History of CNMs in the US
Although midwives have been attending births in America since its colonization, the profession of nurse-midwifery was established in the early 1920's as a response to the alarming rate of infant and maternal mortality in the U.S.
U.S. INFANT AND MATERNAL MORTALITY STAGGERING
In Washington, D.C., the Children's Bureau, the first organization to investigate and report on matters surrounding the welfare of children and child life throughout America, published its first report with appalling statistics: 124 babies per 1,000 were dying, and the maternal mortality rates were equally as devastating. Recognizing the importance of prenatal care, the Bureau outlined a plan to combat the poor pregnancy outcomes that included providing public health nurses for prenatal instruction.
During the same time period, a group of obstetricians, nurses and mothers formed the Maternity Center Association (MCA) in New York City to address the problem of poor pregnancy outcomes and improve the health of mothers and infants. MCA looked to foreign countries with outstanding maternal child health records to serve as models. In these countries, the most prominent figure in the maternity cycle was the nurse-midwife. They saw that these specialty nurses might be the answer to
America's growing MCH problems, but, unfortunately no nurse-midwives were working in this country.
A CALL FOR NURSE-MIDWIFERY IN THE U.S.
Mary Breckinridge, a pioneering nurse who founded the Frontier Nursing Service (FNS) in eastern Kentucky, was the first to bring nurse-midwifery to the United States. Breckinridge established the FNS in the early 1920s to provide family health services to isolated areas in the Appalachian mountains by sending public health nurses to their patients by horseback. After learning about nurse-midwives in Europe, she saw first-hand their contributions to maternity care by traveling to France and England, where she was trained in nurse-midwifery. In 1929, she brought British nurse-midwives to FNS who were the first nurse-midwives in America. They joined the public health nurses in providing quality healthcare to patients in remote areas. Their success was readily apparent. In a study completed by Dr.
Louis Dublin on the first 1,000 births attended by nurse-midwives in Eastern Kentucky, he reported that there were no maternal deaths due to pregnancy or labor.
The Maternity Center Association and the Lobenstine Clinic, with encouragement from the Children's Bureau, set up the first nurse-midwifery school in the U.S. Hattie Hemschemeyer, a Public Health Nurse educator, was named Executive Director of the program. She was also one of the program's first graduates in 1933. Although no longer in existence, the MCA's educational program is recognized as one of the nation's leaders in nurse-midwifery education.
When the future of the Frontier Nursing Service was threatened by World War II, the second nurse-midwifery educational program was established. The British nurse-midwives wanted to return to Britain and serve their fellow countrymen in their time of need, so in November 1939, the Frontier Graduate School of Midwifery opened with two students. Fifty years later the school is still in operation -- as the Frontier School of Midwifery and Family Nursing -- and has graduated over 500 students. It now stands as both a leader in nurse-midwifery in the United States and a tribute to the accomplishments of Mary Breckinridge and her contemporaries.
NURSE-MIDWIFERY IS STANDARDIZED IN U.S.
By the mid 1950s, seven educational programs were in operation and although nurse-midwives were being recognized in the health care community for their value in providing quality, cost effective care to indigent and geographically disadvantaged women, they still faced many obstacles. After practicing nearly 30 years in America, nurse-midwives still had no professional organization to represent their needs and concerns and accredit educational programs. Nurse-midwifery education and standards were being
set by other nursing organizations, including the National Organization for Public Health Nursing (defunct in 1952) and the Maternal and Child Health Council of the National League for Nursing. In 1955, the American College of Nurse-Midwifery was incorporated in New Mexico by Hattie Hemschemeyer with
the goal of addressing the needs and concerns of America's nurse-midwives. In 1969, the organization merged with the Kentucky-based American Association of Nurse-Midwives and changed its name to the American College of Nurse-Midwives (ACNM). Today, ACNM still serves as the professional
organization for certified nurse-midwives in the United States. It also serves as the organization that sets the standards by which nurse-midwifery is practiced in the U.S. and accredits nurse-midwifery educational programs.
The popularity and acceptance of nurse-midwifery increased dramatically in the 1970s and 1980s. The number of CNMs practicing jumped from 275 in 1963 to 1,723 in 1976, to 2,550 in 1982, to over 4,000 in 1995. Certified nurse-midwives (a title adapted after the implementation of formal certification measures) were no longer only caring for indigent women and children. More affluent consumers discovered the benefits of the personalized, holistic health care that the modern-day nurse-midwives had to offer. Birthing centers began springing up around the country offering prenatal counseling, extensive
personal care during birth and close collaboration with physicians -- all characteristics of the nurse-midwifery profession.
CERTIFIED NURSE-MIDWIVES IN HEALTHCARE TODAY
Today, over 6,000 certified nurse-midwives practice in all 50 states and many developing countries. In 1998, CNMs attended 277,811 deliveries, mostly in hospitals. This number accounts for 9 percent of all U.S. births. Furthermore, certified nurse-midwives continue to be highly regarded in the health care community. Two reports by the Institute of Medicine and the National Commission to Prevent Infant Mortality, praise their contributions in reducing the incidence of low birthweight infants and call for their increased utilization.
Through its sixty year history, the profession of nurse-midwifery has withstood many obstacles, including most recently the fight of malpractice insurance. American's certified nurse-midwives continue as key primary care providers in the area of maternal and infant health, with rates for premature and low birthweight infants below the national average. CNMs are vital to the future of well-woman healthcare.
