Nurse-Midwives

Women have been giving birth by "natural" methods for thousands of years, since pain medication, hospitals, and medical intervention were largely unavailable until recent years. Women gave birth at home, guided by other women who were designated assistants, or midwives. Midwife means "with woman," and early midwives, like today's professional nurse-midwives, coached mothers-to-be through their pregnancy and labor. They helped women deliver their babies and taught new mothers how to care for their infants.

In the early 1900s, however, birth was transformed from a natural event into a technological marvel. New pain medications and medical procedures took birth into the 20th century, and childbearing moved from home to hospital. Back then, midwives practiced mainly in rural areas where doctors were unavailable, or where poorer women could not afford to deliver in a hospital.

Ironically, as these medically assisted births became more prevalent in America, professional midwifery became more regulated than it had been in the past. In the early 1920s, nurse Mary Breckenridge founded the Frontier Nursing Service in eastern Kentucky to bring medical services to people in areas too poor for hospitals, as well as to women who could not afford to have their babies delivered by a high-priced doctor. After completing her midwifery training in England, Breckenridge made prenatal care an additional focus of her service.

Midwife care around the world was proving itself to be both low in cost and high in quality. The Maternity Association and the Lobenstine Clinic (both in New York) established the first U.S. midwifery school and graduated its first class in 1933. In the mid-1930s, the Frontier Nursing Service opened its own nurse-midwifery school, and it remains today (now known as the Frontier Nursing University) the oldest continuing U.S. midwifery program.

During the next few decades, most women who were able to deliver in a hospital preferred the lull of pain medication and the perceived safety of the medical establishment, and midwifery remained a tool of poor and rural women. Pregnancy and childbirth were considered medical procedures best left in the hands of obstetricians and gynecologists. Both the medical community and the public have generally frowned upon midwifery in favor of doctors and hospitals.

Since the 1960s, however, this attitude has been changing as more women insist on more natural methods of giving birth. In 1968, the American College of Nurse-Midwives (ACNM), the premier midwife organization in the United States, was established. This creation of a nationally standardized entity to regulate midwife training and practice introduced midwifery as a positive, healthy, and safe alternative to hospital births. The nurse-midwife, officially known as a certified nurse-midwife (CNM), has gradually become accepted as a respected member of the health care teams involved with family planning, pregnancy, and labor.

A number of studies have indicated that babies delivered by nurse-midwives are less likely to experience low birth weights and other health complications than babies delivered by physicians. The American College for Nurse-Midwives reported a 33 percent increase in certified nurse-midwife-attended births from 1998 to 2008. In 2017, certified nurse-midwives attended 351,968 births, which was a slight increase compared to 2016.

The proven safety standards of births attended by nurse-midwives, the cost-effectiveness of a CNM-assisted pregnancy and labor, and the personal touch that many women get from their nurse-midwives, will ensure that CNMs become vital links between traditional birthing practices and the high-tech worlds of today and tomorrow.