The rise, fall and rise of nurse-midwifery in America

For most of history, the care of women, particularly childbearing women, has been delivered by healers and health care providers who were women. This article is an overview of the historical, social, political, economic, and philosophic forces that shaped the role of women, especially midwives, who care for childbearing families. As healers and health care providers, midwives (and later, nurse-midwives) have based their practice on the natural process of pregnancy and birth. Their holistic view dominated childbirth until the 18th century, when the existence of midwives began to be challenged by institutions. In the United States, the marriage of midwifery with nursing in the 1920s, followed by the consumer childbirth revolution of the 1960s, gave new strength to the profession of nurse-midwifery. Later, health economics provided additional support for nurse-midwifery practice, with demonstrated reduced costs and improved quality. At the cusp of the 21st century, internal and external political forces have now led to the inclusion of nonnurses in the profession of midwifery in the United States. Despite the ever-changing political, economic, and societal climate, midwives consistently have brought superior outcomes and family-centered caring to their practice and their patients.