooks, J. P. (1997). Midwifery and childbirth in America. Philadelphia: Temple University Press.

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