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Nurse-midwives: then and now

In honor of the 40th anniversary of the University of Minnesota School of Nursing’s nurse-midwife degree program, Melissa Avery, Ph.D., C.N.M., R.N., director of the midwifery specialty, reflected on how nurse-midwifery has changed.

Midwives have been attending births for thousands of years.

“But in the United States in the early 1900s, as the field of medicine became more formalized and specialized, birth started moving to hospitals,” said Avery. Midwives began to play a lesser roll.

By 1925, midwives began making a comeback with the founding of the Frontier Nursing Service in Kentucky. Nurses who were also educated as midwives traveled by horseback and on foot to provide healthcare to women and children in isolated mountain areas of Kentucky.

A study of the first seven years of the service, conducted by Metropolitan Life Insurance Company, documented a substantially lower infant and maternal mortality rate than in the rest of the country, providing a boost to the practice of midwifery.

By the 1970s, Avery said, birth with midwives became more popular among middle-class women, leading to increased demand for their services. In 1973, Sharon Rising, recruited from Yale University, came to Minnesota to start a nursing midwifery curriculum at the U of M’s School of Nursing. The center was located in a house near campus.

Women came to the clinic for prenatal care and group discussions and had their babies at University Hospital. The center was closed several years after she left the university.

These days, most midwives practice in hospitals or clinics and consult with physicians and other healthcare professionals as needed. Any woman with significant pregnancy complications, such a woman pregnant with twins or who has pre-existing diabetes or hypertension, is referred to a physician, Avery said.

Midwives’ primary focus is normal pregnancy and birth as well as women’s gynecologic health. Today midwives also have the authority to prescribe medications, and their services are reimbursed by insurance companies.

Avery believes midwifery can help reform maternity care in the United States. With maternity care accounting for approximately $100 billion in health care costs per year, “there’s a better way,” she said. If midwives provided care to a larger proportion of women, she said, we could help advance the national healthcare goals of better care, better outcomes and lower cost in partnership with our nurse and physician colleagues.

To read the original, full-length piece this post is adapted from, check out the School of Nursing’s website here.

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