Blazing Trails, Building Fences, and Raising Towers: A Historical Review of Nurse-Midwifery and Childbirth in the United States

Background:  The United States compares poorly among the world’s nations in terms of maternal and infant mortality.  Public health experts increasingly argue for midwifery care as an important approach to improving the quality of maternal and newborn care.  Despite this growing consensus, nurse-midwives attend only 8 % of births in the United States. 

Purpose:  To review the history of childbirth and nurse-midwifery in the United States, including the economic, political, and social factors impacting the development and expansion of nurse-midwifery, providing insight into the current status of nurse-midwifery, childbirth, and maternity care in this country.

Methods:  A review of current literature related to the history of childbirth and nurse-midwifery was conducted using CINAHL and Academic Search Complete databases.

Results:  Issues of financial status, gender, political power, and race impacted the development of nurse-midwifery, providing implications for current research.

Conclusions:  Childbirth evolved from an in-home, social event among women to a hospital based, solo experience attended by men.  Traditional midwifery declined as attendance of childbirth was overtaken by physicians trained in obstetrics.  The profession of midwifery was practically eliminated by the 1950s, with the exception of midwives caring for poor, underserved women in the rural south and immigrant women in the northeast and southwest regions of the United States.    Nurse-midwifery developed in response to high maternal and infant mortality rates, expanding as women sought non-traditional care within the hospital setting.