Origins of Nurse-Midwifery in the United States and Its Expansion in the 1940s

Katy Dawley, CNM, PhD


J Midwifery Womens Health. 2003;48(2) 

In This Article

Nurse-Midwives Begin to Offer Care to Middle-Class Women

Changes in women's self-concept during World War II, after the war, and throughout the postwar baby boom preceded nurse-midwifery's expansion into care of middle-class women. Newly independent women carried their desire to control their own destiny into the health care arena. Combined with the move of birth into the hospital. women's health activism created changes in the way women wanted to experience birth and opened doors for nurse-midwifery.

In 1940, most women were given the amnesiac "twilight sleep" for pain relief and had no memory of their baby's birth. By the end of the decade, both lay women and health professionals began to reject "twilight sleep" secondary to growing concern about adverse effects on both women and their newborns. Nurse-midwives were active participants in, and benefited from, this movement which fostered women's participation in childbirth.[1,61,62,63,64,65]

In his 1944 Childbirth Without Fear, Grantly Dick-Read, an English obstetrician, advocated education about the processes of birth and techniques of relaxation to break the fear/tension/pain cycle of parturition.[66] His teachings spoke directly to the nurse-midwives at MCA, whose mission included education of women and families about physical changes of pregnancy, fetal development, and preparation for labor and birth. MCA offered pregnancy classes for both mothers and fathers at its New York clinics, produced patient education materials for nationwide distribution, and conducted classes in parent education for nurses around the country.[55] The Association began educating nurses and parents about Dick-Read's method of natural childbirth, which included techniques to be used by women in labor to eliminate pain and decrease the need for anesthesia. This stimulated the introduction of natural childbirth and family-centered care into hospital obstetric programs and further set the stage for the expansion of nurse-midwifery.

In January 1947, MCA arranged to bring Grantly Dick-Read and colleague Helen Herdman, a physiotherapist who designed exercises to assist with relaxation in labor, to America for a speaking engagement at MCA's annual meeting and for a nationwide tour. Interest in Dick-Read's method spawned MCA classes in natural childbirth education for obstetric nurses, first in New York City and then around the country. Having read and discussed Dick-Read's book, wives of Yale University students arrived at Grace New Haven Hospital determined to have unmedicated childbirths. Their requests stimulated interest among physicians and nurses, and MCA and Yale instituted a joint project to research the feasibility of introducing education for childbirth in both clinic and private services.[67]

Beginning in 1947, this pilot project provided the first opportunity for nurse-midwives to work under their professional title in a major university hospital. In support of this 2-year research program, MCA provided fellowships for Helen Herdman, two physicians associated with the project, and six nurse-midwives to oversee the integration of natural childbirth into the clinic and hospital system. During her stay at Yale, Herdman taught physicians and nurses the exercises she had developed for natural childbirth. Nurse-midwives each had a 6-month fellowship at the hospital. In this capacity, they taught childbirth classes, supported women during labor, provided postpartum education, and educated nurses, physicians, and medical students in the Dick-Read method. Husbands were part of the labor support team and helped care for their babies after birth in the newly instituted rooming-in program.[68] In her final report, one of the nurse-midwives said, "I saw ... average women applying themselves with a quiet confidence. ... I saw them meet [labor] squarely, without panic. And what I saw in their faces afterwards was simply the look of glowing pride in their own accomplishment."[69] The program, which educated slightly more than 500 women, was so successful that at the end of 2 years it was made available to all women using the hospital, and in 1952 MCA began a similar 2-year partnership with Columbia Presbyterian Hospital in New York City.[70]

Women throughout the United States were introduced to natural childbirth, rooming-in, and the Grace New Haven Program through pictorial essays in national publications such as Reader's Digest,[71]Life,[72] and Today's Woman,[73] each of which followed a woman through her prenatal classes and the birth experience. The message of these articles was that this was a better way to birth a baby. Modern Romances[74] also had first person accounts by women who used Dick-Read's natural childbirth techniques to birth their babies. In the words of one, " ... when my baby came into the world I felt a deep, all pervading, glorious joy. ... I was happy beyond words."[74] Although the joint programs together served less than 1,000 women, knowledge of natural childbirth reached millions of women all over the country through these articles in popular magazines and prompted them to seek out education for natural childbirth.

Nurse-midwives integrated family-centered care and education for natural childbirth into their mission. In 1954, the Committee on Organization, which was responsible for founding the American College of Nurse-Midwifery, defined the functions of the nurse-midwife. These functions were heavily weighted toward involvement of the father through family-centered care and the education of parents so they could participate fully in labor and approach childbirth with "security and anticipation."[75] In fact, several respondents to a questionnaire suggested that more emphasis be given to this educational role in the definition of the nurse-midwife.[75] In 1955, MCA convened a meeting of newly formed parents organized childbirth education groups. The International Childbirth Education Association was formed 5 years later, in part, as a result of this conference.[1]

Nurse-midwives, obstetric nurses, enlightened physicians, and childbearing women who pioneered in the movement for natural and family-centered birth were part of a larger women's movement to regain control of birth. In the process, nurse-midwifery was recognized as a specialty that encouraged the participation these advocates sought, and the profession entered a period of major expansion.


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