CONTENTS List of Tables Foreword by Charles S. Mahan, M.D. Preface Organization and Objectives Acknowledgments Chapter 1 What Is Midwifery? Etymology The Care of Pregnant Women: Separation into Two Different Professions Varying Definitions and Kinds of Midwives The International Definition of a Midwife How Does a Midwife Differ from a Traditional Birth Attendant? America's Many Kinds of Midwives Chapter 2 Brief History of Midwifery in the West Antecedents: Midwifery from Earliest History Through the Middle Ages Development of Midwifery Education in France "Man-Midwives" and the Increasing Role of Doctors Midwifery and Obstetrics in the British Isles Midwifery in the United States: Colonial Times Through the Nineteenth Century Lack of Licensure and Regulation of Midwives Midwifery at the Turn of the Century The Real Causes of High Maternal and Infant Mortality Rates Development of Obstetric Nursing The Natural Childbirth and Breast-Feeding Movements Begin Chapter 3 The Begging of Nurse-Midwifery Mary Breckinridge and the Frontier Nursing Service The Maternity Center Association: Beginnings of Nurse-Midwifery Education The Work of the First Nurse-Midwives The Origins and the First Work of the American College Nurse-Midwives The More into University Medical Centers and High-Volume Charity Hospitals Chapter 4 Midwifery Amid the Social Movements of the 1960s and 1970s Support for Nurse-Midwives as Health Care Providers for the Poor Special Nurse-Midwifery Services for Care of Pregnant Adolescents Grouping Nurse-Midwives with Nurse Practitioners and Physician Assistants The Impact of Major Federal Government Programs Childbirth Care During the 1960s and 1970s Unanticipated Effects of the Risk Approach to Maternity Care Home Births and the Origins of a New Kind of Lay Midwife The Farm in Summertown, Tennessee The Birth Collective at Fremont Women's Clinic in Seattle The Birth Center of Santa Cruz Criticism of Medicine and the Reaction of Obstetricians to Lay Midwives The Reactions of Nurse-Midwives Development of the ACNM's System of Quality Assurance Core Competencies and Accreditation to Ensure Quality Education Ensuring the Competence of Nurse-Midwives at Entrance into the Profession A Working Relationship with Obstetricians Clear Definitions and Exclusive Criteria for a Certified Nurse-Midwife Progress in Nurse-Midwifery Education During the 1970s Changes in Nurse-Midwifery Clientele and Practice Nurse-Midwives Move into the Private Sector Development of Free-Standing Birth Centers Nurse-Midwifery in the U.S. Military Services Early Models of Direct-Entry Midwifery Training The Seattle Midwifery School The Arizona School of Midwifery Precepted Experience at a High-Volume Birth Center Correspondence Courses Short Workshops Increasing Physician Resistance to Nurse-Midwives Chapter 5 Maternal and Infant Health and the Health Care System, 1980-1995 High Cost of Hospital Care for Uninsured Pregnant Women and Newborns Medical Efforts to Constrain Midlevel Health Care Providers The American Academy of Family Physicians' Position on Nurse-Midwives The American College of Obstetricians and Gynecologists' Position Importance of Nurse-Midwives' Relationships with Physicians Medical Opposition to Lay Midwives The Medical (and Midwifery) Malpractice Liability Insurance Crisis Impact on Nurse-Midwifery Impact on Direct-Entry Midwives Increased Use of Alternative Health Care Development of a System of Supports to Ensure Quality Care in Birth Centers The National Birth Center Study How to Start a Birth Center Workshops Trends in Hospital Care During Labor and Delivery Efforts to Reduce the Rate of Cesarean Sections Factors Associated with Higher or Lower Cesarean Delivery Rates Low Cesarean Rates Associated with Birth Centers and Care by Midwives "Active Management of Labor" as a Way to Reduce the Cesarean Rate Effect of a Constant Supportive Companion Throughout Labor Educational Approaches, Clinical Guidelines, and Peer Review Eliminating Financial Incentives America's High Rates of Low Birth Weight and Infant Mortality Focus on Prenatal Care Access to Effective Reproductive Health Care for Socioeconomically High-Risk Women Health Objectives for the Nation Reasons for Poor Access to Effective Care Reproductive Health Care Providers Prenatal Care Care During Labor and Delivery Obstetrician-Gynecologists Family Practice Physicians Physician Assistants Access to Care for Rural Women Recommendations to Increase Use of CNMs to Increase Access to Care Implementation of the Recommendations About Midwives Expansion of Medicaid Eligibility Trends in the Numbers of Births and the Characteristics of Childbearing Women What Kind of Maternity Care Do Women Want? Managed Health Care and the Changing Health Care System Aggressive Growth of Private For-Profit Managed Care Organizations Effects on Medicaid Effects on Public Hospitals Reduced Government Health Care Budgets Primary Care Providers as Gatekeepers Small, Perhaps Transient Cost Reductions, and Concerns About Choice, Access, and Quality of Care Effects on Health Care Providers Effects of For-Profit Managed Care on Indigent Pregnant Women Chapter 6 Midwifery in America: Philosophy, Objectives, and Body of Knowledge How Does Midwifery Differ from the Care Provided by Physicians? A Focus on What is Normal Versus a Focus on Pathology Overlapping but Unique Fields of Knowledge Differences in Beliefs about the Nature of Pregnancy and Birth Dr. Michael Odent and "The Undisturbed Birth" Emphasis on Emotional, Social, and Environmental Factors Beliefs About the Role of the Client Versus That of the Health Professional Less Narrow Definitions of Normal Objectives of the Care Development of the Body of Knowledge Data on the Effectiveness of Care During Pregnancy and Childbirth Gaps in the Base of Essential Information Research on Normal Pregnancy Research on Midwifery Practice Contributions of American Direct-Entry Midwives Chapter 7 Midwifery in America, 1980-1994: Percent of Births, Place of Birth, and Clientele Birth Certificates -- Source of National Natality Data Underreporting of Births Attended by Midwives Trends in Place of Birth and Birth Attendants Birth Sites Birth Attendants What Kinds of Women Use Midwives? Women Whose Out-of-Hospital Birth Were Attended by Midwives, 1975-1988 Ethnicity of Women Whose Births Were Attended by Midwives, 1982-1989 Women Whose Births Were Attended by CNMs in Hospitals, 1988 and 1989 Women Whose Births Were Attended by CNMs in Birth Centers Women Whose Births Were Attended by Other Midwives in Birth Centers, 1989 Women Who Have Home Births States That Have a Relatively High Proportion of Midwife-Attended Birhts Risk Factors Among Women Served by Midwives Chapter 8 Nurse-Midwifery in America 1980-1995 Laws that Regulate the Practice of Nurse-Midwifery Prescription Privileges and Mandated Third-Party Payment New Legislative Issues What Boards Regulate Nurse-Midwifery Practice? Legal Requirements for ACNM Certification Mandated Master's or Bachelor's Degrees Defining Episiotomies as Surgery and Thus as the Practice of Medicine New York's New Midwifery Law Nurse-Midwifery Education The Role of the ACNM Core Competencies Nurse-Midwifery Education During the Early 1980s Identifying Problems and Setting Goals Expansion of Clinical Learning Sites Focus on the Role and Skill of the Educator The First Distance Learning Program of Nurse-Midwives Distance Learning for Nurses Throughout the Nation Increasing Numbers of Educational Programs, Students, and Graduates The Controversy Regarding Mandatory Degrees Flexible Programs That Accept Students a Variety of Backgrounds Financial Support of Nurse-Midwifery Education Quality Assurance Accreditation of Nurse-Midwifery Education Programs Examination and Certification of Nurse-Midwives at Entry into Practice Certification of Nurse-Midwives Educated in Other Countries Incorporating New Procedures into Nurse-Midwifery Practice Peer Review Data Describing Nurse-Midwives Nurse-Midwifery Practice as Defined by the ACNM Core Competencies An Expanding Scope of Practice ACNM Support for Home Births Extending Nurse-Midwifery Practice Beyond the Age of Reproduction New Procedures and Approaches: Care of Women with Complications Nurse-Midwives as Primary Care Providers Rescinding a Policy that Prohibited Performing Abortions Nurse-Midwives' Practice Circumstances Where Do Nurse-Midwives Work? CNMs Who Attend Births Nurse-Midwives' Use of Time During Clinical Care Findings from the Public Citizen's Health Research Group 1994 Survey Nurse-Midwifery Practice Models Nurse-Midwifery Practice in Free-Standing Birth Centers Nurse-Midwifery Services in Tertiary Academic Hospitals Practice in Small Towns and Rural Areas Nurse-Midwifery Services to Meet the Needs of Special Populations Nurse-Midwifery in Health Maintenance Organizations Home Births Collaborations with Physicians Medical Collaboration in a Nurse-Midwifery Practice or Service Role of Physicians in a Medical/Midwifery Partnership or Team ACNM's Agreements and Disagreements with ACOG Collaboration with Family Physicians Supervision and Vicarious Legal Liability Barriers and Supports to Nurse-Midwifery Practice Findings from National Studies Professional Liability Insurance Prescriptive Authority Hospital Privileges Third-Party Payment for Health Care Relationships with Physicians Antitrust Issues The Mass Movement to Managed Care Mutual Support, But Significant Disagreements with Nursing Chapter 9 Development of Direct-Entry Midwifery, 1980-1995 Legal Status Summary of State Laws Affecting Direct-Entry Midwives Laws That Require Three Years of Formal Midwifery Education State Midwifery Organizations Consumer Support The Midwives' Alliance of North America Membership in the International Confederation of Midwives Development of Standards and Qualifications MANA's Statement of Values and Ethics Ambivalence About Certification MANA Core Competencies for Basic Midwifery Practice Data Collection and Research Seminars and an Interorganizational Work Group on Midwifery Education The Evolution of a Process to Certify Professional Direct-Entry Midwives The North American Registry Exam for Midwives The Decision to Develop a National Certification Process Job and Task Analysis and Development of a Manual Skills Exam NARM's Certification Process Informal Educational Opportunities Study Groups Apprenticeships Workshops, Conferences, and Seminars Books and Other Learning Materials Schools and Organized Courses Training Programs Available in 1995 Access to Clinical Experience Developing a Process to Accredit Direct-Entry Midwifery Education Programs The Midwifery Education Accreditation Council (MEAC) Practice Informed Consent Prenatal Care Care During Labor, Birth, and the Postpartum Period Midwifery Methods to Reduce and Help Women Cope with Pain Methods and Theories Related to Preventing and Treating Dystocia The Holistic Health Care Model Use of Intuition and Other Subjective Knowledge Christian Midwives Controversy About the Need to Refer Women with Certain Complications Medical Care for Women and Newborns with Serious Complications Recruitment, Selection, and Retention What Kinds of Women Apply to Direct-Entry Midwifery Schools? Barriers as Well as Increasing Support for Practice ACNM's Role in Direct-Entry Midwifery Education and Certification Challenges for Direct-Entry Midwifery in the United States Chapter 10 The Quality, Safety, and Effectiveness of Midwifery as Practiced in the United States The Primacy of Safety Outcomes of Nurse-Midwifery Care When the Births Occur in Hospitals: Overview Methodologic Problems in Looking for Causes of Better or Worse Outcomes Prenatal Care Prenatal Care Provided by Midwives Effect of CNM Care on the Incidence of Low and Very Low Birth Weight MD and RN Care During Labor and Delivery in Hospitals Support for Women in Labor Frequent Use of Technical Procedures and Obstetric Interventions Induction of Labor Continuous Electronic Fetal Monitoring Epidural Anesthesia Routine Intravenous Infusions and Withholding Food and Fluid Oxytocin Augmentation and Amniotomy: Birth by the Clock Interventions in the Second Stage of Labor: More Birth by the Clock Routine or Liberal Use of Episiotomies Effects of Midwifery Care on Labor and Delivery Interventions Meta-Analysis of Comparative Studies Published Between 1969 and May 1992 Six Studies Published Since May 1992 Nurse-Midwifery Care and the Rate of Cesarean Deliveries Summary Nurturing and Protecting the Newborn and the Family Breast-Feeding and the Importance of the Period Immediately After Birth Rooming-In Support During the First Few Weeks at Home Contraception Empowering Women Chapter 11 Safety of Out-of-Hospital Births in the United States Why Do Women Have Planned Out-of-Hospital Births? Difficulty of Conducting Adequate Research on Out-of-Hospital Births Birth and Death Certificate Data Data from Specific Out-of-Hospital Birth Practices or Services Mortality Review Reports Comparison Groups International Data The Netherlands The United Kingdom Canada Limitations of the Application of Data from Other Countries Area-Wide Data on Out-of-Hospital Birhts Arizona, 1978-1981 Missouri, 1978-1984 Washington, 1981-1990 Toronto, Ontario, 1983-1988 Vermont, 1989-1994 National Data for 1989 Data on the Safety of Births in Free-Standing Birth Centers Data on the Safety of Out-of-Hospital Births Attended by Direct-Entry Midwives Data on the Safety of Home Births Attended by CNMs Mortality Rates as the Primary Measure for Safety Maternal Mortality Intrapartum and Neonatal Morality Comparison Groups Interpretation of Morality Rates Summarized in Table 13 Differences in the Proportion of Deaths That Occur During Labor Postterm Births Result in Higher Morality Low Morbidity Associated with Home Births Transfers During the After Labor, and Cesarean Deliveries Attending High-Risk Births at Home Summary Chapter 12 Effects of Midwifery Care on Costs and Other Special Contributions The Effect of Midwifery on Health Care Costs Cost Savings from Nurse-Midwifery Care with In-Hospital Births Cost Savings from Use of Birth Centers and Home Births Providing Care to Underserved, Hard-to-Serve Women Research on "Underserved, Hard-to-Serve" Women Summary Chapter 13 Midwifery in Canada, Australia, New Zealand, and Japan Purpose of This Chapter The International Confederation of Midwives Midwifery in Europe Midwifery Education and the European Economic Area Midwives Directives Having a Baby in Europe -- A WHO Report from the Early 1980s The Alternative Maternity Care Movement Midwifery Practice During the Early 1990s Midwifery in Selected Countries The Netherlands: Autonomous Midwives and Many Home Births Legal Status and Protection of Midwives' Role Place of Birth and Cesarean Deliveries A National System for Sorting Women by Risk Status Home Nursing Assistance for Postpartum Mothers Safe Home Births A Limited Scope of Practice Education Practice Arrangements and Conditions Great Britain: Demands for a New Approach to Maternity Care "Changing Childbirth" -- A Mandate to Improve Maternity Care Midwifery Education and the Resurgence of Direct-Entry Midwifery Canada History Ontario Quebec Alberta British Columbia Provinces in Line for New Laws: Manitoba and Saskatchewan The Varying Reactions of Physicians Australia History Recent Events and the Current Situation Midwifery Education New Zealand History Independent Midwifery Practice Japan History Efforts to Reestablish Midwifery Birthing Homes Current Practice Education, Employment, and Retention of Midwives Chapter 14 The Current Situation and Recommendations for the Future Two Ways of Viewing Pregnancy and Birth Favorable and Unfavorable Trends Brief Recap and the Medicalization of Childbirth in the United States The Effects and Effectiveness of High-Tech Childbirth Care The Scientific Evidence Brief Recap of the Development of Midwifery in the United States Benefits of the Midwifery Model Dominance of the Medical Model Cultural Considerations Ignorance and Confusion About Midwifery Fear of Danger Obstetrician-Gynecologists as Primary-Care Physicians Pain as a Pivotal Issue The Effectiveness, Untoward Effects, and Cost of Epidurals The Nature of Pain During Childbirth Childbirth Education as an Alternative Support During Labor as an Alternative Midwife Approach to Pain Control Meeting the Needs of Socioeconomically High-Risk Women Professionals Who Focus on the Needs of Indigent Pregnant Women Nurse-Midwives' Contributions High Proportion of Births to Socially Disadvantaged Women Short-Term Savings or Long-Term Cost Effectiveness? Recommendations Made by Other Groups Recommendations from Prestigious National Institutes and Commissions Recommendations from National Women's Health Organizations Recommedations from a Consumer Advocacy Organization The Mother-Friendly Childbirth Initiative Recommendations to Broaden the Objectives and Focus of Maternity Care Public Health Service Recommendations on the Content of Prenatal Care A Focus on the Mother Watching Our Words Other Recommendations Women's Right to Access Both Maternity Care Models Women's Right to Pain Control Opportunities to Reduce the Long-Term Cost of Health Care Training of Physicians, Midwives, Nurses, and Doulas Recommendations Regarding Birth Centers and Home Births The Possibility of Achieving These Recommendations Potential Positive Effects of Managed Health Care Barriers to Change Seeking Complementarity References Index
The definitive account of the many forces that intersect over the issue of childbirth
Judith Pence Rooks, a past president of the American College of Nurse Midwives, has taught in a school of nursing, a school of medicine, and a midwifery school associated with the historic Frontier Nursing Service in Kentucky. She was the Principle Investigator for the National Birth Center Study, which was conducted at the Columbia University School of Public Health. She reported the results in the New England Journal of Medicine. She has worked as an epidemiologist at the U.S. Center for Disease Control and an "expert" in the Office of the Surgeon General. In 1993 she received the Martha May Eliot Award for exceptional service to mothers and children from the American Public Health Association.
"...clear, articulate, and well-researched work... [It] is a treasure trove of information and resources to everyone who works in the maternity services, to policy-makers, and to women. No library or bookshelf should be without it. This scholarly treatise is the most exhaustive, balanced, and comprehensive book on midwifery that has been written, and it will serve as an impetus and inspiration to a broad audience." - Birth "We have been waiting a long time for this book: a comprehensive, readable, and authoritative discussion of the important role of midwifery in the United States. It will spark a passionate - and long overdue - dialogue about the way pregnant women are taken care of in this country." - Roger A. Rosenblatt, MD, MPH, Professor and Vice Chair of the Department of Family Medicine, University of Washington, Seattle "Rooks has written a comprehensive, balanced and eminently readable book." - The Journal of the Association for Research on Mothering
"...clear, articulate, and well-researched work... [It] is a treasure trove of information and resources to everyone who works in the maternity services, to policy-makers, and to women. No library or bookshelf should be without it. This scholarly treatise is the most exhaustive, balanced, and comprehensive book on midwifery that has been written, and it will serve as an impetus and inspiration to a broad audience." - Birth "We have been waiting a long time for this book: a comprehensive, readable, and authoritative discussion of the important role of midwifery in the United States. It will spark a passionate - and long overdue - dialogue about the way pregnant women are taken care of in this country." - Roger A. Rosenblatt, MD, MPH, Professor and Vice Chair of the Department of Family Medicine, University of Washington, Seattle "Rooks has written a comprehensive, balanced and eminently readable book." - The Journal of the Association for Research on Mothering
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