Midwifery In The United States Research Articles

The History of Midwifery in the United States.

The History of Midwifery in the United States.

Burnout of the US midwifery workforce and the role of practice environment.

ObjectivesTo determine the prevalence of burnout among the midwifery workforce and the association between fixed personal and practice characteristics and modifiable organizational factors, specifically practice environment, to burnout among midwives in the United States.Data SourcePrimary data collection was conducted via an online survey of the complete national roster of certified nurse‐midwives and certified midwives over 3 weeks in April 2017.Study DesignThe study was a cross‐sectional observational survey consisting of 95 items about personal and practice characteristics, respondents' practice environments, and professional burnout.Data Collection MethodsThe inclusion criterion was actively practicing midwifery in the United States. Data were analyzed with bivariate analyses to determine the association between personal and practice characteristics and burnout. A hierarchal multilinear regression evaluated the interrelationship between personal and practice characteristics, practice environment, and burnout.Principal FindingsOf the almost one third (30.9%) of certified nurse‐midwives and certified midwives who responded to the survey, 40.6% met criteria for burnout. Weak negative correlations existed between burnout and indicators of career longevity: age (r(2256) = −0.09, p < 0.01), years as a midwife (r(2267) = −0.07, p = 0.01), and years with employer (r(2271) = −0.05, p = 0.02). There were significant relationships between burnout score and patient workload indicators: patients per day in outpatient setting (F(5,2292) = 13.995, p < 0.01), birth volume (F(3,1864) = 8.35, p < 0.01), and patient acuity (F(2,2295) = 20.21, p < 0.01). When the practice environment was entered into the model with personal and practice characteristics, the explained variance increased from 6.4% to 26.5% (F(20,1478) = 27.98, p < 0.01).ConclusionsOur findings suggested that a key driver of burnout among US midwives was the practice environment, specifically practice leadership and participation and support for the midwifery model of care. Structural and personal characteristics contributed less to burnout score than the practice environment, implying that prevention of burnout may be achieved through organizational support and does not require structural changes to the provision of perinatal health.

Midwives Mentoring Midwives: A Review of the Evidence and Best Practice Recommendations.

Mentoring involves a reciprocal relationship between a more experienced person (mentor) who offers guidance and counsel to a less experienced person (mentee). Reported benefits of mentoring among students of varying health professions include skill acquisition, understanding of the professional role, acclimation to the culture of the health profession, and personal and professional development. Globally, the midwifery profession has a long-standing history of mentoring students and new graduate midwives. However, only one study has described a formal mentoring program within the US midwifery profession. Therefore, to inform best practice for both formal and informal mentoring programs, current mentoring programs are summarized and a state of the science review on mentoring within midwifery in the United States and internationally was conducted. Three types of mentoring relationships are discussed: (1) student to student (peer), (2) midwife to student, and (3) midwife to new graduate midwife. Effective models and recommended approaches for the development and expansion of mentoring are discussed, to sustain, diversify, and scale up the midwifery workforce. Personal attributes and action steps of effective mentors and mentees are provided.

A Transatlantic View – Midwifery in the USA

Although midwives are the lead professionals for uncomplicated pregnancies and coordinators of maternity care in the United Kingdom (UK),1 they are not the default healthcare provider for women and birthing people in many areas of the United States (US).In this article, Victoria Pollack explores how midwifery in the US is thriving despite several challenges, some of which are unique to the US, and others that mirror challenges experienced in the UK.

The Regulation of Professional Midwifery in the United States

The World Health Organization (WHO) designated 2020 as the International Year of the Nurse and the Midwife. Part of the WHO campaign focuses on the fact that nurses and midwives comprise more than half of the shortfall in the global health workforce. In the United States, maternity care is critical because half of rural counties have no access to maternity providers and because the rate of maternal morbidity and mortality continues to climb, surpassing rates of countries with similar incomes. Midwives have a proven record for quality, safety, cost-savings, and high patient satisfaction, yet they attend only 10.2% of births in the United States. In many countries with better maternal mortality and morbidity outcomes, midwives attend 50% to 70% of births. This article reviews the history of professional midwifery in the United States, including the development of the certified midwife credential, outlines current challenges in regulation of the profession, and summarizes widely accepted recommendations to improve access to high quality maternal and child health through support of the midwifery workforce. It is intended to assist state boards of nursing in understanding how they might expand their authority to include the licensing and regulation of certified midwives.

Black midwifery in the United States: Past, present, and future

AbstractWhile sociologists have long explored health and illness, much of it has been androcentric and White‐centered. Scholars began to focus more on women's health including pregnancy and birth in the 1970s yet have historically largely ignored Black women's birth experiences. Midwifery in the United States was once the standard practice for prenatal care and birth. However, the vast majority of births have been medicalized and now occur in hospital settings. In this review, I will highlight the role of race in the historical shifts in the provision of care to Black pregnant and birthing women, the marginalization of Black midwives historically and currently, medical racism, outcomes of laws in the 20th century, the voices of Black midwives and mothers, the activism of radical Black birth organizations and finally, how increasing access to midwifery care may help to address current racialized crises in maternal and infant mortality. Midwifery care typically leads to excellent physical and emotional outcomes for low‐risk mothers and infants, and reduces reliance on medical interventions. As the United States currently has alarming racialized rates of maternal and infant mortality despite vast medicalization, there is much to consider about increasing access to midwifery care in the United States.

A Survey of Midwives' Attitudes Toward Men in Midwifery.

The midwifery profession in the United States demonstrates a significant lack of diversity. The critical need to address the lack of racial and ethnic diversity in the midwifery workforce is well recognized; little attention, however, has been given to gender diversity. This study focused on gender diversity within midwifery, specifically with regard to men who are midwives. Nearly 99% of midwives in the United States are women. No research has previously explored the attitudes of the predominantly female midwifery workforce toward its male members. An invitation to an internet survey was sent to the American College of Nurse-Midwives (ACNM) membership. Quantitative and open-ended questions assessed attitudes toward and experiences with male midwives, whether members thought men belong in the profession, whether gender impacts quality of care, if ACNM should facilitate gender diversification, and whether exposure to male midwives impacts attitudes toward gender diversification. Data analysis of qualitative responses used a qualitative description methodology to identify common themes. Six thousand, nine hundred sixty-five surveys were distributed, and 864 participants completed the survey. Respondents reported beliefs that men belong in midwifery (71.4%), that gender does not affect quality of care (74%), and that ACNM should support gender diversity (72%). Respondents' perspectives revealed 3 dichotomous themes pertaining to the core nature of midwifery and how men fit within the profession: 1) inclusion versus exclusion, 2) empowerment versus protection, and 3) sharing with versus taking from. Often, the same respondent expressed both aspects of the dichotomy simultaneously. This study contributes new information about midwives' attitudes and beliefs toward gender diversity in midwifery in the United States. The values of professionalism, tradition, feminism, protection, and diversification inform participant responses. Findings support efforts toward gender diversification and have implications for implementation in education and practice.

Knowledge of US Midwifery Credentials Among Members of the American College of Nurse-Midwives.

Three midwifery credentials are granted in the United States: certified nurse-midwife (CNM), certified midwife (CM), and certified professional midwife (CPM). Confusion about US midwifery credentials may restrict growth of the midwifery profession. This survey assessed American College of Nurse-Midwives (ACNM) members' knowledge of US midwifery credentials. ACNM members (N = 7551) were surveyed via email in 2017. The survey asked respondents to report demographic information and to identify correct statements about the education, certification, and scope of practice of CNMs, CMs, and CPMs. Responses to 17 items about all midwives certified in the United States, a 5-item subset specific to CNMs/CMs, and one item related to location of midwifery practice by credential were analyzed. Nearly a quarter of the membership (22.1%) responded to the survey. Higher scores on the survey indicated greater identification of correct statements about the education, certification, scope, and location of practice of CNMs, CMs, and CPMs. Significant differences in scores were found among ACNM members based on their level of education, degree of professional involvement in midwifery, and prior practice as a nurse. ACNM members with higher scores on the survey held a doctorate, worked in Region I, and had greater professional leadership involvement in midwifery organizations. Participants with less nursing experience prior to their midwifery education also scored significantly higher on the survey. Although two-thirds of respondents correctly answered items on the preparation, credentialing, and scope of practice of CNMs, CMs, and CPMs, a significant minority had gaps in knowledge. Results of this survey suggest the need for outreach about US midwifery credentials. Future research to replicate and expand upon this survey may benefit the profession of midwifery in the United States.

The limits of law in securing reproductive freedoms: midwife-assisted homebirth in the United States

Recent years have seen increased activism on behalf of homebirth midwives, with grassroots movements in many states focused on gaining professional status for midwives, and legislation regulating and decriminalizing their practice. However, changing the legal status of homebirth midwifery in the United States may not be the most important issue in creating access for maternal services of this type; in fact, legal status is relatively unimportant to this issue. Participant-observation and interviews indicate that, regardless of legal status, homebirth midwives may be subject to prosecutorial discretion, onerous reporting and insurance requirements, and increased state reach via administrative agencies. These findings reaffirm other studies that have pointed to the limits of law; the gap between doctrine and legislation, and implementation; and the contingent and constitutive relationships between law and transformational change.

A History of Midwifery in the United States: The Midwife Said Fear Not

A History of Midwifery in the United States: The Midwife Said Fear Not

Home Birth Midwifery in the United States : Evolutionary Origins and Modern Challenges.

Human childbirth is distinct in requiring-or at least strongly profiting from-the assistance of a knowledgeable attendant to support the mother during birth. With economic modernization, the role of that attendant is transformed, and increased access to obstetric interventions may bring biomedicine into conflict with anatomical, physiological, and behavioral adaptations for childbirth. This article provides an overview of the role of midwifery in human evolution and ways in which this evolutionary heritage is reflected in home birth in the contemporary United States. Opportunities remain for evolutionary scholars to apply their knowledge and skills to strengthen culturally consonant, evolutionarily grounded maternity care within a complex, multilevel, pluralistic medical system.

A history of midwifery in the United States: the midwife said fear not

A history of midwifery in the United States: the midwife said fear not

A History of Midwifery in the United States: The Midwife Said Fear Not by Helen Varney and Joyce Beebe Thompson

A History of Midwifery in the United States: The Midwife Said Fear Not by Helen Varney and Joyce Beebe Thompson

Midwives as primary care providers for women.

Midwives certified by the American Midwifery Certification Board (AMCB) are prepared to provide primary care to women from menarche across the lifespan and to well newborns to 28 days using consultation, collaboration, and referral to other providers as needed. The scope of midwifery in the United States did not always include primary care for women, although imprecise definitions of primary care make this difficult to study. The expansion of the scope of practice occurred in response to population needs and research on nurse-midwifery practice patterns. The scope of practice of midwifery is tied to educational standards through the regulation and licensure at the state level. Although the current scope of practice includes primary care for women, many certified nurse-midwives and certified midwives are unable to practice to the full extent of their education due to state-level licensure restrictions. We discuss the addition of primary care to midwifery and the current state of AMCB-certified midwives as primary care providers for women.

"It is better to light one candle than to curse the darkness": the legacy of Doris Haire.

"It is better to light one candle than to curse the darkness": the legacy of Doris Haire.

“The Satisfactory Midwife Bag”: Midwifery Regulation in South Carolina, Past and Present Considerations

This study examines regulatory efforts directed toward black midwives in South Carolina in the early twentieth century as evidenced within the state's Board of Health documents. Using qualitative content analysis and Abbott (1988) and Starr's (1982) discussion of the medico-legal relationship between doctors and the legal profession, I critically examine South Carolina's Sanitary Codes in order to discern the temporal nature of midwifery law in the early twentieth century. I argue that the language within these legislative stipulations governing granny midwives become more restrictive over time in the early twentieth century thanks to antimidwifery advocacy by US physicians and health officials. Further, I demonstrate how the South Carolina State Board of Health ensured that grannies operated appropriately using other black women as midwifery supervisors. This study illustrates how despite the lack of universal laws governing midwifery in the United States in the early twentieth century, South Carolina actively engaged in “rounding up” the midwife using state-appointed midwifery supervisors, increasingly restrictive practice stipulations, and mandatory midwifery training seminars. This research was supported by a Doctoral Dissertation Enhancement Grant and Fellowship.

Legal Briefing: Home Birth and Midwifery

This issue's "Legal Briefing" column covers recent legal developments involving home birth and midwifery in the United States. Specifically, we focus on new legislative, regulatory, and judicial acts that impact women's' access to direct entry (non-nurse) midwives. We categorize these legal developments into the following 12 categories. 1. Background and History 2. Certified Nurse-Midwives 3. Direct Entry Midwives 4. Prohibition of Direct Entry Midwives 5. Enforcement of Prohibition 6. Challenges to Prohibition 7. Forbearance without License 8. Voluntary Licensure 9. Unclear and Uncertain Status 10. Growth of DEM Licensure 11. Licensure Restrictions 12. Medicaid Coverage

Mainstreaming Midwives: The Politics of Change (review)

Reviewed by: Mainstreaming Midwives: The Politics of Change Susan L. Smith Robbie Davis-Floyd and Christine Barbara Johnson, eds. Mainstreaming Midwives: The Politics of Change. New York: Routledge, 2006. x + 557 pp. Ill. $85.00, £70.00 (cloth, ISBN-10: 0-415-93150-9; ISBN-13: 978-0-415-93150-2); $31.95, £15.99 (paperbound: ISBN-10: 0-415-93151-7; ISBN-13: 978-0-415-93151-9). In Mainstreaming Midwives, anthropologist Robbie Davis-Floyd and sociologist Christine Barbara Johnson document the developments in midwifery in the United States from the 1970s to the present. The book covers the struggles and successes of lay midwives who sought to create an independent profession of midwifery, known since the 1990s as "direct-entry midwifery." Historians of twentieth-century midwifery often end their investigations at mid-century, when midwifery declined among such groups as Japanese Americans and African Americans. In this exhaustive collection of case studies and recent histories, the authors present the latest phase in the long history of American midwifery, this time among predominantly middle-class, white women. The collection is strongly influenced by the birth activism and scholarship of Davis-Floyd, a medical anthropologist at the University of Texas, Austin: not only did she write or cowrite six of the thirteen chapters, but the other contributors make references to her encouragement and insights. The authors, mostly midwives and/or social scientists, frequently refer to the political motivations for their research, identifying their approach by such terms as "activist anthropology" (p. 314). These ethnographic studies of grassroots midwifery are built on dozens, even hundreds, of interviews with the various players. [End Page 234] The book's overall argument is that the efforts to legalize and professionalize midwifery through political activism, litigation, and legislation came at a price. The midwifery renaissance, the authors convincingly demonstrate, entailed competing cultures of midwifery. In particular, competition between nurse-midwives and lay midwives grew, and disagreements erupted among members within each group. Distinctions and power inequalities between nurse-midwives and lay midwives have a long history, as Laura Ettinger showed in Nurse-Midwifery: The Birth of a New American Profession (2006). The goal of the editors, therefore, is to provide a better understanding of the different perspectives and to urge collaboration and unity in the interest of midwife survival. The book is divided into three parts that fit together nicely to reveal the hotly contested, multiple meanings of midwifery. Part 1 provides discussion of the two major national midwife organizations, the American College of Nurse-Midwives and the Midwives' Alliance of North America, and their creation of direct-entry midwife options. Nurse-midwives, who increasingly sought independence from nursing, nonetheless were dismayed by lay midwives' disregard for formal midwifery educational requirements and hospital training. Lay midwives, who struggled to retain the home as the site for birth and apprenticeship as a method of midwife training, were offended by efforts to turn midwives into university-trained practitioners. Part 2 details midwife activism and the legislative battles with state medical organizations and nursing organizations in Florida, Minnesota, Colorado, Virginia, Iowa, and Massachusetts. Part 3 explores key issues in moving midwifery into the mainstream, including the presence of "renegade midwives." Overall, this is a fascinating book, although I take issue with a few assertions. First, Davis-Floyd labels this latest population of birth attendants "postmodern midwives" in order to highlight their differences from previous midwives who served various ethnic communities. She argues that postmodern midwives are "educated, articulate, organized, political, and highly conscious of their cultural uniqueness and importance" (p. 4)—yet, many of the Japanese American midwives who practiced along the American west coast and in Hawaii in the first half of the twentieth century also fit this description. Second, drawing on the case of Ontario, Davis-Floyd asserts that American midwives should follow the Canadian model of unified midwifery in which "all midwives can practice at home or in hospital and can offer the full range from low- to high-tech birth" (p. 65)—but this is simply not an accurate description of the situation for midwives in many Canadian provinces, including my own. Still, this book is a significant resource for scholars interested in American...

Midwives, Marginality, and Public Identity Work

Because midwifery in the United States is an occupation at the margins of medicine, midwives must frequently negotiate competing identity claims. This article examines the public identity work of a group of midwives by focusing on two important tools they use to accomplish this work: boundary negotiation and impression management. Drawing on data from indepth interviews with twenty-six licensed, nurse, and empirical midwives in the state of Florida, this article illustrates the ways in which midwives frame their identities in relation to history and media representations and manage public identities through boundary negotiation and impression management. I argue that the marginality of this occupation lends itself to competing categories of identity that midwives must negotiate. These categories become salient when midwives confront historical and media representations of childbirth and midwifery as well as the perceptions of the general public, consumers, lawmakers, and medical professionals. In the United States, midwifery is an occupation that exists on the fringes of the mainstream medical system. Under the threat of attack by the medical profession, the media, and lawmakers, midwives often feel a need to legitimate their occupation and activities. The twenty-six midwives in this study have strong opinions about how they are perceived and represented by the general public, consumers, the medical community, lawmakers, and the media. In response to these images, they draw on history, the media, medicine, professionalism, education, and appearance to frame their identities. This article shows how midwives use the tools of boundary negotiation and impression management to construct a public identity. Holstein and Gubrium (2000:215) argue that identity “materializes in myriad nooks and crannies of everyday life, reflecting one sense of who we are in one site, turning a second option for personal definition in another one.” Unlike individuals working in more mainstream occupations who have relatively fewer competing categories of public occupational identity, midwives must work at sorting out who and what they are because of their marginal status. They skillfully define situations as they

Midwifery’s research heritage: A Delphi survey of midwife scholars

A Delphi survey was conducted with midwife scholars to determine the top 10 midwifery studies worthy of recognition in 2005, the 50th anniversary of the American College of Nurse-Midwives (ACNM). This survey was undertaken by students of Philadelphia University's Graduate Midwifery Program as a service-learning project on behalf of the ACNM Division of Research. Selected midwife scholars participated in 2 or 3 rounds of response and feedback to achieve consensus about research deemed historically or currently important to midwifery practice. The top 10 studies, as determined by the 19 participating midwife scholars, are presented here. These results are offered as reflection on research that has helped to shape and define the discipline of midwifery in the United States.