Midwifery In The United States Research Articles

The profession of midwifery in the United States: Looking back and looking forward

The profession of midwifery in the United States: Looking back and looking forward

Women, Health and Nation: Canada and the United States since 1945 (review)

Reviewed by: Women, Health and Nation: Canada and the United States since 1945 Linda Kealey Women, Health and Nation: Canada and the United States since 1945. Edited by Georgina Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson. Montreal and Kingston: McGill-Queen's University Press, 2003. Pp. x, 438, $27.95 paper In the last decade the history of health and medicine has witnessed a revival, spurred in part by a growing interest in the social history of medicine, health funding for research in the social sciences and humanities, and contemporary concerns with health-care funding and policy making. Women, Health and Nation is a collection of twenty essays, most of them originating from a 1998 conference and research project, the latter funded by the Burroughs Wellcome Fund 40th Anniversary Award for the History of Medicine and Science. Concentrating on post-Second World War Canada and the United States, the essays promise cross-border comparisons, a promise that is partially fulfilled. As in any collection of essays, there are strengths and weaknesses, and in this particular example, the comparisons are more often implicit than explicit. The editors identify five themes in the volume: the power of the nation-state, the role of biomedicine, the diversity of women's health needs and experiences, women's agency, and the role of reproduction in women's health activism and history (4-9). But the volume does not always follow this thematic organization, providing us instead with one short chapter called 'Why Borders Matter,' and sections on biomedicine, childbirth, patients and providers, and women's activism. While in their introduction the editors emphasize the nation-state theme as 'foremost,' specific comparisons are drawn most clearly in chapter 1 by the editors, chapter 2 by Barbara Clow on thalidomide use, chapter 5 by Alison Li on [End Page 149] menopause and the marketing of premarin, and in chapter 17 by Susan Smith and Dawn Nickel on nursing in palliative care. The remaining chapters focus on either Canada or the United States. Nevertheless, a number of excellent essays raise questions and confront previously accepted approaches. The comparative chapters suggest that borders mattered, but not always and not in every situation. The editors' chapter surveys developments on both sides of the forty-ninth parallel, noting that while Canada moved into insuring health services in the late 1950s and the 1960s, the Americans brought in insurance for targeted populations. Later the differences become more striking, as Canada strengthened provisions for universal care while the United States severely limited or froze access to health care. Similarly, the editors pinpoint clear differences in women's health activism but note that in both countries the pressures of a post-September 11 world put 'unprecedented demands on Medicare' (36). Clow's chapter on thalidomide demonstrates the more cautious approach taken by American regulatory agencies, which refused to permit the sale of the deforming drug; it also insists on the need to consider the social and cultural factors that led women to take the drug, taking the consumer's perspective. Li's article, on the other hand, explores the selling of drug treatments for menopause to younger and younger women and the different policy responses of Canadian and American drug regulators. Smith and Nickel dig into the differences between American hospice care outside the hospital and Canadian palliative care nursing in a hospital setting, the latter influenced by federal-provincial funding arrangements in the context of changing cultural norms about death and dying. Indeed nursing and midwifery provide another thread in this collection, representing nearly one third of the articles. Both Laura Ettinger and Aline Charles examine the role of nursing sisters. Ettinger analyses the role of the first sisters to practise midwifery in the United States, while Charles focuses on the 'religious labour' of hospital sisters in Quebec, a work role that disappeared by the 1980s as nuns became salaried and unionized too. Judith Zelmanovitz and Kathryn McPherson draw our attention to northern and Aboriginal communities and the regional and cultural tensions experienced at nursing outposts as nurses, often not trained in midwifery, found themselves performing deliveries and importing southern medical practices to the North. Similarly, Karen Flynn's essay underlines...

ACNM essential documents: a midwife’s suit of armor

As the oldest professional midwifery organization in the United States, The American College of Nurse Midwives (ACNM) represents the profession of midwifery in the United States and sets standards for education, certification, and practice. The ACNM has generated and revised several critical documents that provide guidance for the scope of midwifery practice, individually and collectively. This article reviews essential ACNM documents and their role in supporting professional midwifery.

An update on the credentialing of midwives by the ACNM

This paper chronicles the events that took place between April 1994 and February 1995 specific to setting the standard for professional midwifery in the United States through the credentialing of midwives (other than nurse-midwives) by the American College of Nurse-Midwives (ACNM). A collection of documents that record the actions of ACNM leaders and the views of ACNM members related to this issue is also provided. The ACNM Board of Directors has determined that any non-nurse who is a graduate of an ACNM Division of Accreditation accredited midwifery program and has passed an ACNM Certification Council (ACC) national midwifery examination will be called an ACC Certified Midwife.

The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts.

The case of Hanna Porn affords an opportunity to examine how the laws that led to the abolition of midwifery in Massachusetts evolved and were applied to the midwife whose case set the state legal precedent. Mrs Porn served primarily a Finnish-Swedish clientele of wives of laborers. The outcomes of the births she attended appear to have been positive, and she maintained a neonatal mortality rate of less than half that of local physicians. She also repeatedly defied court orders to stop practicing. Her case exemplifies the efforts that occurred nationally to abolish midwifery in the United States.

Self-certification in lay midwives' organizations: A vehicle for professional autonomy

The recent resurgence of lay midwifery in the United States has been intimately connected with the establishment of grassroots organizations which address women's health issues and make the reappearance of the lay midwife a different kind of phenomenon than was the case earlier in this century. This paper describes the organizational structure of 32 lay midwives' organizations and compares them to a model of alternative women's health groups as well as more traditional health professional organizations. Are lay midwives' groups the beginnings of new professional organizations which eventually will become part of the dominant system or do they model themselves more closely after alternative women's health groups? Voluntary self-certification in five lay midwives' groups is described in detail as a means of determining how a group handles the question of integration with or separation from the existing medical care system. Certification plays a critical role in promoting acceptance and credibility of midwifery practice and is seen increasingly as a mechanism to preempt regulation by another body.

The Politics of Childbirth: The Re-Emergence of Midwifery in Arizona

Interviews with 27 licensed lay midwives in Arizona demonstrate the continuing macroand micro-political struggles over definitions and control of childbirth. Physicians define childbirth as a potentially pathological process requiring active medical intervention. They also continue to regard lay midwives as dangerously unqualified and home birth as unnecessarily risky despite state licensure of midwives who attend home births. On the other hand, midwives define childbirth as a safe, normal process in most cases, and see physician opposition as self-serving and misinformed. They also stress the advantages of their holistic, family-centered care. Although state licensure gives lay midwives some protection from legal risks, physicians' continuing dominance in the health care arena has powerful, adverse consequences for both midwives and their clients. A cornerstone of the feminist health movement is the belief that women must take charge of their own health care if they are to liberate themselves from men's control (Boston Women's Health Book Collective, 1984; Corea, 1985; Ruzek, 1978). The male-dominated medical profession has maintained control over women by defining menstruation, menopause, childbirth, and other female physiological processes as dangerous and pathological - requiring medical treatment. Contrary to this definition, feminists argue that these processes and the wide variation in women's experience of them are normal, while many routine medical procedures that physicians use to treat women's health care problems either endanger women's health or are simply unnecessary. For example, they view the historical use of medical practices such as ovariotomy and clitoridectomy to treat hysteria, frigidity, and masturbation, as well as recent restrictions on birth control and abortion, and denial or imposition of sterilization, as helping men to maintain their dominance over women (Barker-Benfield, 1976; Corea, 1985; Ehrenreich and English, 1973; Gordon, 1976; Koumjian, 1981). Moreover, they see the current rates of cesarean sections, hysterectomies, and mastectomies -rates which are unnecessarily high (Dicker et al., 1982; Mueller, 1985; Roos, 1984; U.S. Department of Health and Human Services, 1981)- as further evidence that physicians neither understand nor have sympathy for women's health problems, and that they do not exercise sufficient caution in subjecting women to new or radical treatment regimens. Feminists are not alone in their opposition to standard practices of the male-dominated medical profession. Both feminist and non-feminist women are united in their concern over the widespread medicalization and medical control of childbirth. Both groups fear that routinized medical intervention may do more harm than good to women and their babies. Additionally, non-feminists fear that such medicalization and medical control pose a threat to family bonding and the family's control over decision-making. They criticize hospital procedures which isolate women in labor from their families, separate newborns and their mothers, and discourage breast-feeding (see for example, the journals Birth and Mothering). The recent re-emergence of lay midwifery in the United States is one example of how women are attempting to regain control over their own health care by demedicalizing the childbirth process. A number of excellent historical analyses of midwifery exist (e.g., Devitt, 1979a,b;

A historical development of midwifery in the black community: 1600–1940

Over the past 25 years there has been a rebirth of the profession and practice of midwifery in the United States. Emerging out of the rebirth have come numerous accounts of the history of midwifery. In this article, the author reviews the development of midwifery in black communities of the rural southeastern states from the 1600s through the 1940s. Several questions emerge as areas for further study.

Two roads-which one?

Critical questions confront the American College of Nurse-Midwives (ACNM). What is the ACNM's responsibility to the profession of midwifery in the United States? Who should set the standards of midwifery practice? Should the ACNM recognize other educational pathways to midwifery? What effect would the answers to these questions, either positive or negative, have on nurse-midwifery and on the ACNM? A comprehensive data base pertaining to the subject of any change in titling or education is given. Directions and choices are articulated.

Misuse of Health Statistics

To the Editor.— Ludwig and Collette have performed an important and needed service in writing the article, "Some Misuses of Health Statistics" ( 216 :493, 1971). However, they have also stumbled into one of the pitfalls they warn about. Their association of midwifery in the rural South with a high infant mortality in that region leads them to an unwarranted conclusions. The association cited is certainly not a valid argument against the expansion of midwifery in the United States, as they imply. Most midwives in the rural south are lay midwives. Approximately 4,400 were practicing in 1968. 1 By contrast, nurse-midwives in this country and most midwives in European countries are highly trained. The confusion by Ludwig and Collette of lay midwives (largely uneducated) with professionally trained midwives leaves their interpretation about this subject open to question. Further, many socioeconomic and environmental factors in the rural South may well have more

Midwifery in the United States

Midwifery in the United States

Midwifery in the United States: How Shall We Care for the Million Mothers Whose Babies Are Born at Home?

Midwifery in the United States: How Shall We Care for the Million Mothers Whose Babies Are Born at Home?