By Allison Sadr, CNM
“When a child is born, the entire Universe has to shift and make room.” Ina May Gaskin
Midwifery is an ancient profession, with a proud tradition of providing care for women and babies during pregnancy and childbirth. The earliest birth attendants were women. In ancient mythology, goddesses (but not gods) were present at deliveries. In “primitive” tribes studied by anthropologists in the last century, the laboring woman would be accompanied by her mother or other female relative. Birthing stools and midwives are also mentioned in the Old Testament.
The history of obstetrics is inextricably linked with the history of midwifery. Obstetrix is the Latin word for midwife: it is thought to derive from obstare (to stand before”), because the attendant stood in front of the woman to receive the baby. Only in the 20th century did the subject taught in medical schools change its name from “midwifery” to “obstetrics,” perhaps because a Latin name seemed more academic than the Anglo-Saxon, derived from mid, “with,” and wyf, “woman.” The first successful cesarean section in the British Isles was performed by an Irish midwife, Mary Donally, in 1738.
Nurse-Midwives in the United States
Although midwives have been attending births in America since its colonization, the profession of nurse-midwifery was established in the early 1920s as a response to the alarming rate of infant and maternal mortality in the United States. A group of obstetricians, nurses and mothers formed the Maternity Center Association (MCA) in New York City to address the problem.
MCA looked to foreign countries with outstanding maternal child health (MCH) records to serve as models. In these countries, the most prominent figure in the maternity cycle was the nurse-midwife. They saw that these specialty nurses might be the answer to America’s growing MCH problems, but unfortunately, no nurse-midwives were working in the United States at that time.
During this same time period, Mary Breckinridge, a pioneering nurse, founded the Frontier Nursing Service (FNS) in eastern Kentucky. FNS was founded to provide family health services to isolated areas in the Appalachian Mountains by sending public health nurses into rural communities on horseback. After learning about nurse-midwives in Europe, Breckinridge saw first-hand their contributions to maternity care by traveling to France and England. In 1929, she brought British nurse-midwives to FNS who were the first nurse-midwives in America. They joined the public health nurses in providing quality healthcare to patients in remote areas.
American nurse-midwives trace their history to these rural and urban settings where mothers and their babies frequently had little access to health care. From the beginning, nurse-midwives were able to provide essential primary care to women and their families in a variety of settings. These early experiences provided the first documented evidence in the United States that nurse-midwives could reduce the rates of maternal and infant mortality and improve the health of women, especially among under-served populations.
Certified Nurse-Midwives Today
For over 70 years, nurse-midwives in America have worked to improve the health of women and infants. Today’s certified nurse-midwives (CNMs) practice in collaboration and consultation with other health care professionals, providing primary, gynecological and maternity care to women in the context of the larger health care system. Our partners in providing care include OB/GYNs, family practice physicians, nurse practitioners, physician assistants, midwives, nurses, childbirth educators and doulas.
The popularity and acceptance of nurse-midwifery has been increasing dramatically over the past 35 years. The number of CNMs in practice jumped from 275 in 1963 to over 4,000 in 1995, as more women discovered the benefits of personalized, holistic healthcare that modern-day nurse-midwives have to offer. As of June 2008, according to the American Midwifery Certification Board, there are 11,320 CNMs and certified midwives in the US. In 2005 CNMs attended over 306,000 deliveries. This number accounts for more than 11% of all vaginal births that year in the United States.
Today’s nurse-midwives practice and promote a philosophy of health. They are a national resource for improving the health of our nation’s families. Through the nurse-midwives at Prince George’s Hospital Center, the mothers, babies and families in our community have seen first-hand the positive health benefits of midwifery care.