A History of Midwifery in the United States

Helen Varney Burst, MSN, CNM, DHL (Hon.), FACNM, is Professor Emeritus at the Yale University School of Nursing. Joyce Beebe Thompson, DrPH, CNM, FAAN, FACNM, is Professor Emeritus at the University of Pennsylvania and Western Michigan University, and an international consultant in midwifery education, women’s health, and human rights.

Contents
Preface


Acknowledgments


Abbreviations


Introduction


Definitions, Titles, and Credentials


Nurse-Midwives


Lay, Empirical, Community, and Direct-Entry Midwives


Midwifery and Midwives Through the Centuries


Midwifery Models of Care


The ACNM Midwifery Model of Care


MANA: “The Midwives’ Model of Care™”


Summary of Midwifery Models of Care


SECTION I: EARLY HISTORY OF MIDWIFERY IN THE UNITED STATES (1600s–1940s)


1. The Early Voices of Midwives


The Voices of Predecessor Midwives in Antiquity


The Voices of Midwives in the Colonies (1607–1775) and Early History of the United States (1776−Mid-1800s)


The Voices of Traditional African American Antebellum Slave Midwives (1619–1861)


The Voices of Granny Midwives (Late 1800s−Mid-1900s)


The Voices of Immigrant Midwives and Other Midwives in the Late 1800s and Early 1900s


2. Silencing the Early Voices of Midwives: 1600s to 1800s


Advances in Knowledge and Exclusion of Midwives and Women From Learning


Midwifery in Europe


Study Abroad for Physicians and Their Takeover of Midwifery in the United States


Development of Medical Schools and the Flexner Report


Women in Medicine


Professionalization of Medicine and the Specialty of Obstetrics


Pain Relief During Childbirth: Ether and Chloroform


3. Silencing the Early Voices of Midwives (Late 1800s–Early 1900s)


The “Midwife Problem”


Legislation/Rules/Regulations and the Practice of Midwifery


Nursing and Midwifery


The Bellevue School for Midwives


“Twilight Sleep”


Professionalization of Nursing, Nursing Education, and Public Health Nursing


Professionalization of Midwifery Needed to Survive


4. Silencing the Early Voices of Midwives (Late 1910s–Mid-1940s)


Closure of the Bellevue School for Midwives


Restrictive Legislation


The Continuing Move Into Hospitals


Silencing the Immigrant Japanese Sanba Midwives


SECTION II: HISTORY OF EARLY NURSE-MIDWIFERY PRACTICE AND EDUCATION IN THE UNITED STATES (1920s–EARLY 1950s)


5. Nursing Roots


Florence Nightingale


Public Health Nursing


Public Health Policies, Programs, and Public Health Nursing


Children’s Bureau


Prenatal Care


Maternity Center Association


Public Health Nurses as Midwives


Sheppard–Towner Act


6. The Nurse-Midwife Starts Practicing (1920s–Early 1950s)


Frontier Nursing Service


Lobenstine Midwifery Clinic


Practice of Early Nurse-Midwifery Education Program Graduates (1925–1954)


Family-Centered Maternity Care and Natural Childbirth


7. Early Education for Nurse-Midwives (1920s–1954)


Manhattan Midwifery School


Lobenstine/Maternity Center Association Midwifery School


Frontier Nursing School of Midwifery


Tuskegee School of Nurse-Midwifery


Dillard University Flint-Goodridge School of Nurse-Midwifery


Catholic Maternity Institute School of Nurse-Midwifery and Catholic University of America


SECTION III: HISTORY OF THE RESURGENCE OF COMMUNITY MIDWIVES AND EARLY EDUCATION PATHWAYS IN THE UNITED STATES (1960s–1980s)


8. Resurgence of Community Midwives


Consumer Demand for Out-of-Hospital Birth


Responses to Consumer Demands


Midwife Responses to Consumer Demands


Legal Responses to Consumer Demands


Organizational Responses to Consumer Demands


Variety of Lay Midwife Practitioners in the 1960s and 1970s


Communication and Networking


9. Early Education Pathways for Community and Lay Midwives (1970s and 1980s)


Apprentice Education: 1800s to 1970s


Definitions


Early History of Apprentice Education in Medicine


Early History of Apprentice Education in Nursing


Apprentice Education in Midwifery During the 1970s and Early 1980s


Key Issues Related to Apprentice Education in Midwifery


Academic Models of Lay/Community Midwife Education


The Maternity Center at El Paso Training Program (1976)


Arizona School of Midwifery (1977)–Tucson


Seattle Midwifery School (1978)


Utah College of Midwifery/Midwives College of Utah (1980)—Salt Lake City


Northern Arizona College of Midwifery (1981)


Maternidad La Luz (1987)—El Paso


The Northern Arizona School of Midwifery (1988)—Flagstaff


The New Mexico College of Midwifery (1989)/National College of Midwifery (1991)—Taos


SECTION IV: DEVELOPMENT OF MIDWIFERY ORGANIZATIONS—LIFE-GIVING FORCES FOR MIDWIVES


Introduction and Overview of Professionalism and Professionalization


Definition and Characteristics of a Profession


Key Characteristics of a Professional


Professionalism and Professionalization


 10. The American College of Nurse-Midwives


Predecessor Organizations


Founding of the American College of Nurse-Midwifery


Organizational Development


Incorporation


The Seal of the American College of Nurse-Midwifery/Nurse-Midwives


Mission


Bylaws and Structure


Presidents


Headquarters/National Office


Communication


A.C.N.M. Foundation


Awards


Core Documents


Definitions


Philosophy


Functions, Standards, and Qualifications


Core Competencies


ACNM Code of Ethics


Peer Review


Home Birth, Practice Settings, and Review of Clinical Practice Statement Documents


 11. Midwives Alliance of North America


Predecessor Organizations


First International Conference of Practicing Midwives (January 14–16, 1977)


National Midwives Association (June 1977)


Second International Conference of Practicing Midwives (March 17−19, 1978)


Meeting of CNMs and Non-Nurse Midwives (October 30, 1981)


Founding of Midwives Alliance of North America


Organizational Development


MANA Goals


First Convention and the MANA Process


Mission


Philosophy


Bylaws


Presidents


Committee Structure


Statistics and Research Committee


Communication/Public Relations (Education) Committee


Communication/MANA News


Central Office


Essential (Core) Documents


Standards and Qualifications for the Art and Practice of Midwifery


Core Competencies for Basic Midwifery Practice


MANA Statement of Values and Ethics


MANA Position Statements


Descriptive Statistics


Coda


 12. National Association of Certified Professional Midwives


Early History and Founding


Organizational Development


Purpose and Aim


Board of Directors


Standards Committee


Practice Committee


Core Documents


Mission


Philosophy and Principles of Practice


Scope of Practice


The Standards of Practice for NACPM Members


Issue Brief: Certified Professional Midwives in the United States


NACPM Website


Coda


SECTION V: HISTORY OF NURSE-MIDWIFERY PRACTICE AND EDUCATION IN THE UNITED STATES (1950s−1980s)


 13. Nurse-Midwifery Practice (1950s–1980s)


Nurse-Midwives Move Into Large City and University Medical Center Hospitals


Psychoprophylaxis


Technological Advances and the Continuing Quest for Pain Relief


Nurse-Midwives Move Into Private Practice With Births Both In and Out of a Hospital


Nurse-Midwives Create the Modern Out-of-Hospital Birth Center


Practical Practice Help From the ACNM


Evaluation and Effectiveness Studies


Descriptive Studies


 14. Nurse-Midwifery Education (1955−1980s)


Types of Programs


Growth Spurts


Education Workshops


Developments in Education


Mastery Learning Using Modules


Directors of Midwifery Education


A Textbook for Midwifery


Distance Learning


SECTION VI: HISTORY OF DIRECT-ENTRY MIDWIFERY EDUCATION AND THE CREDENTIALING OF MIDWIVES IN THE UNITED STATES


 15. Direct-Entry Midwifery Education


American College of Nurse-Midwives (1978–1996)


ACNM Education Committee


ACNM Division of Accreditation


Midwives Alliance of North America (1983–1991)


MANA Education Committee


National Coalition of Midwifery Educators


Association of Midwifery Educators


 16. Credentialing of Midwives


Accreditation


Accreditation Commission for Midwifery Education and Predecessors


Committee to Study and Evaluate Standards for Schools of Midwifery


Committee on Curriculum and Accreditation


Committee on Approval of Educational Programs


Division of Approval


Division of Accreditation


Accreditation Commission for Midwifery Education


Midwifery Education Accreditation Council


Credentialing Committee


MEAC Incorporated


MEAC Criteria for Direct-Entry Midwifery Education Programs


USDOE Recognition


Early MEAC-Accredited Programs


Certification


American Midwifery Certification Board and Predecessors


ACNM Testing Committee


Division of Examiners


ACNM Certification Council/American Midwifery Certification Board


North American Registry of Midwives


MANA Interim Registry Board


Creation of the MANA Registry Examination


North American Registry of Midwives Incorporated


Conversion From Registry to Certification Examination


NARM Certification of Direct-Entry Midwives


Licensure


Certified Nurse-Midwives and Certified Midwives


Legislation Committee


Political and Economic Affairs Committee/Government Affairs Committee


Lay and Direct-Entry Midwives


Licensure Debates


State Recognition of Lay Midwifery Practice Prior to 1982


State Recognition of Direct-Entry Midwifery Practice After 1982


Certified Professional Midwives


The Big Push for Midwives Campaign (2008)


SECTION VII: EXTERNAL/INTERNAL RELATIONSHIPS AFFECTING MIDWIFERY


 17. Federal Legislation Affecting Midwifery Practice


The American College of Nurse-Midwives’ Involvement in Legislation


Washington Task Force


Legislation Committee


Master Plan and ACNM Legislative Response Mechanisms


ACNM Lobbyist


Early Federal Legislation


Midwives-PAC


Direct-Entry Midwifery Groups’ Involvement in Legislation


MANA Legislative Committee


MANA Legislative Conferences


MANA Legislative Lobbyist, 1994


NACPM and the Midwives and Mothers in Action Campaign


Collaborative Efforts in Maternity Care Legislation


Safe Motherhood Acts, 1996, 2002


Affordable Care Act of 2010


Coalition for Quality Maternity Care


 18. Midwives With Women and Childbearing Families


Consumers and Midwives Working Together for Safe Choices Among Childbirth Alternatives


Maternity Center Association


La Leche League, 1958, and La Leche League International, 1964


International Childbirth Education Association, 1960


American Society for Psychoprophylaxis in Obstetrics/Lamaze, 1960


National Association of Parents & Professionals for Safe Alternatives in Childbirth, 1975


Other Partnerships Supporting Safe Alternatives in Childbirth


Listening to Women


ACNM Ad Hoc Committee on Consumer Affairs


ACNM’s Listen to Women Campaign


Citizens for Midwifery, Inc.


Childbirth Connection 2005


Public Policy Agenda for Women


Midwives With Vulnerable Populations


ACNM Position Statements on Health Policy


American Public Health Association Policy Statements on Midwives and Women’s Health


Safe Motherhood Initiatives, USA


 19. Midwives (CNMs) With Physicians


Historical Evolution


Joint Statements


Coda


20. Midwives (CNMs) With Nurses and Nursing


Early Confusion With Identity of Nurse-Midwives


Nurse Practitioners, Physician Assistants, and ANA


National Federation of Specialty Nursing Organizations and ANA


ANA and Early Certification Efforts


ACNM’s Continuing Internal Struggle With Self-Identification and the Working Document


Nurse-Midwives and OB-GYN Nurse Practitioners


ANA Develops a Credentialing Center


ANA Defines Nurse-Midwives as Nurse Practitioners


ACNM Defines Nurse-Midwives


ANA Defines Nurse-Midwives as Advanced Practice Registered Nurses


AACN and Accreditation


Nursing Response to ACNM Involvement in Direct-Entry Midwifery


Nurse-Midwives Included in APRN Regulation


Self-Identification and Loss of Autonomy


Coda


 21. Midwives With Midwives: United States


Carnegie Meetings Stimulate Midwifery Dialogue in the United States


First Carnegie Meeting: July 16 to 18, 1989


MANA–ACNM Activities Between the Two Carnegie Meetings


Second Carnegie Meeting: July 22 to 24, 1990


The MANA-ACNM Interorganizational Workgroup on Midwifery Education


Carnegie Funds Awarded


Goals of IWG


Selection of Workgroup Members


The IWG Meetings


Factors Mitigating Against Achievement of Carnegie and IWG Goals


Different Organizational Processes


Words and Concepts Without Common Meaning


Philosophy of Inclusiveness


Level of Midwifery Education


University Affiliation for Midwifery Education


Misunderstanding on Who Develops Education Programs


Suspicions About IWG Activities


Final Outcomes of IWG Meetings


The Grand Midwife Statement


Midwifery Certification Document


Liaison Planning Document


Continuing ACNM and MANA Dialogue


The Bridge Club


ACNM–MANA Liaison Group


United States Midwifery Education, Regulation, and Association


 22. Midwives With Midwives: International


The International Confederation of Midwives


Brief History


Aim and Strategic Actions


Organization and Structure


ICM Activities and Documents


ICM International Definition of the Midwife


ICM Mission and Vision


ICM International Code of Ethics for Midwives


ICM Philosophy and Model of Midwifery Care


ICM Essential Competencies for Basic Midwifery Practice


ICM Global Standards for Education and Regulation


The Three Pillars of Education, Regulation, and Association


ACNM’s Role in International Midwifery


Index