Midwifery - Midwifery

February 5, 2012


		1 Introduction 2 Historical perspective 3 Midwifery in the United States 4 Midwifery in the United Kingdom 5 Midwifery in Canada 6 See also 7 External links

Obstetrics Midwifery

Midwifery

Wikipedia

Midwifery is a term used to describe several types of health care practitioners, other than physicians, who provide prenatal care to pregnancy|expecting mothers, attend the Childbirth|birth of the infant and provide postpartum care to the mother and infant. Nurse-midwives in the United States may also provide Gynecology|gynecological care. Practitioners of midwifery are known as midwives, a term used in reference to both women and men (the term means "with the woman").

Most midwifes are independent practitioners who work with obstetricians when the need arises. They usually deal with normal births only, but are trained to recognize and deal with deviation from the norm. If something abnormal is discovered during prenatal care, the client is sent to an obstetrician. Other midwives will deal with abnormal births, including breech birth. In many areas of the world, traditional birth attendants fill this role.

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Historical perspective

Historically, midwifery has been one of the few medical practices dominated by female practitioners. From Agnodice in ancient Greece to the 18th century in Europe, the care of mothers and delivery of infants has been regarded, both by patients and by the medical profession, as appropriately carried out by women. In the 18th century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives. At the outset of the 18th century in England, most babies were caught by a midwife, but by the onset of the 19th century, the majority of those babies born to persons of means had a surgeon involved. A number of excellent full length studies of this historical shift have been written.

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Midwifery in the United States

There are two main divisions of modern midwifery in the US, nurse-midwives and direct-entry midwives.

Nurse Midwives

In the United States, nurse-midwives are advanced practice nurses who have specialized in the practice of obstetrical and gynecological care of relatively healthy women. In addition to a registered nursing license, most nurse-midwives have a master's degree in nursing. Nurse-midwives practice in hospitals and medical clinics, and may also deliver in birth centers and at home. They are able to prescribe medications in 48 out of the 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives may work closely with an obstetrician, who provides consultation and assistance to patients who develop complications. Often, women with high risk Pregnancy|pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery education programs and serves as the national specialty society for the nation's certified nurse-midwives.

Direct Entry Midwives

Direct entry midwives vary greatly in their training, certification and methods. Some are graduates of colleges or schools of midwifery, which offer degree and certification programs of different lengths. Others choose to become Certified Professional Midwives through the North American Registry of Midwives.

The American College of Nurse-Midwives (ACNM) certification council also provides accreditation to non-nurse midwife programs, as well as colleges which graduate nurse midwives. All midwives certified by ACNM must pass the same certifying exam.

Another organization, the Association for Childbirth at Home International (ACHI), also prepares direct entry midwives with a very detailed and technically competent program.

Other midwives follow the time-honored path of the traditional birth attendant, learning the trade through apprenticeship and hands-on experience rather than a more formal course of study.

Practice in the United States

Midwives catch babies in any number of settings. While the majority of nurse-midwives work in hospitals, some nurse-midwives and many non-nurse-midwives catch babies at home birth|home. In many states, midwives form birthing centers where a group of midwives work together. Laws regarding who can practice midwifery and in what circumstances vary from state to state, and some midwives practice outside of the law.

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Midwifery in the United Kingdom

Midwives are practitioners in their own right in the United Kingdom, and take responsibility for the antenatal, intrapartum and immediate postnatal care of women. Nearly all births are supervised by midwives, mostly in a hospital setting. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen month course (leading to a degree qualification), or by undertaking a three year degree in midwifery.

All practicing midwives must be registered with the Nursing and Midwifery Council, and are subject to the local supervising authority. Most midwives work within the National Health Service, providing both hospital and community care, but a significant proportion work independently, providing total care for their clients within a community setting.

To be a midwife is to be responsible, at all times, for the woman for whom you are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains some choice and control over her childbirth experience. Many midwives are opposed to the so-called 'medicalisation' of childbirth, preferring a more normal and natural option, to ensure a more satisfactory outcome for mother and baby.

Community midwives

There are also numerous midwives working in the community, in addition to the midwives working in hospitals. The roles of community midwives include the initial appointments of pregnant women, the running of clinics, postnatal checks in the home, and attending home births.

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Midwifery in Canada

Midwifery made a comeback as a viable birth option in Canada in the 1960s, along with other aspects of heath care reform that trace their roots to that decade of societal ferment and change. After several decades of intensive political lobbying by midwives and consumers, regulated midwifery has become part of legislated medical care in the provinces of British Columbia, Alberta, Manitoba, Ontario, and Quebec. It may be legislated in Saskatchewan, Nunavut,and the North West Territories as well.

Midwives in Canada have come from a variety of backgrounds, including nurse-midwifery, lay midwifery and direct-entry midwifery. However, they are all simply known as 'midwives', regardless of their original training. From the original 'alternative' style of midwifery in the 1960s and 1970s, midwifery practice has become somewhat standardized in all of the regulated provinces: midwives offer continuity of care within group practises, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care as long as the woman's health remains normal. When women have deviations from normal in their pregnancies, they are then subject to being referred out of midwifery care without any right to a voice in the decision-making.

There are three provinces that now offer midwifery education, which consists of a four year baccalaureate degree in midwifery, usually based in a university setting. In British Columbia, this university training is under the auspices of the School of Medicine at the University of British Columbia.

The professionalization of midwifery has brought midwives into the mainstream of medicine with hospital privileges, malpractice insurance and membership requirements in the provincial 'colleges' (disciplinary bodies). The result has been a shift away from woman-centred, consumer friendly care to a more self-protective focus much like physicians.

Since obstetrics is the most Litigation|litigated profession in medicine, it stands to reason that midwives are now protecting themselves by engaging in similar routine testing and much of the same aggressive medical interventions as physicians. The trade off, for avoiding the criminal and civil litigation of the 1980s and 1990s, has been to join the system in order to sidestep civil lawsuits. Practises that were never seen in midwifery (e.g., induction of labor at 41 weeks gestational age, administration of epidurals, sending women for routine ultrasounds, and administering antibiotics and Vitamin K routinely to newborns) have become commonplace since regulation. The words of Ivan Illich, "The death knell of a viable Underground resistance|underground organization is legalization," are descriptive of what has happened to midwifery in Canada.

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