Midwifery in the United States*Early history: midwives were mostly uneducated women and “granny midwives”, trainedthrough experience and folklore.*Mid to late 1800s, the philosophy of childbirth shifted from a community “women with women”focus to a medical, “physician with women” focus. By 1900, doctors attended approximately halfof all births in the United States; however midwives still attended births of lower-class, poorerwomen.*Early 1900s: despite efforts to eradicate midwifery, some midwives continued to practice.*1914: Dr. Fredrick Taussig suggested training nurses as midwives in response to the governmentsgrowing recognition of the need for maternity care, and the consequent increased availability ofgovernment funding for maternity care.*This resulted in the formation of several schools of nurse-midwifery, as well as establishment ofseveral community midwifery practices, notably the Maternity Care Association in New York andthe Frontier Nursing Service in Leslie County, Kentucky.*Since then, the profession of midwifery has continued to grow and expand! (Rooks, 1997)
Midwifery: Current Global TrendsThere are currently approximately 5,000 practicingnurse-midwives in the United States, and since 1975the number of nurse-midwives has continued to groweach year (Brigham and Women’s Hospital, 2011)!According to the World Health Organization (WHO), there is a critical globalshortage of “skilled birth attendants” (doctors, nurses or midwives). 34% of the world’s births occur at home without a trained medical professionalpresent. The World Health Organization cites midwifery as a key component of improvingglobal maternal and child health, and seeks to promote the profession on a globalscale!(WHO, 2011)
What is a midwife? A certified nurse midwife (CNM) is a licensed health care provider that is trained in both nursing and midwifery (ACNM, 2006). A certified midwife (CM), is also licensed, but is trained in midwifery only (ACNM, 2006). The professional organization for midwifery in the United States is the American College of Nurse-Midwives. CNMs and CMs are nationally certified by the American Midwifery Certification Board through a national midwifery certification exam. CNMs must complete a graduate school program prior to taking the examination. CNMs are licensed through each state’s Board of Nursing or Medical Board. Certification must be kept current! Recertification for competency of practice is completed every 5 years and approved both by the issuing state government of practice and by the American College of Nurse-Midwives.(ACNM, 2006; ACNM, 2010)
What do nurse-midwives do? They help women give birth in hospitals, birthing centers, and at home to approximately 300,000 babies per year. But that’s not all!!!! (ACNM, 2006)
What Else do Nurse-Midwives Do? They are primary care providers for women across their lifespan!*Nurse-midwives are trained not only to attend births, but to provide prenatal andpostpartum care.*Nurse-midwives are trained to provide prenatal, labor and birth, and postpartumcare…. as well as primary care services to women throughout the lifespan--adolescence,pre-baby, post-baby, all the way through menopause, and beyond!*Nurse-midwives are not limited to reproductive issues--they are trained to becompetent in general primary care of women! They can treat common ailments anddisorders, perform comprehensive physical exams, order medications andlaboratory/diagnostic tests, and provide comprehensive health and wellness education! *Nurse midwives also provide treatment of partners for sexually transmitted infections… *They can also provide normal newborn care for the first 28 days of a baby’s life! (ACNM, 1997; ACNM, 2010, Rooks, 1997)
Midwife-Led Care….Believes: That pregnancy and birth is a normal physiologicalprocess for women, not a disease or illness. Promotes: Compassionate and continuous partnership withwomen and their families for health care decisions Provides: Individualized woman and family-centered care,education, and empowerment to make care choices Is based on: Evidence-based care (ACNM, 2010)
Midwife-Led Care During Labor and Birth Midwives believe in attentive waiting for normal physiologicalprocesses during pregnancy and birth Midwives are trained in and use appropriate interventions andtechnology for existing or possible health issues Midwives collaborate and refer to other member of health carewhen needed to provide best possible health care Midwives believe in attendance during both labor and birth! (AABC, 2007)
Benefits of Midwifery Care*Reduced use of pain meds and epidural anesthesia *Reduced episiotomies *Increased chance of normal vaginal delivery*Shorter hospital stays for hospital birth experiences *Increased breastfeeding rates (AABC, 2007)
At a hospital… Choices, choices…. Where can I have At home... my baby? At a birth center…Midwives can be found in allthree places!
Hospital Risks 1.No control 2.Hospitals are associated with illness 3.Rules, policies, and red tape 4.Less privacy 5.Less involvement of father of baby 6.Birth usually managed by those trained in pathology not “natural” 7.Some separation of mother and baby 8.Not much rest for the motherBenefits1.Many mothers feel safe here2.Safest environment for complications3.No last minute transfers4.Only option for cesarean birth5.Immediate pediatric attention to the baby6.Round the clock care for mother and baby (Jones, n.d.)
Home BirthBenefits Risks1.Privacy and comfort of 1.Woman greatlyown home responsible for her own2.Complete control health3.No interventions 2.Negative4.Caregivers come to her judgment/social stigma5.Low cost 3.Emergency transport6.Often midwife may be necessaryattended 4.No analgesics 5.Not generally covered by insurance (Jones, n.d.)
Risks Birth Center 1. Rigid screening criteria 2. Transfers during labor or postpartum 3. No pediatricians on staff Benefits 4. No two to three day stays1. Family centered care2. Home-like setting3. Support and respect4. Safe and secure5. Balance of human touch andtechnology6. Time7. Part of a healthcare system8. Covered by most insurancecompanies9. Midwife attended birth (Jones, n.d.)
More About Birth Centers... Birth centers offer a safe and acceptable alternative place for healthy pregnant women to deliver and have births. Birth centers have a proven track record of safety with midwife care in a comfortable home like environment. Birth centers are cost effective and affordable for patients. Birth centers provide a full range of family care services from well woman care, pregnancy, and postpartum newborn care. (ACNM, 2010)
Safety of Birth Centers Results from National Birth Center Study demonstrated that Birth Centers have a reduced C-section rate of 4.4% Reduced intrapartum and neonatal mortality rate of 1.3 per 1000 births Low neonatal mortality rate of 0.8/1000 births and 2.3 per 1000 if after 42 weeks pregnancy Clients’ overall satisfaction rate of care in all birth centers rated at 98.8% (AABC, 2010) (Rooks et al., 1989)
Frequently Asked Questions…What if there are birth complications? Midwifery as a profession has a deep respect for the natural process ofchildbirth and advocates for a non-interventional approach in the case of uncomplicated childbirth. However, midwives are trained in the use of medical or technical interventions in the case of birth complications!The ACNM promotes a risk-benefit decision making process that includes the woman as a key decision maker.Midwives are also expected to collaborate and refer to physicians, when needed, for more specific care (see next slide….) (ACNM, 1997)
Frequently asked questions…How do midwives and doctors work together? Midwives and doctors each have unique roles in caring for women! The focus of a physician or obstetrician is often on disease; the focus of a midwife is on “normal” (on health and wellness). While midwives focus on wellness and normal pregnancy, not every pregnancy is normal! Nurse-midwives are expected to “consult, collaborate or refer” with/to physicians and other health care team members when complications arise (ACNM, 1997). Additionally, physicians can take advantage of the midwife’s expertise in “normal”…. Care of women should be a team effort!
Frequently Asked Questions…. What about pain relief during labor and birth?*Midwives are trained to help women through the labor andbirth process….*This includes learning pain relief strategies!*Midwives can prescribe medications for pain relief in labor, ifneeded, to complement other strategies for pain relief. (Varney, Kriebs, & Gregor, 2004)
Frequently Asked Questions…. What defines midwifery practice?“*Recognition of pregnancy, birth, and menopause as normal physiologic and developmental processes*Advocacy of non-intervention in the absence of complications*Incorporation of scientific evidence into clinical practice*Promotion of family-centered care*Empowerment of women as partners in health care*Facilitation of healthy family and interpersonal relationships*Promotion of continuity of care*Health promotion, disease prevention, and health education*Promotion of a public health care perspective*Care to vulnerable populations*Advocacy for informed choice, shared decision-making, and the right to self-determination*Cultural competence*Evaluation and incorporation of complementary and alternative therapies in education and practice*Skillful communication, guidance and counseling*Therapeutic value of human presence*Collaboration with other members of the health care team.”(ACNM, 2008)
For more information about midwifery-related care: Please visit:*www.mymidwife.org *www.midwife.org*www.birthcenters.org
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ReferencesAmerican College of Nurse Midwives (1997). Position statement: Collaborative management in midwifery practice for medical, gynecological and obstetrical conditions. Retrieved from http://www.midwife.org/index.asp?bid=59&RequestBinary=TrueAmerican College of Nurse Midwives. (2006). Share with women: What is a midwife? Journal of Midwifery and Women’s Health. Retrieved from http://www.midwife.org/siteFiles/news/sharewithwomen51_5.pdfAmerican College of Nurse Midwives (2008). Core competencies for basic midwifery practice. Retrieved from http://www.midwife.org/index.asp?bid=59&RequestBinary=TrueAmerican College of Nurse Midwives (2010). Accreditation and certification for midwives. Retrieved from www.acnm.orgAmerican Association of Birth Centers. (2007). www.BirthCenters.org. Retrieved from http://www.BirthCenters.orgCenter for Disease Control and Prevention (1998). New study shows lower mortality rates for infants delivered by certified nurse midwives. Retrieved from http://www.cdc.gov/nchs/pressroom/98news/midwife.htmCenter for Disease Control and Prevention (2003). Quick stats: Percentage of births attended by midwives. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5504a7.htm
References (continued)Declerq, E. (2011). Trends in midwife-attended births: 1989-2007. Journal of Midwifery and Women’s Health, 56(2), 173-176.Jones, P. (n.d.). Advantages and disadvantages of birthing at home, birth center, and hospital. Retrieved from http://www.houstonnaturalbirth.com/adv_homebirth.shtmlMidwifery Facts (2011). Retrieved October 12, 2011 from http://www.choicemidwives.org/?page_id=16Morrison, S. S. (1998). Evaluation of caesarean sections in women in a collaborative practice setting: Comparison of certified nurse midwives and physicians dissertation, California State University, United States. Retrieved from http://proquest.umi.com.ezproxy.midwives.orgRooks, J. P. (1997). Midwifery and childbirth in America. Philadelphia, PA: Temple University Press.Rooks, J., Weatherby, N., Earnst, E., Stapleton, S., Rosen, D., & Rosenfield, A. (1989). Outcomes of Care in Birth Centers. The National Birth Center Study.The New England Journal of Medicine, 321(26): 1804-1811.Varney, H., Kriebs, J. M., & Gegor, C. L. (2004). Varney’s Midwifery (4th ed.). Sudbury, MA: Jones and Bartlett.World Health Organization (2011). Making pregnancy safer. Retrieved from http://www.who.int/making_pregnancy_safer/topics/skilled_birth/en/index html