Comparing the History & Progression of Midwives

The word midwife is formed in Middle English from two words mid and wife. At first glance, the meaning of wife would seem to be clear. However, “wife” often meant “woman” in Middle English. The other element is the prefix mid-, meaning “together with.” Thus putting it all together defines midwife as “with woman” (Midwife n., n.d.).  A midwife is a health care profession in which a man or women, offer care for childbearing women during pregnancy, labor, birth and the postpartum period. In this paper I will be talking about the history of midwifery and how far midwifery has come.

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The history of midwifery dates back to the beginning of times. The first midwives recorded in history are mentioned in the biblical books of Genesis and Exodus. These midwives took care of women for physical pain and the journey of childbirth. Childbearing women in the early centuries did not know the processes of giving birth and had an increased fear of death. Ancient Egypt midwifery was a recognized female occupation. Ancient Egyptian midwives followed codes and laws that were basic public sanitation, including concepts of quarantine and principles of contagion for epidemic diseases, hygiene, and dietary restrictions and regulations. Midwifery in the Ancient Greco-Roman world included a wide range of women, including older women who continued folk medical traditions in the villages as well as trained midwives (Varney and Thompson, 2016).  Each of these cultures followed their own rules of public sanitation and birthing process rules and regulations.  It was not until 1920, that Winslow defined public health, as the provision of quality health for individuals, families, and communities as part of the core practice of public health that all health care providers were to follow.  Now, all midwives follow specific guidelines that use the same public sanitation with the exception of different
Religious and cultural practices, in each midwife practice. These practices have helped in disease preventions, improvement of the development of vaccines and other preventive strategies in which we have today.
In 1940 it was evident that nurse-midwifery would benefit from a national standard organization to better expand the profession and protect midwifery standard of practice. The first formation was the Kentucky State Association of Midwives created by Mary Breckinridge in 1929 (Varney and Thompson, 2016). The name of the organization was changed in 1941 to the American Association of Nurse-Midwives. The other effort to establish a national nurse-midwifery program was by Hattie Hemschemeyer. This effort resulted in the formation of the National Association of Certified Nurse-Midwives. With the studies of organizations and research came the requirements needed for certification to become a Certified Nurse Midwife. Certified Nurse Midwife must pass an exam to become a licensed Certified Nurse Midwife. The study of the advancement of research and the role of working together and having the same practice throughout has “improved outcomes, saved money, and well positioned for growth,” (Varney and Thompson, 2016, p. 282). The education and certification of Certified Nurse Midwives now meet one standard across the United States, and numerous studies using measures from Apgar scores the rates of vaginal birth after cesarean have shown that midwifery care has favorable outcomes (Beal et al., 2015).
In today’s practice of midwifery, men or women can study to become a midwife. Before the late 18th century, men were excluded from childbirth. “It was considered immodest, improper, indecent, and even immoral for a man to observe or examine a woman during childbirth” (Varney & Thompson, p. 10). Childbirth was an exclusively female event that took place in a mother’s home, attended by midwives and the mother’s female friends and relatives. Midwives trained through an apprenticeship with more experienced midwives and generally practiced independently in their communities. This practice was held until the 1700s in England and the 1800s in the United States. By the 19th century, about half of the nation’s births were attended by physicians. This was known as the “midwife problem” which was a shift from a social to medical approach and obstetrics represented an extreme change in the gender dynamics of birth. Universally, female midwives were declining as women had childbirth with physicians who were exclusively male. Feminists resisted the inclusion of men into the practice of what was traditionally women’s work and believed that for centuries it was considered inappropriate for men to help with childbirth, why change now? In the early 19th century women did not have many rights and were expected to serve domestic roles. This also contributed to the “midwife problem.”  The discovery of obstetric forceps by the Chamberlen brothers served as a symbolic difference between woman midwives and man-midwife physicians. Overall this turned women (especially upper-class women) to accept man-midwives and physicians to attend their births. The obstetric forceps promised safer deliveries and greater pain management (Varney & Thompson, 2016).
Throughout early history, midwives were also called upon to assist women, men, children and animals with illnesses and injuries. Physicians were often difficult to access for geographic or economic reasons. Martha Ballad, a colonial midwife practicing in what later became the state of Maine is a great example of this. In a three week period in 1787, Ballard attended 4 births, responded to one false labor, made 16 medical calls including the dispensing of medication to at least one individual, harvested and prepared medicinal herbs, and prepared three bodies for burial (Hoover, Holt, 2016). Early midwives were fully involved into the social, spiritual, economic, and legal lives of their communities. Assisting their neighbors through every stage of development and all major life transitions, including death.
There has been a recent movement across the United States to incorporate palliative care and hospice care into both home and inpatient setting. With this movement there has been a rapid increase in demand for these services and has resulted in a severe shortage of qualified palliative care providers. Trained certified nurse-midwives/certified midwives are viewed to be well equipped to help serve as hospice and palliative care clinicians. Midwives skilled in assisting women and families with the transition of pregnancy to motherhood can use their education and skills to help individuals and families through the transition from life to death (Hoover, Holt, 2016).  The similarities between these two states of human life allow for a midwife to easily practice with both states.  A few of the similarities shared with these two human experiences include stress, anxiety, and pain. Midwifery training to help symptom management and supporting individuals through difficult experiences such as birth, also gives midwives a unique perspective that is easily translated to help assist individuals and families through the passage between life and death. In order to assist the patient and his or her family members with the emotional work so central to palliative care, the end of life must be normalized. Just as the midwife supports women and their families across the lifespan by normalizing pregnancy, birth, menopause and other life transitions, the palliative care clinician does the same for those experiencing the end of life transition in comparison.  All of these events must be honored as sacred, special, and unique. Overall, it has been found that integrating midwives into palliative care teams as clinicians would help strengthen hospice and palliative care programs, enhance end-of-life care for patients and their families, and open he door for greater midwifery career satisfaction.
The midwifery profession has faced and worked through many barriers over the past century, resulting in significant progress in providing access to care to women and families. “In the US, the profession and practice has evolved significantly since being introduced.  Certified Nurse Midwifes have risen every year since 1989” (Walker, 2014). Midwifery care has been found to result in lower costs due to unnecessary, invasive and expensive interventions.  Midwifery is also found now to lower rates of cesarean birth, labor induction, less use of regional anesthesia and a significant reduction in the incidence of third and fourth degree perineal tears (Walker, 2014). As we can see, midwifery has come a long way while comparing the history of midwifery with today’s midwifery.
Midwifery will continue to evolve in the healthcare delivery system as increasing demands of midwives are needed and the positive benefits that are associated with midwifery today.
References

Midwife (n.). (n.d.). Retrieved from https://www.etymonline.com/word/midwife
Beal, M. W., Batzli, M. E., & Hoyt, A. (2015). Regulation of Certified Nurse-Midwife Scope of Practice: Change in the Professional Practice Index, 2000 to 2015. Journal of Midwifery & Womens Health, 60(5), 510-518. doi:10.1111/jmwh.12362
Gilmore, F. (2016, December 20). Pain Relief Fit For The Queen: Anesthesia Comes Of Age. Retrieved from https://ideastations.org/science-matters/science-news/pain-relief-fit-queen-anesthesia-comes-age
Hoover, C. V., & Holt, L. (2016). Midwifing the End of Life: Expanding the Scope of Modern Midwifery Practice to Reclaim Palliative Care. Journal of Midwifery & Womens Health, 61(3), 306-314. doi:10.1111/jmwh.12454
Varney, H., & Thompson, J. B. (2016). A history of midwifery in the United States the midwife said fear not. New York, NY: Springer Publishing Company, LLC.
Walker, D., Lannen, B., & Rossie, D. (2014). Midwifery Practice and Education: Current Challenges and Opportunities. The Online Journal of Issues in Nursing, 19(2), 4th ser. doi:10.3912/OJIN.Vol19No02Man04