Midwifery Practice and Education

Current Challenges and Opportunities

Deborah Walker, DNSc, CNM, FACNM, FAAN; Barbara Lannen, MSN, CNM; Debra Rossie, MS, CNM


Online J Issues Nurs. 2014;19(2) 

In This Article

Abstract and Introduction


Midwifery clinical practice and education has changed significantly since Mary Breckinridge first introduced nurse-midwives to the United States in 1925. This article discusses current challenges in midwifery clinical practice and education and proposes possible solutions. Midwifery clinical challenges include restrictive legislation and business-related barriers, including but not limited to physician supervision restrictions, prescriptive authority, out-of-hospital birth legislation, and third party reimbursement. Educational challenges highlighted include the current healthcare climate's influence on midwifery education, the contribution of clinical sites and preceptors, and the benefits of midwifery education.


Midwifery is an ancient profession still actively practiced throughout the world. In the United States, the first modern day nurse-midwives were British-educated women brought to this country by Mary Breckinridge in 1925. Their focus was to provide healthcare in the remote mountains of rural Kentucky (King et. al, 2013) for an organization that became known as the Frontier Nursing Service (FNS). The same year, the first school specifically established to educate nurse-midwives was established in New York City, the Manhattan Midwifery School.

From these early beginnings, the profession has grown to include 13,607 Certified Nurse-Midwives (CNMs), 87 Certified Midwives (CMs) (AMCB, 2014b) and 39 CNM/CM education programs (ACNM, 2012b). The current maternal-infant healthcare climate in the US is widely acknowledged to be in great need of modification with midwives being seen as key in returning birth care to a more normal, physiologic state that is woman-centered. Consequently, more needs to be done to realize the goal of every woman and family having access to midwifery care. Yet legislative, business, and education challenges to midwifery practice remain. Reviewing all the clinical practice and educational challenges is not within the scope or space limitations of this paper; thus, select current clinical practice and educational challenges as well as possible solutions are discussed.