Midwifery is the term traditionally used to describe the art of assisting a woman through childbirth. In the modern context, this term is used to describe the activities of these health care providers who are experts in women's health care including giving prenatal care to expecting mothers. They attend the birth of the infant and provide postpartum care to the mother and her infant. Practitioners of midwifery are known as midwives, a term used in reference to both women and men (the term means "with woman").
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Midwives are autonomous practitioners who are specialists in normal pregnancy, childbirth and the postpartum. They generally strive to help women have a healthy pregnancy and natural birth experience. Midwives are also primary care givers providing general women's health care. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but often are at odds because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.
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Midwives refer to obstetricians when a woman requires care beyond her or his areas of expertise. In many jurisdictions, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain situations that are considered abnormal, including breech birth and posterior position, using non-invasive techniques. In many areas of the world, traditional midwives, renamed "traditional birth attendants" by the World Health Organization (WHO) and other groups, are the only available providers for childbearing women.
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Midwives were once used to treat Female hysteria.
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Defining midwifery
According to the WHO definition, a midwife is a person who, having been regularly admitted to a midwifery educational programme that is duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
Adopted by the International Confederation of Midwives, 19 July 2005 This definition is controversial and not everyone agrees with the exclusion of traditional midwives who in developing countries often are the only people available to assist women in birth.
Historical perspective
Historically, midwifery has been one of the few medical practices dominated by female practitioners. From Agnodice in ancient Greece to the 18th century in Europe, the care of mothers and delivery of infants has been regarded, both by patients and by the medical profession, as appropriately carried out by women. In the 18th century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives. Whether this was a valid claim, or not, can be seen in the entry for Justine Siegemund, a renowned seventeenth century German midwife, whose Court Midwife (1690) was the first female-authored German medical text.
At the outset of the 18th century in England, most babies were caught by a midwife, but by the onset of the 19th century, the majority of those babies born to persons of means had a surgeon involved. A number of excellent full length studies of this historical shift have been written.
German social scientists Gunnar Heinsohn and Otto Steiger have put forward the theory that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion . According to Heinsohn and Steiger´s theory, the modern state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague (also known as the black death) which had swept over the continent in waves, starting in 1348.
They thus interpret the witch hunts as attacking midwifery and knowledge about birth control with a demographic goal in mind. Indeed, after the witch hunts, the number of children per mother rose sharply, giving rise to what has been called the "European population explosion" of modern times, producing an enormous youth bulge that enabled Europe to colonize large parts of the rest of the world.
While historians specializing in the history of the witch hunts have generally remained critical of this macroeconomic approach and continue to favor micro level perspectives and explanations, prominent historian of birth control John M. Riddle has expressed agreement.
Nurse midwives
In the United States, Nurse Midwives are advanced practice nurses who have specialized in the practice of obstetrical and gynecological care of relatively healthy women. In addition to a registered nursing license, many nurse-midwives have a master's degree in nursing. Nurse-midwives practice in hospitals and medical clinics, and may also deliver in birth centers and at home. They are able to prescribe medications in 48 out of the 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery education programs and serves as the national speciality society for the nation's certified nurse-midwives. At present approximately 5500 Certified Nurse-Midwives are practicing in the U.S.
Direct-entry midwives
A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not also require her to become educated as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings. At present, there are approximately 900 CPMs practicing in the US.
A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York, New Jersey, and Rhode Island). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs. At present, there are approximately 50 CMs practicing in the US.
The North American Registry of Midwives (NARM) is an international certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). CPM certification validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This international certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university- based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.
