The herstory of midwifery in the US is an interesting story. An extensive timeline can be found at https://midwiferytoday.com/web-article/history-midwifery-childbirth-america-time-line/
In this first blog for Birthing Journeys I will give you a very brief look at the herstory of Midwifery in the US and how I, as a pioneer in the field, fit into that herstory.
Midwifery has been around for thousands of years, as women all over the world would assist other women in childbirth. According to Midwifery Today Magazine’s timeline, New York City first required the licensing of midwives in 1716. Doctors were not usually formally educated, so midwives were utilized for childbirth due to a greater knowledge base.
Formal training first began in 1765; however, many midwives felt that childbirth was the domain of women and they were reluctant to receive training from male instructors. Also, many women were not literate which made formal education near impossible.
Beginning in the early 1800s, middle-class families started using doctors for childbirth. As anesthesia became more widely used towards the end of the 1800s and early 1900s, delivery began shifting to hospitals. By 1900, physicians were attending about half of the nation's births. Midwives were only used for those who could not afford a doctor. During the economic boom in the early 1920s, upper and middle-class women preferred doctors, instead of the "lower class" midwives.
By the 1950s, eighty-eight percent of births occurred in hospitals, increasing to ninety-seven percent in the 1960s. However, during this time formal education for nurse midwives and the concept of family-centered maternity care was introduced in the field of obstetrics.
A resurgence in midwifery sprung up in the 1970s along with the women's movement. Feminists maintained that childbirth is natural, and hospitalization and supervision by a physician are not required.
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A movement developed to “deinstitutionalize” the dependent and “demedicalize” critical life events, such as childbirth and dying. The interest in hospices and homebirths derived, at least in part, from a desire to escape professional dominance as well as from the desensitizing environment of the hospital.
In the early 1970s, women’s groups also began learning gynecological self-care and encouraging a revival of lay midwifery. Feminists argued that medical care needed to be demystified and women’s lives demedicalized. They maintained that childbirth is not a disease and that normal deliveries do not require hospitalization and the supervision of an obstetrician.
It was during the 1970’s that I was called into the midwifery profession. My first son was born in the hospital. It was a typical hospital birth with too much intervention. He was slow to nurse and the sickliest of my 3 children, the other 2 being born at home. There were no midwives in the area at that time. However, a friend of mine decided to have a home birth and found a doctor to attend. It was from that birth that midwifery was born in my life. Women all over the area started asking Judy to help them with their desire to have a homebirth. And I was the person that assisted her. We read every book we could about Obstetrics, midwifery, homebirth and newborn care. It was on-the-job training at it’s best. We met other homebirth midwives throughout the state and picked their brains every time we could get together. We were paid initially with items bartered such as garden vegetables, chickens, homemade rugs and numerous other items. Our husbands complained that this was a very expensive hobby, so eventually we started charging money for our services.
Lay midwifery was not legal in the state in which I lived, or anywhere for that matter. I was always in fear of being arrested. I eventually decided to become a Certified Nurse-Midwife (CNM) after 10 years of attending births as a lay midwife. I attended births for another 15 years as a CNM.
The conflict over homebirth proved to be one of the most bitter between the medical profession and the women’s movement. While no state forbade homebirth, ACOG (American College of Obstetrics and Gynecology) actively discouraged it. Doctors who participated in homebirths by offering backups in emergencies were threatened with loss of hospital privileges and even their medical licenses.
By the mid-1980s, regulations were introduced by the American Medical Association (AMA) to prohibit midwives from practicing without physician supervision and were finalized by the mid-1990s.
Today, CNM’s are highly educated, specialized professionals who work in collaboration with obstetricians to provide holistic women's health and maternity care. They attend births in hospitals, home or birth centers. And there are several other legal avenues in which to enter the profession. A Certified Professional Midwife (CPM) is a professional independent midwife certified by the North American Registry of Midwives (NARM) and adheres to the Midwives Model of Care. CPMs are not required to hold a nursing degree or other credential. A Certified Midwife (CM) is a midwife certified by the American Midwifery Certification Board (AMCB). The CM role was created in 1997 in order to expand routes of entry to midwifery education. The CM program includes identical content in midwifery and women's health as the CNM program, but does not require a nursing degree. A Licensed Midwife (LM) is a midwife who is licensed to practice in a particular state. As of 2018, licensure for direct-entry midwives, such as Certified Professional Midwives, is available in 31 states.
The US Midwifery Education, Regulation, and Association (US MERA) is made up of individuals from seven national organizations: North American Registry of Midwives (NARM), Midwifery Education Accreditation Council (MEAC), Midwives Alliance of North America (MANA), National Association of Certified Professional Midwives (NACPM), American Midwifery Certification Board (AMCB), Accreditation Commission for Midwifery Education (ACME) and American College of Nurse Midwives (ACNM). These organizations have worked together since 2011 to “envision and work toward a more cohesive midwifery presence inspired and informed by global midwifery standards and competencies adopted by the International Confederation of Midwives in 2011.”
I hope you enjoyed learning a little bit about the herstory of midwifery in America. I encourage every healthy pregnant woman to seek the care of a midwife, no matter where you want to birth your baby. Midwives today, no matter their route of entry, are very well trained and will do their best to provide you with an unforgettable birth experience.
Sara Liebling, CNM, APRN
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