Perspectives on the past, view of the present: relationship between nurse-midwifery and nursing in the United States

Abstract

Relationships between U.S. nurses and nurse-midwives developed during the Progressive Era around two major points: the knowledge that lower maternal and infant mortality in England and Europe was associated with well-educated midwives, and the desire of some nursing leaders to substitute nurse-midwives for traditional midwives. In the process, traditional midwives were labeled dirty and dangerous and the practice of nurse-midwifery was marginalized. At the same time, research on nurse-midwifery showed excellent maternal and infant outcomes at the only two demonstration sites where nurse-midwifery was practiced between 1925 and 1941. This data helped the Children's Bureau and MCA push the expansion of nurse-midwifery in the South and Southwest. As their numbers expanded, nurse-midwives organized nationally within the national public-health nursing association. When the association merged with other nursing organizations, however, nurse-midwives were denied their request to maintain an autonomous section on the grounds that they practiced medicine. This rejection caused a split between nursing and nurse-midwifery that continues to affect interactions between the two groups of professionals. In the 1970s, the ANA, which by now supported the nurse practitioner role, embraced nurse-midwifery as an extension of nursing practice. This permitted regulation of nurse-midwifery under nurse-practice acts in all but a handful of states. Unfortunately, in the majority of these states nurse-midwives were not named in statute and their practice became legally invisible. Today, many state boards require a master's of nursing for licensure even though research has shown no difference in certification exam scores between master's- and nonmaster's-prepared nurse-midwives. During the 1970s, middle-class women began to seek the services of a new group of apprentice-trained midwives, and, eventually, these midwives created their own national organization. In the early 1990s, the two national midwifery organizations met formally to craft recommendations for the education and certification of non-nurse midwives and a single standard of midwifery care. Although both organizations had developed processes for accrediting educational programs and certifying non-nurse midwives, the job of drafting a single standard of care remains incomplete. As a result, one of the major tasks facing U.S. nurse-midwives is the need to redefine their relationships with both nursing and apprentice-trained direct-entry midwives. Completion of this task holds the promise of boosting the public image of midwifery, elevating the place of midwives in the care of women and infants, and improving maternal and child health outcomes in America.