The evolution of professional obstetric nursing in the United States (1880's-present): Qualitative content analysis of specialty nursing textbooks

Abstract

Background: Professional maternal-newborn/obstetric nursing in the United States emerged in the mid- 19th century coinciding with the increased medical management of childbirth. Before this mothers were attended by female family members, friends, neighbors and lay nurses or midwives.

Objective: To trace the evolution of professional maternal-newborn/obstetric nursing since its inception, identify factors which may have influenced this evolution, and consider how this knowledge can inform current issues and challenges in caring for childbearing families.

Methods: Qualitative content analysis, informed by historical research methods, was used to analyze selected content from a sample of maternal-newborn/obstetric nursing textbooks published from the 1880's to the present.

Findings: The last 150 years have been characterized by vast changes in medicine, technology and the healthcare system which have all influenced the evolution of professional maternal-newborn/obstetric nursing. Over the decades there has also been a significant change in the conceptualization of pregnancy/childbearing and our relative understanding of maternal and infant vulnerability. Findings revealed, however, that over time the primary focus of professional maternal-newborn/obstetric nursing care has consistently been: "protection, counseling/teaching and support" of childbearing families. In the U.S. maternal-newborn/obstetric nurses currently face many challenges including caring for an increasingly diverse patient population within a complex, technologically advanced healthcare system. This system is characterized by a high rate of cesarean section births, frequent intervention in vaginal births, disparities in access to care, and a high rate of preventable morbidity and mortality.

Conclusions: Since its origins the nursing profession has matured and nursing's allegience is now clearly to patients and society Today's nurses have the opportunity to play a key role in advocating for healthcare reform which would allow for less interference in the natural birth process, maximize patient outcomes, decrease inequities, and make comprehensive care for all mothers and infants a national priority.

Keywords: History; Infant; Newborn; Nursing; Obstetrics; Pregnancy.