Nurse-midwifery emerged during the first three decades of the 20th century out of the vision of public health nurses who pioneered in the creation of prenatal care. Pursuing professional self-interest and a desire to decrease maternal and infant mortality, they joined obstetricians in a campaign to eliminate the traditional midwife. In pursuit of these goals, they ignored the reality that traditional immigrant and African American midwives had better maternal outcomes than the general practitioners delivering babies at that time.
Traditional midwives' role in the management of birth declined as a result of decreased immigration, Americanization of immigrant women, and the campaign to end their practice. By the 1930s, physicians managed 85% of all laboring women. Except for African American women in the South, who had no option but traditional midwives, and women served by FNS in Hyden, Kentucky, and MCA in New York City, women did not have access to midwifery care.
That began to change in the 1940s when the profession entered a period of sustained expansion. Nurse-midwifery achieved national recognition as a specialty as the result of three main factors: 1) expanding access to health insurance, 2) reemergence of a childbirth movement demanding the kind of care nurse-midwives championed, and 3) a shortage of obstetricians. Initially, this expansion occurred as a result of the shortage of obstetricians during the post-World War II baby boom, combined with women's demands for natural childbirth. In response, hospitals opened limited opportunities for nurse-midwives to provide childbirth education and clinical care to pregnant and birthing women. In addition, public health leaders from the Children's Bureau, health departments, foundations, and Maternity Center Association created new nurse-midwifery practices and new educational programs to meet the health care needs of women in the South and Southwest. In the process, they pioneered the homelike free-standing birth center, which would later become important in attracting middle-class women to nurse-midwives and in developing the autonomy of the profession.
Building on this foundation, nurse-midwifery would make major advances in subsequent decades. Initially organized within the National Organization of Public Health Nursing in 1944, nurse-midwives would later form their own national organization to set and maintain professional standards. In the 1950s, nurse-midwives would enter major teaching hospitals as clinical practitioners of midwifery care, but it would take until the 1960s and beyond for the profession to significantly increase the number of educational programs and to have a clinical presence in hospitals in most states in the United States. This move into the hospital would come at a price: the closure of most home birth and birth center services, including those in Georgia, Santa Fe, and New York City. It would not be until the 1970s that nurse-midwives would again follow the path of their founders and create institutions specifically for the practice of midwifery. What is important to recognize is that the major advances in the second half of the 20th century were possible only because of the carefully executed beginnings and the early expansion in the pivotal decade of the 1940s.
Funding for this research came from the National Institute of Nursing Research grant NR07445 and the Kurz Family Foundation.
Address correspondence to Katy Dawley, 235 Pelham Road, Philadelphia, PA 19119-2624, USA.
J Midwifery Womens Health. 2003;48(2) © 2003 Elsevier Science, Inc.
Cite this: Origins of Nurse-Midwifery in the United States and Its Expansion in the 1940s - Medscape - Mar 01, 2003.