Midwives-An Old Profession, a New Alternative

Midwives New York
Co-Editor-in-Chief, Tracy E. Austin, MD
Thursday, January 21, 2010 - 07:01 PM


An Old Profession, a New Alternative

The word “midwife” comes from the old English vernacular and means “with woman.”
Midwives have been around for centuries. Ancient Hindu records, Greek and Roman manuscripts, and even the Bible all mention midwives.

By 1560, Parisian midwives were required to pass a test, and obtain a license, to be a midwife. Not all countries had laws this strict, however. English midwives received little formal training and it was not until 1902 that the country required a license. America adopted the English model of midwifery.

Midwifery History

Early American midwives learned their craft through apprenticeship and tradition. Midwives did not receive any training in medicine or hygiene. As the medical profession emerged, women (originally called healers) could not attend the universities that trained doctors.

In many cases, these midwives were more proficient than the new doctors. In 1910, midwives delivered about half the babies born. Most of these babies were from poor, working class immigrants, or black families. The emerging obstetricians could see possible patients slipping through their fingers and thus began their attack on the midwives.

A Bad Reputation

The medical society did not feel that women could handle all of the information that a doctor needed to know. Publicly, the obstetricians launched an attack on the midwives using science and restructuring skills. They claimed that midwives were “hopelessly dirty, ignorant, and incompetent.” However, the midwife treated the mother and child, taking into consideration the needs of both.

Obstetricians of the day, wanted to use their newly learned surgical techniques even when endangering the patients. The midwives were the more competent of the two but the medical profession had the power and clout so state after state passed laws banning midwives. This necessitated the foundation of the first nurse-midwifery school in 1932. The idea was to incorporate the necessary medical training into the midwifery’s traditional training.

Modern Midwives

Midwives today come from many different types of backgrounds. The subtitle that a midwife uses indicates her level of education and training.

A Certified Nurse-Midwife (CNM) has a minimum of a bachelor’s degree by an accredited school. Some of them have a master’s or doctoral degrees. A CNM has completed both nursing and midwifery training. The American College of Nurse Midwives certifies them once they pass both state and national licensing exams. Ninety-six percent of births in a hospital are assisted by a CNM.

A Certified Midwife (CM) has trained in midwifery, but is not a registered nurse. They meet practice standards of the North American Registry of Midwives. They possess at least a bachelor’s degree. Because this certification has only existed since 1996, there are not many CMs and many states do not recognize this certification.

A lay or direct-entry Midwife (DEM) does not have a college degree or certificate. Not every state requires them to work with doctors or allows them to practice. They usually practice in homes or non-hospital birth centers.

Direct-entry midwives have probably trained through an apprenticeship, workshops, formal instruction, or any combination of the three. A lay midwife is not certified or licensed but trained informally, through apprenticeship or self-study.

The North American Registry of Midwives certifies A Certified Professional Midwife (CPM) after passing written exams and hands on skill evaluations. Both a certified nurse- midwife and direct-entry midwives can apply for this certificate. They are required to have out-of-hospital birth experience and usually practice at home or birth-centers. The legal status varies according to state.

What Midwives Do

Throughout the patient’s pregnancy, a midwife counsels the mother-to-be. They monitor the physical, physiological, and social well-being of the patient. They encourage the mothers to trust their own instincts and seek out the answers they need to help them make those decisions.

In a high-risk pregnancy, a doctor should be available and the baby should be delivered in a hospital. A midwife sometimes encourages physical positioning during labor. Physical positioning includes such ways as walking around, showering, rocking, or leaning on a birthing ball. Unlike doctors, midwives allow the patient to eat and drink during labor.

Certified nurse-midwives use some more conventional medical interventions such as electronic fetal monitoring, pain medications, epidurals, episiotomies, if needed. However, without a doctor present, midwives cannot use these tools. Birthing centers may or may not be equipped with these items. Midwives cannot give a cesarean section. If the patient needs a c-section, the midwife must call an obstetrician to perform the procedure. Certified midwives train in basic life support for newborns, so if the need arises they can care for the baby, until a pediatrician arrives.

Patients of midwives use fetal monitoring less often and very often do not need epidurals, episiotomies, and c-sections for a successful delivery. In part, this is because midwives only see low risk patients, but researchers think that the attitude a midwife brings to the situation helps to ease the patient into a sense of trust and serenity enough that the patient only requires a minimal amount of pain relievers.

If the patient has had prior problems in childbirth, is expecting multiple births, or has a medical problem such as diabetes or high-blood pressure, doctors recommend that the patient use a doctor for delivery. Certified nurse-midwives, who work closely with doctors and operate in a hospital, can take on a high-risk patient. For referenced resourced information, go to http://www.smilemd.com/midwives/an-old-profession-a-new-alternative.aspx