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MIDWIFERY AS A PROFESSION.
Term Paper ID:28563
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Development of the profession. U.S. & European historical roots. Nurse-midwifery education & role in health care system. ACNM goals. Current challenges.... More...
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Paper Abstract:
Development of the profession. U.S. & European historical roots. Nurse-midwifery education & role in health care system. ACNM goals. Current challenges.
Paper Introduction:
MIDWIFERY AS A PROFESSION
Introduction
This research paper will address the development of midwifery as a profession. The introduction will discuss the definition of midwifery and profession, and an overview of the profession. The development of the midwifery profession will then be presented to include: U.S. historical roots and European antecedents; the importance of education in competency and practice; additional cultural, social, legal, political, and economic influences; ACNM actions and results; and current challenges that nurse-midwives face.
Definitions
Profession is defined by the Merriam Webster's Collegiate Dictionary, 10th edition, as "A calling requiring specialized
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It is concluded by some thatmultiprofessional education may lead to a more cohesive practice amongthese professionals (Fraser, Symonds, Cullen, & Symonds, 2 , p. Ashford, J. Midwifery as a Profession Although the numbers of CNMs that attend hospital births in the U.S.has grown from 19,686 in 1975 to 196,977 in 1994, in Europe, midwives arethe principal attendants for 75% of the births (Gabay & Wolfe, 1997, p.386). 67-69). Kraus further points out that these clear definitions alleviateconfusion that exists regarding the many terms used to describe thisprofession. Results of the AEO are that as of 1996, 17 have completed the pilotprogram and 15 have been certified and entered the practice of nurse-midwifery. 61). Characteristics of nurse-midwife patients and visits, 1991.American Journal of Public Health, 89(6), 9 6-9 9. Initially midwifery wasdominated by foreign-trained or informally trained midwives. Hogan, A. The use of the multiple choice format, instead of the essayformat, has allowed for the examination of larger numbers of candidates, anincrease in areas of information, and feedback about exam performanceresulting from educational programs. at onepoint and then tended to disappear by the 193 s. (2 ). F., & McCool, S. The Church often licensedmidwives in Europe. 7). The effects of maternalmortality reach the individual, the family, and the society as a whole.Motherhood can be viewed as a prerequisite for national development(Rauyajin & Yoddumnern-Attig, 1993, p. Childbirth inEngland, 166 -177 . Economic pressures and a renovation of America's health care system,has led to methods of providing cost-effective health care. TheChronicle of Higher Education, 43(4), A16. Medical Teacher, 22(2),179-183. Recent actions ofthe ACNM include the following: The Assured Equivalency Option (AEO), amechanism to assist the education of nurse-midwives in other countries; therationale for use of the multiple-choice format on the certificationexamination; the award of a time-limited credential; and decisionsregarding the development of guidelines for accreditation of non-nurse-midwifery education and credentials (Fullerton, Roberts, & Valhoff, 1996,p. McCool, W. At this time the scientific study of humananatomy and physiology, beginning around 15 , was not available to women(Ashford, p. 65-66; Rowlands, 1997, p. Women remained the voices in the Popular Health Movement of the 183 sand 4 s. The current need for more affordable maternity care by insuranceproviders and the public, has led to an increased demand for CNMs in theU.S. Alternatively, it is believed by others that midwifery declined dueto problems within the profession and changes in U.S. C. Nurse-midwifery is recommended as a needed solution for improvingquality health care with lower costs. B.(1999). The Midwives Alliance of north America (MANA) certified those whowere not nurses (Draus, 1997, p. Slattery, L. In the 196 s and 7 s, CNMs were legal in moststates. Once identified as abortionists, the midwifery discipline becameunder medical scrutiny and state control. has thehighest rate of obstetrical intervention and a problem with malpracticesuits. Priorto the 2 th century, midwives attended around 4 % of births in the U.S.,but by 195 this rate dropped to around 3%. This report is titled "Charting a Course forthe 21st Century: The Future of Midwifery" and it recommends thateducators, policy-makers and professionals need to consider reformsregarding midwife practice, regulation, credential, and education, as wellas their reimbursement. In 1955 the American College of Nurse-Midwiveswas founded in Washington, DC, which set the standards for nurse-midwiferyeducation and certification. Journal of Nurse-Midwifery, 42(4), 326-343. (1997). Feminism and nurse-midwifery, historical overview and current issues. 326). R. (1975). Midwifery education has determined the knowledge, skills, science,and art of midwifery. lags behind otherindustrialized countries that include midwives as a central part of thecare of most pregnant women. Stock-Morton, P. Every country in the European region has perinatal and infantmortality rates that are lower than the U.S., yet in 7 % of European birthsthere is no physician in the room. 322). Nurse-midwifery: The beneficialalternative. 19). A midwife does not have to be a nurse, however, midwiferyeducation must require or grant a baccalaureate degree. A tribute to the pioneers. In the early eighteenth and nineteenth-century, most individuals inAmerica sought women midwives for health care. A time-limited credential, issuedafter January 1, 1996, is valid for 8 years, and provides for continuedcompetency assessment. What's in a name, defining the profession ofmidwifery. 69;Anonymous, 1994, p. (1997). How nurse-midwives define themselves inrelation to nursing, medicine, and midwifery. Education & Midwifery As the profession was declining in the U.S., it was also growing asmidwifery responded to the demands of the medical and lay community. The 2 th century brought thegrowing medical profession to the forefront and the continued argumentagainst midwifery. Ethics and midwiferypractice. (199 ). Nation's Health, 29(5), 24. TheChildren's Bureau was established in 1912, which drew up a plan to protectmaternity and infancy; it included providing public health nurses forprenatal care. Managed care plans are urged to cover midwifery.The report concludes that the difficulty in recognizing midwifery resultsfrom the fact that physicians and midwives face the challenge of sharedauthority with different views regarding the birthing process (Anonymous,1999, p. Stock-Morton (1996) also reports that themidwife was not only to aid women bearing children, but also make decisionswhether to bear or not to keep the baby. T., Roberts, J. Knowledge was generated in universities and wasunavailable to the midwife, and the physician viewed pregnancy andchildbirth as needing intervention, much as an illness. In a populationsurvey, in 1991, it was established that 3 CNMs were in clinicalpractice, and 5.4 million visits to the CNMs included 2 % that were notrelated to pregnancy, and 7 % were from women and infants who had poorhealth care access or outcomes. Midwives provide most of the pre- andpostnatal care and they are the principal birth attendant at uncomplicatedbirths. The report points out that the U.S. Rauyajin, O., & Yoddumnern-Attig, 1993). L. Midwives around the world face the challenge of providing helpwithout harming the individual. As a result of these policies, an increase in ACNM membership hasbeen found, doubling the student membership, and increasing charter membersto 6,44 as of January, 1996. McMillen further states thatthis campaign became a "classic Progressive Era reform movement" with "Acoalition of private interest groups-physicians, female reformers, nurses,and journalists-of the native-born, white middle class identified aproblem, investigated and documented its extent in 'objective' reports, andmobilized to promote a state-sponsored solution." This reform was thoughtto be successful because it "channeled anxiety about female sexuality intosupport for the medical program of midwife control" (p. (1996). ACNM Actions & Results The ACNM has the goal of increasing education access for themidwifery practice and adherence to standards of quality for the quality ofthis education and the clinical practice of midwifery. ACNM accredited andpreaccredited nurse-midwifery and midwifery education programs, programinformation. 66). The introduction will discuss the definition of midwifery andprofession, and an overview of the profession. Anonymous. The history of midwifery in the UnitedStates. 322-326). They found more services, education, andindividualized care to be available (Lawrence, 1997, p. Instruments were used for caesareans and removal of impacted fetuses. (1997). The definition of midwife is distinguishedfrom the following definition of Traditional Birth Attendant (TBA), whichwas published by the World Health Organization in 1992: A person who assists the mother during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other traditional birth attendants (Kraus, Editorial). Mothering, 54, 64-72. Journal of Nurse-Midwifery, 34(6), 323-333. Scoggin, J. 326-7). M., & Johnson, T. While attempting to establish themselves in the early 2 thcentury, obstetricians viewed midwives as resulting in the field's lowstatus. Journal of Gender Studies, 6(3), 326-7. (1996). Currently the Division ofAccreditation (DOA) of the ACNM, is the accrediting agency for nurse-midwifery and midwifery education programs (Slattery & Burst, 1997, p.325). Priorto the 15 s, midwives always participated in births, and their skillswere handed down from generation to generation (Ashford, 199 , p. Midwifery wasmentioned in the Old Testament books of Genesis and Exodus as well as inthe writings of Greek and Roman physicians. Fraser, D., Symonds, M., Cullen, L., & Symonds, I. The Middle Ages also brought the beginning or recognition of thefield of medicine among the European wealthy. Definitions Profession is defined by the Merriam Webster's Collegiate Dictionary,1 th edition, as "A calling requiring specialized knowledge and often longand intensive academic preparation" (cited by Kraus, 1997). Paine, L. The MCA graduated around 12 nurse-midwives a year when it began.It soon became evident that one school was not enough to provide educationfor as many nurse-midwives as needed. O. With this lack of formal training and organization, midwiveshad difficulty adapting to the growth of society and its need for a moreadequate health care system (Anonymous, 1997, p. Social cost of maternaldeaths. A certified nurse-midwife (CNM) as one who is educated in both nursing and midwifery, and hasevidence of certification according to the requirements of the AmericanCollege of Nurse-Midwives. health care system needs toinclude midwifery as a component of comprehensive health care for women andfamilies. A16). J. It is concluded that these findings may bedue to the tendency for federal support of nurse-midwifery education thatfavors programs where graduates practice in undeserved areas, or thetendency for regulation and practice barriers to be less problematic inthese areas. Recentdevelopments in professional midwifery education and credentialing.Journal of Nurse-Midwifery, 41(4), 322-327. 326). Traditionally, the birthattendant has been an older women who has given birth herself and learnedabout the process from other women. This fact may help alleviate the fearthat obstetricians are safer than midwives. 395). Not either/or, but obstetricians andmidwives together. 323-7; Ashford, p. Journal of Nurse-Midwifery, 42(2), Editorial. Kraus, N. These nurses needed training in midwifery. In a recent Report on confidential Enquiries into MaternalDeaths, it was proclaimed that midwives, GPs and obstetricians need to worktogether in a collaborative way. Even thoughstatistics showed that mortality birth rates were higher with physicianattendance only, the culture favored scientific technology and doctors andbegan to fear the midwife (McCool & McCool, pp. Theprofession was unorganized and tended to work apart from the medicalcommunity. L., Lang, J. Journal of Nurse-Midwifery,41(1), 36-42. Wagner, M. 179). The advent of the complex societybrought with it the growth of the traditional birth attendant (TBA) into aprofessional midwife who earned her living by attending to births. Additional Cultural, Social, Legal, Political, & Economic Influences McMillen (1996) reports that midwives were common in the U.S. E., & Valhoff, W. Church controlleduniversities started to formally train physicians, who were upper-classmales. Thompson, J. (1999). MANA is a member of the ICM(Ashford, p. The development of themidwifery profession will then be presented to include: U.S. Fullerton, J. Following the Councilof Trent that consolidated the Catholic Reformation, midwives took an oathwhich included stipulations such as not using sorcery, and not aborting afetus (Ashford, p. 392). M. 65; Stock-Morton, p. Anonymous. 66; McCool & McCool, 1989, pp. Midwifery practice: An urgent need. Journal of Nurse-Midwifery, Summer, 6-11. (1997). (1989). 64; McCool & McCool, p. E., & Thompson, H. Rowlands, A. Meanwhile, the International Confederation of Midwives (ICM) wasformulated in Europe, and this group improved the midwifery servicesregarding availability, education, and regulation as a profession; it nowsets the standards for midwifery practice, worldwide (Ashford, p. Thus these changes are resulting inincreasing numbers of nurse-midwives working in today's health care system(Fullerton, Roberts, & Valhoff, pp. Settlers relied on midwivesfrom Europe who had continued to serve the poor, since very few Europeantrained male physicians joined settlers in America. In 199 , TheInternational Confederation of Midwives adopted the following definition ofMidwife: A person who, having been regularly admitted to a midwifery educational programme, duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery (Kraus, Editorial).The Board of Directors of the American College of Nurse-Midwives (ACNM)complies with this definition. Auniversity department merger of midwifery and obstetrics: A step on thejourney to enhancing interprofessional learning. Maternal death and disability is reportedto affect over three million women each year. In the early 16 s the French municipalities licensed midwives.Louise Bourgeois is a well-known Frenchwoman who practiced as a midwife for27 years, to the French court and the royal family. (1997). E., & Burst, H. Public Health Reports, 112(5), 395. Witchhunts at times began with the accusation of a midwife causing sterility ordeath of a newborn, or aiding abortion (p. Gabay, M., & Wolfe, S. Study examines why midwifery disappeared. 66). 69). Male surgeons were found predominantly in London. Itis argued that although these interventions resulted in fewer maternaldeaths during labor, more women tended to die of puerperal infections afterthe birth. 26; Thompson & Thompson, 1997, p.14). MIDWIFERY AS A PROFESSION Introduction This research paper will address the development of midwifery as aprofession. Thus the need for midwifery as a profession to decrease excessiveinterventions by obstetricians in the normal birth process (Wagner, 199 ,p. M., Strobino, D. References Anonymous. historicalroots and European antecedents; the importance of education in competencyand practice; additional cultural, social, legal, political, and economicinfluences; ACNM actions and results; and current challenges that nurse-midwives face. Mary Breckenridge started theFrontier Nursing Service in Kentucky in 1925, to train nurse-midwives. health care. To determine what is needed to insure professionalcompetency of the non-nurse-midwife, identification of knowledge, skills,and abilities of nurse-midwifes was determined and it was concluded thatthe education in basic midwifery must lead to no less than a baccalaureatedegree. Lawrence, H. I. 24). 6 ). Task force urges managed care plans to covermidwifery. Although nursing is helpful as a background formidwifery education, midwifery education rather than nursing educationprepares the midwife. Development of the Midwifery Profession U.S. World Health, 5 (2), 14-15. Midwifery care in 2 th century America. The Middle Ages brought regulations governing midwives; fear ofwitchcraft, magic, and the devil, led to the male-dominated Church'srequirement that midwives follow a moral code. Journal of Women's History, 8(1),6 -79. In1939 FNS opened a school of their own (Hogan, 1975, p. At the beginning of the 16 s, male physicians were beginning toattend difficult births. Current Challenges In European countries, the group of practicing midwives outnumberobstetricians, and they provide the primary health care for women withnormal pregnancy and birth. These findings point to the fact that midwifery is needed,not only for those pregnant women who can afford alternatives, but also forthose who cannot afford them (Paine, Lang, Strobino, & Johnson, 1999, pp.9 6-9 8). V. Further the U.S. This disappearance isthought to be in part, due to their being linked to abortion, byobstetricians. Historical Roots & European Antecedents Women have always helped one another give birth. Thus the role of midwife wasoutside the system of male dominance which was a disruptive force. By the end of theeighteenth century, men-midwives had grown in number and control in Europeand their domination of the health care system began to influencechildbirth in America (Ashford, p. (1997). (199 ). 326). Seventy five years of internationalcollaboration: A birthday for midwives. Women who have poor access to health services or expectpoorer outcomes are particularly benefitted by the CNM. Thus the war between physicians and midwives began and thisEuropean controversy led to the social belief that midwives needed to betrained in scientific methods and become part of the medical system(Ashford, pp. The MaternityCenter Association (MCA) was founded in New York City in 1915, and it tookover the Lobenstine Midwifery Clinic and School in Harlem in 1934 (Ashford,p. It is education that has developed and broughtmidwifery to its current level of professional status (Kraus, 1997). PublicHealth Reports, 112(5), 392. (1996). Public Health Reports, 112(5), 386-394. The ACNM initially certified only those candidates who were alsonurses. as well. In response to this demand, the ACNM is committed to increasing thenumbers of CNMs from 5, to 1 , ; this would allow for CNMs to bepresent at 1 % of U.S. births, by the year 2 1 (Scoggin, 1996). WIN News, 2 (3), 19. (1996). 64;McCool & McCool, 1989, p. In 1982 the Midwives Alliance of North America (MANA) wasformulated, which improved communication among midwives and established newguidelines for competency and safety. The making of man-midwifery. World Health, 46(3), 25-27. However, as men became trained and considered to be moreknowledgeable regarding health matters, and the American MedicalAssociation (AMA) was formed in 1948, the controversy between doctors andmidwives became present in the U.S. However, group discussions at aDepartment of Health Learning Together Conference, demonstrated conflictingattitudes between doctors and midwives, and studies show that women areaware of this conflict and do not like it. Control and limitation of midwives inmodern France: The example of Marseille. (1994). (1997). In 1993, theAmerican College of Obstetricians and Gynecologists (ACOG) brought forth aninitiative encouraging collaboratation between all modes of women's healthcare, including physicians and non-physician providers such as mid-wives.A 1995 study demonstrated that patients in collaborative practices reportedmore patient satisfaction. Midwives were then to report illegitimate births tothe church, baptize dying babies, and they were not to use herbal knowledgefor abortion or birth control. A report issued by a task force of the Pew Health ProfessionsCommission and the University of California San Francisco Center for theHealth Professions, states that the U.S. 44). CNMs have been shown to haveexcellent success rates, high levels of patient satisfaction, and less useof interventions. McMillen, L. Mothering,54, 69.----------------------- 13
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