A History of “Nurse” in Nurse-Midwife

Frontier Nursing Stories

Frontier Nursing Service

Nurse-Midwifery was introduced to the United States from England in 1926 in response to a need for maternity services in the Appalachian Mountains of Kentucky.  Mary Breckinridge had founded the Frontier Nursing Service (FNS) which was staffed by nurse-midwives trained in Great Britain.  These midwives were recruited to the United States to provide care for the under-served in the mountain districts of the eastern U.S.  Upon arrival, each midwife was assigned a log cabin and would travel a five-mile radius to care for the families in her specific district. Traveling on horseback, each midwife provided prenatal care, delivery care, pediatric/infant care and preventative care to the population in her designated area.*  The Frontier Nursing Service, now known as Frontier Nursing University, also offered to educate nurse-midwives, which continues today.

Maternity Center Association of New York       

  Several years after the founding of the FNS, the Maternity Center Association of New York established a school to teach midwifery to public health nurses for the purpose of supervising immigrant and rural midwives who were practicing at the time. 1 In these early days, certified nurse-midwifery became an adjunct to the New York City public health service, which evolved from a tradition of professional nursing.

Lay Midwives Were Women of Color

The “lay” midwife was an independent practitioner following traditions of lay healers from their communities or countries of origin.  The lay midwives were primarily women of color and, at this time, there was a dedicated public health effort to discredit them and force them from practice.  Behind these efforts were the practicing physicians and MCA nurse-midwives.**

       Although nurse-midwives, at this point in history, were trained in a traditional, nurse-to-doctor relationship, physicians rarely provided in-person supervision.  Nurse-midwifery practice was confined to women existing within a depressed economic demographic and physician practitioners generally confined their practice to middle and upper class families. 

Middle Class Women Decide They Want Midwives

Of interest, when middle-class women began to demand  nurse-midwifery services, the nurse-midwife became an economic competitor of the physician, a situation that was unacceptable to American physicians practicing the novel specialty of “obstetrics”. Physician outrage was directed in ways to demean and belittle midwifery competency, resulting in growing hostility toward the profession of nurse-midwifery.  In this atmosphere, midwives began to feel the negative impact of their dual identities as nurse and midwife. 2 Unfortunately, economic tensions, competition, and power struggles are still part of the CNM-physician dynamic.

Museums Victoria

         Historically, legislatively, and professionally, certified nurse-midwifery has been associated with nursing and public health.  Currently, States vary on the regulation of CNMs/CMs.  While the majority of States regulate CNMs and CMs under State Nurse-Practice Acts, fewer regulate the profession by Medical Boards and Departments of Health.  At present, only one State, Utah has a dedicated regulatory committee which is independent of the practice of nursing.

1. A Social and Legal Analysis of the Independent Practice of Midwifery.   Vicarious Liability of the Collaborative Physician and Judicial Means of Addressing Denial of Hospital Privileges. 2 Berkely Journal of Gender Law and Justice.  September 2013. Women’s Law Journal 139 (1986). Available at: http://scholarshiip.law.berkely.edu/bjlj/vol2/iss/5.

2. Supra note 18 at 143.

* The Color of Nurse-Midwifery

** Maternity Center Association from What Happened to Midwifery in America?

http://midwivesontrial.com