Article Title:

Midwives-An Old Profession, a New Alternative

Summary:
The word “midwife” comes from the old English vernacular and means “with woman.”
Midwives have been helping women give birth for centuries. Ancient Hindu record
s, Greek and Roman manuscripts, and even the Bible all mention midwives. Their p
resence in history, in essence, hasn’t diminished. However, today midwives are t
hought of as an ancient practice that has been resurrected in the face of the “a
lternative medicine” popularity.
Keywords:
Certified nurse midwives
Article Text:
Midwives - An Old Profession, a New Alternative
Midwives New York
Co-Editor-in-Chief, Tracy E. Austin, MD
Wednesday, March 10, 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, t
o be a midwife. Not all countries had laws this strict, however. English midwive
s received little formal training and it was not until 1902 that the country req
uired 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 p
rofession emerged, women (originally called healers) could not attend the univer
sities 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 co
uld see possible patients slipping through their fingers and thus began their at
tack 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 pass
ed laws banning midwives. This necessitated the foundation of the first nurse-mi
dwifery school in 1932. The idea was to incorporate the necessary medical traini
ng 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 accre
dited school. Some of them have a master’s or doctoral degrees. A CNM has comple
ted both nursing and midwifery training. The American College of Nurse Midwives
certifies them once they pass both state and national licensing exams. Ninety-si
x 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 existe
d since 1996, there are not many CMs and many states do not recognize this certi
fication.
A lay or direct-entry Midwife (DEM) does not have a college degree or certificat
e. 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 cert
ified or licensed but trained informally, through apprenticeship or self-study.
The North American Registry of Midwives certifies A Certified Professional Midwi
fe (CPM) after passing written exams and hands on skill evaluations. Both a cert
ified nurse- midwife and direct-entry midwives can apply for this certificate. T
hey are required to have out-of-hospital birth experience and usually practice a
t 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 mo
nitor the physical, physiological, and social well-being of the patient. They en
courage the mothers to trust their own instincts and seek out the answers they n
eed to help them make those decisions.
In a high-risk pregnancy, a doctor should be available and the baby should be de
livered in a hospital. A midwife sometimes encourages physical positioning durin
g labor. Physical positioning includes such ways as walking around, showering, r
ocking, or leaning on a birthing ball. Unlike doctors, midwives allow the patien
t to eat and drink during labor.
Certified nurse-midwives use some more conventional medical interventions such a
s electronic fetal monitoring, pain medications, epidurals, episiotomies, if nee
ded. However, without a doctor present, midwives cannot use these tools. Birthin
g centers may or may not be equipped with these items. Midwives cannot give a ce
sarean section. If the patient needs a c-section, the midwife must call an obste
trician 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 pediatr
ician 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 sens
e of trust and serenity enough that the patient only requires a minimal amount o
f pain relievers.
If the patient has had prior problems in childbirth, is expecting multiple birth
s, or has a medical problem such as diabetes or high-blood pressure, doctors rec
ommend 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 pa
tient. For referenced resourced information, go to http://www.smilemd.com/midwiv
es/an-old-profession-a-new-alternative.aspx
Resources:
SmileMD Inc global publishing headquarters - Midtown Manhattan, New York. Nevill
e Coward, Chairman & CEO. http://www.smilemd.com instantly schedules nationwide
online medical and dental appointments for <a href="http://www.smilemd.com/blog/
article.aspx">doctors, dentists and certified nurse midwives new york</a>. Patie
nt versions of medical & dental articles are library referenced for online publi
cation by co-editors-in-chief Judy J. Johnson DDS and Tracy E. Austin, MD. Dr. J
ohnson is a member of The New York Academy of Cosmetic Dentistry. Dr. Austin is
a member of the A.M.A., American Medical Writers Association and the Association
of Health Care Journalists.