1. Why
Midwifery?
Rachel Kendall,
Kristina Michael,
Tina Moreno,
& Angela Reynolds

2. Midwifery in the United States
*Early history: midwives were mostly uneducated women and “granny midwives”, trained
through experience and folklore.
*Mid to late 1800s, the philosophy of childbirth shifted from a community “women with women”
focus to a medical, “physician with women” focus. By 1900, doctors attended approximately half
of all births in the United States; however midwives still attended births of lower-class, poorer
women.
*Early 1900s: despite efforts to eradicate midwifery, some midwives continued to practice.
*1914: Dr. Fredrick Taussig suggested training nurses as midwives in response to the government's
growing recognition of the need for maternity care, and the consequent increased availability of
government funding for maternity care.
*This resulted in the formation of several schools of nurse-midwifery, as well as establishment of
several community midwifery practices, notably the Maternity Care Association in New York and
the Frontier Nursing Service in Leslie County, Kentucky.
*Since then, the profession of midwifery has continued to grow and expand!
(Rooks, 1997)

3. Midwifery: Current
Global Trends
There are currently approximately 5,000 practicing
nurse-midwives in the United States, and since 1975
the number of nurse-midwives has continued to grow
each year (Brigham and Women’s Hospital, 2011)!
According to the World Health Organization (WHO), there is a critical global
shortage of “skilled birth attendants” (doctors, nurses or midwives).
 34% of the world’s births occur at home without a trained medical professional
present.
 The World Health Organization cites midwifery as a key component of improving
global maternal and child health, and seeks to promote the profession on a global
scale!
(WHO, 2011)

4. What is a midwife?
 A certified nurse midwife (CNM) is a licensed health care provider that is trained
in both nursing and midwifery (ACNM, 2006).
 A certified midwife (CM), is also licensed, but is trained in midwifery only (ACNM,
2006).
 The professional organization for midwifery in the United States is the American
College of Nurse-Midwives.
 CNMs and CMs are nationally certified by the American Midwifery Certification
Board through a national midwifery certification exam. CNMs must complete a
graduate school program prior to taking the examination.
 CNMs are licensed through each state’s Board of Nursing or Medical Board.
 Certification must be kept current! Recertification for competency of practice is
completed every 5 years and approved both by the issuing state government of
practice and by the American College of Nurse-Midwives.
(ACNM, 2006; ACNM, 2010)

5. What do nurse-midwives do?
They help women give birth in hospitals,
birthing centers, and at home to
approximately 300,000 babies per year.
But that’s not all!!!!
(ACNM, 2006)

6. What Else do Nurse-Midwives Do?
They are primary care providers for women across their lifespan!
*Nurse-midwives are trained not only to attend births, but to provide prenatal and
postpartum care.
*Nurse-midwives are trained to provide prenatal, labor and birth, and postpartum
care…. as well as primary care services to women throughout the lifespan--adolescence,
pre-baby, post-baby, all the way through menopause, and beyond!
*Nurse-midwives are not limited to reproductive issues--they are trained to be
competent in general primary care of women! They can treat common ailments and
disorders, perform comprehensive physical exams, order medications and
laboratory/diagnostic tests, and provide comprehensive health and wellness education!
*Nurse midwives also provide treatment of
partners for sexually transmitted infections…
*They can also provide normal newborn care for
the first 28 days of a baby’s life!
(ACNM, 1997; ACNM, 2010, Rooks, 1997)

7. Midwife-Led Care….
Believes: That pregnancy and birth is a normal physiological
process for women, not a disease or illness.
 Promotes: Compassionate and continuous partnership with
women and their families for health care decisions
 Provides: Individualized woman and family-centered care,
education, and empowerment to make care choices
 Is based on: Evidence-based care
(ACNM, 2010)

8. Midwife-Led Care During Labor and Birth
 Midwives believe in attentive waiting for normal physiological
processes during pregnancy and birth
 Midwives are trained in and use appropriate interventions and
technology for existing or possible health issues
 Midwives collaborate and refer to other member of health care
when needed to provide best possible health care
 Midwives believe in attendance during both labor and birth!
(AABC, 2007)

9. Benefits of Midwifery Care
*Reduced use of pain meds and epidural anesthesia
*Reduced episiotomies
*Increased chance of normal vaginal delivery
*Shorter hospital stays for hospital birth experiences
*Increased breastfeeding rates
(AABC, 2007)

10. At a hospital… Choices, choices….
Where can I have
At home...
my baby?
At a birth center…
Midwives can be found in all
three places!

11. Hospital Risks
1.No control
2.Hospitals are associated with illness
3.Rules, policies, and red tape
4.Less privacy
5.Less involvement of father of baby
6.Birth usually managed by those trained in
pathology not “natural”
7.Some separation of mother and baby
8.Not much rest for the mother
Benefits
1.Many mothers feel safe here
2.Safest environment for complications
3.No last minute transfers
4.Only option for cesarean birth
5.Immediate pediatric attention to the baby
6.Round the clock care for mother and baby
(Jones, n.d.)

12. Home Birth
Benefits Risks
1.Privacy and comfort of 1.Woman greatly
own home responsible for her own
2.Complete control health
3.No interventions 2.Negative
4.Caregivers come to her judgment/social stigma
5.Low cost 3.Emergency transport
6.Often midwife may be necessary
attended 4.No analgesics
5.Not generally covered
by insurance
(Jones, n.d.)

13. Risks
Birth Center 1. Rigid screening criteria
2. Transfers during labor or
postpartum
3. No pediatricians on staff
Benefits 4. No two to three day stays
1. Family centered care
2. Home-like setting
3. Support and respect
4. Safe and secure
5. Balance of human touch and
technology
6. Time
7. Part of a healthcare system
8. Covered by most insurance
companies
9. Midwife attended birth
(Jones, n.d.)

14. More About Birth Centers...
 Birth centers offer a safe and acceptable alternative place for
healthy pregnant women to deliver and have births.
 Birth centers have a proven track record of safety with midwife
care in a comfortable home like environment.
 Birth centers are cost effective and affordable for patients.
 Birth centers provide a full range of family care services from
well woman care, pregnancy, and postpartum newborn care.
(ACNM, 2010)

15. Safety of Birth Centers
 Results from National Birth Center Study demonstrated that
Birth Centers have a reduced C-section rate of 4.4%
 Reduced intrapartum and neonatal mortality rate of 1.3 per 1000
births
 Low neonatal mortality rate of 0.8/1000 births and 2.3 per 1000
if after 42 weeks pregnancy
 Clients’ overall satisfaction rate of care in all birth centers rated
at 98.8% (AABC, 2010)
(Rooks et al., 1989)

16. Frequently Asked Questions…
What if there are birth complications?
Midwifery as a profession has a deep respect for the natural process of
childbirth and advocates for a non-interventional approach in the case of
uncomplicated childbirth.
However, midwives are trained in the use of medical or technical
interventions in the case of birth complications!
The ACNM promotes a risk-benefit decision making process that includes
the woman as a key decision maker.
Midwives are also expected to collaborate and refer to physicians, when
needed, for more specific care (see next slide….)
(ACNM, 1997)

17. Frequently asked questions…
How do midwives and doctors work together?
Midwives and doctors each have unique roles in caring for women! The
focus of a physician or obstetrician is often on disease; the focus of
a midwife is on “normal” (on health and wellness).
While midwives focus on wellness and normal pregnancy, not every
pregnancy is normal! Nurse-midwives are expected to “consult,
collaborate or refer” with/to physicians and other health care team
members when complications arise (ACNM, 1997).
Additionally, physicians can take advantage of the midwife’s expertise in
“normal”….
Care of women should be a team effort!

18. Frequently Asked Questions….
What about pain relief during labor and birth?
*Midwives are trained to help women through the labor and
birth process….
*This includes learning pain relief strategies!
*Midwives can prescribe medications for pain relief in labor, if
needed, to complement other strategies for pain relief.
(Varney, Kriebs, & Gregor, 2004)

19. Frequently Asked Questions….
What defines midwifery practice?
“*Recognition of pregnancy, birth, and menopause as normal physiologic and developmental processes
*Advocacy of non-intervention in the absence of complications
*Incorporation of scientific evidence into clinical practice
*Promotion of family-centered care
*Empowerment of women as partners in health care
*Facilitation of healthy family and interpersonal relationships
*Promotion of continuity of care
*Health promotion, disease prevention, and health education
*Promotion of a public health care perspective
*Care to vulnerable populations
*Advocacy for informed choice, shared decision-making, and the right to self-determination
*Cultural competence
*Evaluation and incorporation of complementary and alternative therapies in education and practice
*Skillful communication, guidance and counseling
*Therapeutic value of human presence
*Collaboration with other members of the health care team.”
(ACNM, 2008)

20. For more information about
midwifery-related care:
Please visit:
*www.mymidwife.org
*www.midwife.org
*www.birthcenters.org

21. Thank you for reading!
Please complete the
survey.

22. References
American College of Nurse Midwives (1997). Position statement: Collaborative
management in midwifery practice for medical, gynecological and
obstetrical conditions. Retrieved from
http://www.midwife.org/index.asp?bid=59&RequestBinary=True
American College of Nurse Midwives. (2006). Share with women: What is a
midwife? Journal of Midwifery and Women’s Health. Retrieved from
http://www.midwife.org/siteFiles/news/sharewithwomen51_5.pdf
American College of Nurse Midwives (2008). Core competencies for basic
midwifery practice. Retrieved from
http://www.midwife.org/index.asp?bid=59&RequestBinary=True
American College of Nurse Midwives (2010). Accreditation and certification for
midwives. Retrieved from www.acnm.org
American Association of Birth Centers. (2007). www.BirthCenters.org. Retrieved
from http://www.BirthCenters.org
Center for Disease Control and Prevention (1998). New study shows lower
mortality rates for infants delivered by certified nurse midwives. Retrieved
from http://www.cdc.gov/nchs/pressroom/98news/midwife.htm
Center for Disease Control and Prevention (2003). Quick stats: Percentage of
births attended by midwives. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5504a7.htm

23. References (continued)
Declerq, E. (2011). Trends in midwife-attended births: 1989-2007. Journal of
Midwifery and Women’s Health, 56(2), 173-176.
Jones, P. (n.d.). Advantages and disadvantages of birthing at home, birth center,
and hospital. Retrieved from
http://www.houstonnaturalbirth.com/adv_homebirth.shtml
Midwifery Facts (2011). Retrieved October 12, 2011 from
http://www.choicemidwives.org/?page_id=16
Morrison, S. S. (1998). Evaluation of caesarean sections in women in a
collaborative practice setting: Comparison of certified nurse midwives and
physicians dissertation, California State University, United States. Retrieved
from http://proquest.umi.com.ezproxy.midwives.org
Rooks, J. P. (1997). Midwifery and childbirth in America. Philadelphia, PA: Temple
University Press.
Rooks, J., Weatherby, N., Earnst, E., Stapleton, S., Rosen, D., & Rosenfield, A.
(1989). Outcomes of Care in Birth Centers. The National Birth Center Study.
The New England Journal of Medicine, 321(26): 1804-1811.
Varney, H., Kriebs, J. M., & Gegor, C. L. (2004). Varney’s Midwifery (4th ed.).
Sudbury, MA: Jones and Bartlett.
World Health Organization (2011). Making pregnancy safer. Retrieved from
http://www.who.int/making_pregnancy_safer/topics/skilled_birth/en/index
html