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 MIDWIFERY

What is it?
DEFINITION AND EXPLANATION OF MIDWIFERY
Midwifery has historically been known as the practice of guiding and helping a woman through childbirth. Today, this term is understood to describe the activities of health care providers who provide women's health care including all aspects of pregnancy, birth and postpartum care for mothers and babies.

What is it used for?
BENEFITS OF MIDWIFERY
Recent national studies have shown that outcomes for nurse-midwifery labor and delivery care in the U.S. have exceeded the national average. Very low Ceasarean section rates as well as incidence of preterm delivery have characterized the results attained by nurse-midwives practicing in conjunction with physicians.  Nationally these results have been achieved with less use of technology and medical intervention.

Where did it come from?
HISTORY OF MIDWIFERY
1716: Midwives were required by New York City to attain licensure, and were thus expected to serve as a representative of the government.

1760-1850:  Popular books at the time offer self-help measures and common-sense medicine. The development of religious thought rather than medical progress initiates the decline of magic in healing and other spheres of life.

At the end of the 18th century, some midwives had formal training and others did not. The prevailing belief was that women were emotionally and intellectually incapable of learning and applying the new obstetric methods. Wealthy families came to believe that (male) physician-assisted births provided a better hope for a successful outcome than female midwives.

1799: Numerous male and fewer female students began attending newly developed courses in midwifery offered in New York City and Philadelphia.
 
In Colonial America, women in the home routinely provided most medical care.  However, following the War of 1812 increasing numbers of physicians were trained as new medical schools opened.  At this time urban middle and upper class women shifted away from midwives to physicians in assisting their deliveries.

1873:  The nursing profession became increasingly professionalized as formal schools were established in New York.

1900:  Physicians now attended about half the nation's births, including nearly all births to middle- and upper-class women.  Poorer women who could not afford doctors were frequently attended by midwives. Less than 5% of women gave birth in hospitals.

1914:  As Twilight Sleep became popular in the United States, upper-class women joined “Twilight Sleep Societies”.  The use of anesthesia through the birth process was viewed as a sign of the achievements of medicine.

1920:  Intervention-free deliveries became increasingly rare as physicians contended that delivering women needed their techniques to avoid complications.

1921:  30% to 50% of births occurred in hospitals.

1925:  Nurse-midwives were introduced in the U.S. by public health nurse Mary Breckinridge for use in Frontier Nursing Service (FNS). The hills of Kentucky saw resurgence in the use of midwifery as she trained nurse-midwives in the English/Scottish model and sent them to serve the needs of rural families.

1932: Public health nurses were educated in midwifery by the Maternal Care Association (MCA).

1939:   Mary Breckinridge opened the Frontier Graduate School of Midwifery, the first U.S. school for midwives.

1950s: The natural birth movement gains momentum with Dr. Robert Bradley and Dr. Ferdinand Lamaze.

1955: Nurse-midwives began to practice at the Columbia-Presbyterian Sloan Hospital in New York, and the American College of Nurse Midwives (ACNM) is founded.

1970: National certification for nurse-midwifery educational programs was in place.. Female activitists and community womens’ organizations began promoting the practice of midwifery.  Feminists argued that medical care needed to be demystified and birth “de-medicalized”.

1975: Ina May Gaskin published a very popular book, "Spiritual Midwifery."  

1983: The National Association of Childbearing Centers was established.

1992:  “The Professional Midwifery Practice Act” became law in the state of New York.  The act defined midwifery as a profession with a specific scope of practice and called for a board of midwifery to regulate the profession.

1994: The North American Registry of Midwives (NARM) offered its first written examination to test the knowledge needed for safe, beginning-level, direct-entry midwifery practice to implement a process to certify direct-entry midwives. It expanded the process to include entry-level midwives in 1996.

What is it based on?
THEORY OF MIDWIFERY
Modern midwives are normally autonomous practitioners specializing in normal pregnancy, childbirth and the postpartum care. Their goal is to assist their clients in enjoying a healthy pregnancy and a birth experience free of medical interventions.  Midwives may also serve as primary care practitioners for their clients.

Midwives typically believe that birth is a natural and normal experience and that a woman’s body is generally well capable of fulfilling this process.  They differ from physicians in that midwives are educated in recognizing when the birth process is not proceeding properly, whereas obstetricians have specialized training in complications in childbirth and performing surgical interventions.  Although they are capable of handling difficulties such as breech and posterior positioning, midwives can liaison with obstetricians when a woman requires more complicated interventions.  Midwives are often the only health professionals available to provide care to women and babies in many areas of the world.

How is it done?
WHAT WORKING WITH A MIDWIFE IS LIKE
U.S. midwives work in many different environments, including hospitals, clinics, birthing centers and OB/GYN practices. Some are in private practice.  Currently 98% of all Certified Nurse Midwife deliveries occur in a hospital.

Working with a woman before a birth would typically include:

- Giving advice on issues such as healthy eating
 - Explaining options such as hospital or home delivery, natural childbirth and types of pain relief
- Running prenatal and parenting classes
- Monitoring the health of the mother and baby during pregnancy.
 
During labor, duties might involve:

- Checking how labor is progressing
- Monitoring the baby during labor and birth
 - Administering pain relief medication (nurse midwives only) or advising on ways of managing pain, including walking, hydrotherapy tub, shower, massage, birthing ball, etc. (all midwives)
- Delivering the baby, which may include carrying out an episiotomy (surgical cut) and inserting stitches after the birth (nurse-midwives)
- Referral to a doctor if any medical complications arise that could affect the safety of the mother or baby.

Post-natal work with families might include giving advice on feeding, bathing and general care of the baby. Community midwives could also make home visits to check the health of the mother and baby for up to one month after the birth

Who does it?
PRACTITIONER STATUS
Nurse-midwives and direct-entry midwives comprise the two major groups of current midwifery in the United States.

Nurse-midwives
Focusing on the practice of obstetric and gynecological services for healthy women, United States nurse-midwives are nurses who have completed additional education in midwifery.  98% of such practitioners are female, and almost all states grant nurse-midwives prescription privileges. There are currently about 5,500 currently practicing in U.S.

Direct-entry midwives
Direct-entry midwives do not have formal nursing education but instead are educated solely in the practice of midwifery.  Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing.  Direct-entry midwives tend to provide care to women and newborns in home or non-hospital settings and are educated in the Midwives Model of Care.  Direct-entry midwives may encompass Certified Professional Midwives (CPM), Licensed Midwives, or Lay Midwives.