Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding. A practitioner of midwifery is known as a midwife, a term used in reference to both women and men, although the majority of midwives are female. In addition to providing care to women during pregnancy and birth, many midwives also provide primary care to women, well-woman care related to reproductive health, annual gynecological exams, family planning, and menopausal care. Midwives are specialists in low-risk pregnancy, childbirth, and postpartum, although they are trained to recognize and deal with deviations from the normal. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but may be at odds in some countries, where obstetricians are taught to “actively manage” labor, while midwives are taught not to intervene unless necessary.

Midwives refer women to general practitioners or obstetricians when a pregnant woman requires care beyond the midwives’ area 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 more difficult deliveries, including breech births, twin births and births where the baby is in a posterior position, using non-invasive techniques. Compared with obstetricians, midwives offer lower maternity care cost, and midwife-led births are associated with lower intervention rates, reduced mortality and morbidity related to interventions, and fewer recovery complications.

Nurse-midwives were introduced in the United States in 1925 by Mary Breckinridge for use in the Frontier Nursing Service (FNS). Breckinridge chose the nurse-midwifery model used in England and Scotland because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the service and reported a substantially lower maternal and infant mortality rate than for the rest of the country. The report concluded that if this type of care was available to other women in the U.S., thousands of lives would be saved, and suggested nurse-midwife training should be made available in the U.S. Breckinridge founded the Frontier Nursing University in 1939, the first nurse-midwifery education program in the U.S. The Frontier School is still educating nurse-midwives and has added distance learning to its methodology. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier Nursing University faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1500 nurse-midwives.

Further Reading:
Midwife: Info, Training, History
How Long Does it Take To Become a Midwife?

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