What is a Midwife, anyway?
The United States has a long history of midwifery care provided by women who are incredibly skilled at helping women and their families through childbirth. Historically, midwives were not college-educated. It used to be that midwifery skills were passed down from generation to generation within families through apprenticeship. Births were attended by female family members, friends, and midwives. In the 1800s, male physicians began to successfully enter the field of obstetrics and gynecology. By 1900, only 50% of births in America were attended by midwives. This percentage dropped to 10% by 1950, and by 1960, almost all births occurred in hospitals and were attended by physicians. So how did men successfully take over the field of obstetrics and gynecology? They invented tools and technology to promise an “easier birth” to women.
In the late 1800s, the development of obstetric tools like forceps advanced the growing field of “man-midwifery”. Women were faced with the dilemma of continuing to use midwives at home as they always had or to move to the hospitals for the promise of tools and knowledge that would gain them easier labor. In the right hands, these tools could facilitate and reduce the time of labor but in the wrong hands, they could cause harmful vaginal tears. Ultimately, it was fear of death - marketed by these male doctors against midwives - during childbirth that gained men the upper hand in the field.
In 1894, legal restrictions began to regulate midwives in Massachusetts and many states followed suit. The Medical Practice Act established the qualifications necessary in Massachusetts to be a licensed physician. Because this act defined obstetrics as a field in which medical licensing is required, they barred midwives from attending birth by default. Midwives attempted to fight the new laws in court, but they were unsuccessful in overturning them. As midwife-assisted home births became harder to legally obtain, birth moved to the hospital.
Beginning in the 1960s, a natural birth movement that advocated for midwives began to emerge in conjuncture with the feminist movement. Feminist scholars began to question the benefits of medicalized birth and began to advocate for a more natural birth option. In the 1990s, some states began recognizing the reproductive right to choose the way you give birth. These states attempted to pass legislation that would make home birth a viable option for women. California was one of the first states successful in passing legislation to allow midwives to attend home birth. As midwives continued to advocate, programs started popping up throughout the country for women to receive training that would enable them to become certified and licensed within their state. Many of these programs began as a way to meet the needs of women in underserved populations. With the ability to now obtain licensure, midwives have been able to work their way back into birth through home births, birth center births, and within the hospital system. There are several different types of midwives.
The most legally recognized midwife is a Certified Nurse Midwife, or CNM. As the name portrays, a CNM has a background in nursing. More specifically, many CNMs have backgrounds as labor and delivery or women’s health nurses. The benefit of starting with a nursing background is that CNMs have first-hand experience with the medical system and have developed a clinical skillset prior to their clinical experience in school. Being a nurse first also means that they excel at providing the small, personal touches of patient care that only a nurse can give.
After gaining experience as a nurse, CNMs attend school and complete the requirements to graduate with their Master of Science in Nursing. Therefore, CNMs are also Advanced Practice Registered Nurses (APRN or “Nurse Practitioner”). To become certified, the candidate must pass the national board certification exam. After that, they can apply for licensure in their state.
So why should you see a CNM? A CNM is a specialist in women’s healthcare. They care for women from adolescence through menopause. They see women for annual examinations, problem visits, contraceptive visits, preconception visits, and of course for prenatal care, postpartum care, and births. CNMs specialize in normal. They treat the overall health of a person and emphasize education and empowerment. CNMs play a unique role in optimizing the childbirth experience. They recognize that for most women with healthy pregnancies, childbirth is a normal, natural, physiologic process requiring little to no intervention; it is not a “diagnosis” that needs “treatment”. The midwifery philosophy of care includes education and counseling which enables women to make informed choices for their birth experience. CNMs provide support during labor for women choosing an unmedicated birth but are also able to offer pain relief options and increased interventions as women desire or as their needs change during labor.
CNMs work closely with OB physicians and collaborate and refer as needed. They are trained to watchfully wait and anticipate signs of increased risk. They recognize when collaboration or a transfer of care is necessary and know the appropriate venues of getting the client the level of care that is needed for their unique situation.
If you have any questions about how care with a CNM differs from an OB or any further questions about CNMs, we would love to answer them! Please send us a message on our Facebook page, or email your questions to info@harmonyhealthil.com.
