|The percentage of births attended by midwives has slowly risen to account for 7 percent of all births in the United States -- up from just 3.7 percent in 1989 -- reflecting progressively changing attitudes among the American population, the U.S. government and the medical establishment regarding the role of midwifery in health care.|
Midwife Lynne Salzburg helps Lori McCullough, a student midwife, get a
handle on needles, which are sometimes used to give vitamin K to a
newborn or to medicate a hemorrhaging mother.
Despite the increasingly significant role midwives are playing in American obstetric care, barriers still remain that prevent them from reaching the professionís full potential. Midwifery is a well-established profession, but midwives have had difficulty gaining respect from the health care community because of their different beliefs regarding the birthing process and shared authority with physicians.4
During much of the last century, midwives were viewed as competition by the medical establishment, and laws forbade them to practice. Nurse-midwifery -- established in the 1920s -- was partly a result of state regulatory agencies attempting to dispose of midwifery as an independent profession at the turn of the century.3 A path was cleared in 1971 when the American College of Obstetricians and Gynecologists officially approved nurse-midwives. Still, midwives are held back by varying state laws that limit their prescribing privileges; a lack of hospital admitting privileges; and a lack of mandatory third-party reimbursement. One study of 410 nurse-midwives revealed that 64 percent believed their practices were restricted in some way.5
Now, federal and state governments, searching for ways to cut costs and increase womenís access to health care, are looking to midwifery. According to a report on the barriers midwives face, nurse-midwives "hold particular promise in easing the problems of access for women, newborns, and families with children." 3 One study shows that between 1991 and 1995, many states expanded prescriptive authority and broadened insurance coverage for nurse-midwives. 3
Those who believe that midwifery is a viable source of health care are voicing their opinions and making recommendations that may affect the future of the profession. A 1997 U.S. Department of Health and Human Services commentary advocates the advancement of nurse-midwifery care as the "standard for low-risk pregnant women." The author recommends expanding educational opportunities for nurse-midwives and creating public information campaigns on the quality and cost-effectiveness of midwifery care.6 In a 1993 New York Times editorial, two University of Pennsylvania nursing professors recommended increasing hospital access for midwives in order to allow women to receive access to lower-cost health care.1 The same year, the American College of Nurse-Midwives called for the training and certification of 10,000 nurse-midwives by 2001.2 Also, a taskforce devoted to assessing the future of midwifery found the midwifery model of care to be "an essential element of comprehensive health care for women and their families that should be embraced by, and incorporated into, the health care system and made available to all women." 4
Midwives in Florida Today
Florida in particular is aggressively pursuing the use of nurse-midwives, who are seen as cost-effective during this shortage of maternal health care providers. The state is promoting the use of birth centers and nurse-midwives and wants 50 percent of healthy women to be cared for by nurse-midwives and 600 more nurse-midwives to be certified by the year 2000.
1 Aiken, Linda and Claire Fagin. "More Nurses, Better Medicine." New York Times. March 11, 1993, late ed.-final:A23.
2 Brody, Jane E. "Personal Health." New York Times. April 28, 1993, late ed.-final:C11.
3 Declercq, Eugene R., Lisa L. Paine, Diana R. Simmes and Jeanne F. DeJoseph. "State Regulation, Payment Policies, and Nurse-Midwife Services." Health Affairs. The People-to People Health Foundation, Inc. March 1998-April 1998.
4 Dower CM, Miller JE, O'Neil EH and the Taskforce on Midwifery. Charting a Course for the 21st Century: The Future of Midwifery. San Francisco, CA: Pew Health Professions Commission and the UCSF Center for the Health Professions. April 1999. pp 9, 10.
5 Gabay, Mary, MS, Sidney M. Wolfe, MD. "The Beneficial Alternative." Public Health Reports. U.S. Department of Health and Human Services. September/October 1997. 112: pp 386-394.
6 Lawrence, Hal C., MD. "Not Either/Or, but Obstetricians and Midwives Together." Public Health Reports. U.S. Department of Health and Human Services. September/October 1997. 112: pp 395.
Images and words © Copyright 2000 Molly Van Wagner
Last revised: 4.20.2000