As a nurse-midwife, I am proud that Congress has declared this week National Nurse-Midwifery Week.
We've come a long way with babies, and nurse-midwifery is becoming an enhanced profession. In the last six years, I have watched the nurse-midwifery program at Georgetown University School of Nursing develop from an undergraduate-certificate program to graduate school, offering a Master of Science in Nursing degree with a specialty in nurse-midwifery. Education for nurse-midwives now includes academic courses along with clinical training, often side-by-side with medical students and residents.
It has not been easy being a nurse-midwife. The long hours, the constant concern for legislation and the right to practice have consumed many hours. Consequently, when Sen. Daniel K. Inouye (D--Hawaii) introduced a Senate joint resolution in April, 1981, to proclaim this week, April 19-26, as National Nurse-Midwifery Week, I and others wondered about the support we would have among health-care consumers in this country. And would Sen. Inouye's resolution get enough Congressional support to become a bill?
The profession deserves recognition, proclaimed Sen. Inouye, because "of the unique contribution that our nation's nurse-midwives have made to the high quality of life that we possess in the United States . . . they have been working closely with various hospital authorities and the Federal Trade Commission to insure that the consumer will truly have complete freedom of choice and as part of this, that the certified nurse-midwife will be able to have hospital-admitting privileges . . . "
Attitudes toward certified nurse-midwives are changing. Physicians and nurse-midwives are learning slowly to work together in teams. "The rank-and-file obstetrician-gynecologist is aware of the benefits (of nurse-midwives)," says Dr. Ervin Nichols, director of practice activities for the American College of Obstetrics and Gynecology. "They're appreciated, they're accepted."
It's no secret that this has not always been so. In the early 1900s, untrained lay midwives delivered close to half of all children born in this country; the infant and maternal mortality rate was high, and obstetricians and public-health officials began pushing for the removal of midwives.
Although some physicians suggested that educated midwives could improve obstetrical care, midwives were a vanishing breed by 1930. The first formal educational program to teach and supervise nurse-midwives opened in 1935 at the Maternity Center Association of New York City, still a leader in birth options and family-centered care.
In the late '50s, when I entered nursing school, there were less than 300 nurse-midwives practicing in this country, mainly in poor urban and rural areas. Today there are more than 2,000 members of the American College of Nurse-Midwives. A certified nurse-midwife is trained in both nursing and midwifery, with ACNM accreditation. Among areas in which they now assist: Health Maintenance Organizations, private practice, home-births, hospital clinics. One of the newest services, introduced in Washington this year, is the Cities and School Project, which provides schooling, prenatal care and childbirth information for pregnant adolescents. A birthing center is scheduled for a June opening in Bethesda.
The future looks bright for certified nurse-midwives. Medicaid reimbursement has been approved; some insurance companies provide direct reimbursement to nurse-midwives. The time has come for the nurse-midwife to be an integral part of a sophisticated--and personalized--American health-care system.
It's 11 p.m., and my beeper is going off. I'm off to the hospital, where one of our midwifery patients is in labor. It will be a long night, but I cannot help but feel buoyed by this week that is ours.