With Women: Roots of Nurse-Midwifery in the United States
At the turn of the century, midwives attended approximately half of all births in the United States. In the 1910s, however, Progressive-era public health institutions such as the Children's Bureau conducted investigations that highlighted high infant and maternal mortality rates across the country. In many cases, government bodies such as New York City Health Department responded by placing blame for these high mortality rates upon traditional, or lay midwives, who were primarily apprentice-trained and worked in their communities of origin. While evidence pointed to other risk factors, such as limited or nonexistent prenatal care and inadequate hospital facilities, legal and public opinion campaigns curbed midwives' role in American women's birth experiences.
As the role of traditional midwives declined, many urban and rural families lost access to reproductive care. To address this need, advocates suggested the solution of providing public health nurses with midwifery training, because their scope of practice already included maternal and child health. In 1925, Mary Breckinridge established the Frontier Nursing Service in rural Kentucky, introducing the first nurse-midwives to the United States. The Lobenstine Midwifery School and its associated clinic, later merged with the Maternity Care Association, opened in in New York in 1932 in order to train a new generation of nurse-midwives and serve poor families in rural and urban communities. The Tuskegee School of Nurse-Midwifery opened in 1941 with the express purpose of training African American public health nurses to meet the maternity needs of African American women in the rural south.
Nurse-midwifery as a profession continued to grow in the twentieth century, building upon a foundation of nursing knowledge with advanced education in midwifery. The American College of Nurse-Midwives (ACNM),incorporated in 1955, is the largest professional organization of nurse-midwives. ACNM advocates for the profession, advances research, and manages accreditation of graduate programs. A certified nurse-midwife (CNM) has graduated from an ACNM-accredited program, and has successfully passed a rigorous national board examination.
Laying the Foundation: Public Health Nursing and Women’s Healthcare at OHSU
The School of Nursing at OHSU has deep roots in public health nursing. In 1920, the Portland School of Social Work opened, specializing in training baccalaureate-prepared public health nurses. In addition, students preparing for roles as public health nurses were trained in ante- and post-partum care in order to provide care to women in the rural communities of Oregon where they were expected to practice. Early catalogs and program descriptions demonstrate a curricular emphasis on obstetrics, as wellas maternal and infant health, and point to the Maternity Care Association as a model for training nurses to care for women during pregnancy and birth.
Despite this early groundwork, neither OHSU nor Oregon had a sizeable population of nurse-midwives until the 1970s. When Carol Howe, founding program director of the OHSU nurse-midwifery graduate program, arrived in Oregon in 1974, only one CNM worked in active practice in Oregon. Howe obtained medical staff privileges in 1975, and practiced under the Department of Obstetrics and Gynecology in the School of Medicine. The next five years saw the development of a CNM practice at OHSU, initially located within the Department of Obstetrics and Gynecology before moving to the School of Nursing in the mid-1980s.
Planning for the nurse-midwifery graduate program began in the 1970s under Dean Carol Lindeman. An assessment of healthcare needs for maternal and child health, as well as regional educational needs, indicated the need for advanced practice training in midwifery. The school initiated the women's healthcare nurse practitioner graduate program in 1980 under the direction of Mary Ann Curry, laying the foundation for the nurse-midwifery program.
Thirty-Five Years of Nurse-Midwifery Education at OHSU
In 1981, the nurse-midwifery graduate program at OHSU School of Nursing admitted its first cohort, which consisted of two students. The students who started classes in September marked the first class of students studying to become certified nurse-midwives at a university in the Pacific Northwest.
Dean Carol Lindeman recruited Dr. Carol Howe, who had just completed her doctorate at UCSF, back to OHSU with the specific charge of starting a nurse-midwifery graduate program in 1980. Along with Dr. Howe, midwives from the OHSU practice taught in the program. Linda Wheeler and Tom Lloyd joined the program as permanent faculty in 1983. The program continued to grow throughout the 1980s,1990s, and 2000s, and now includes a dozen faculty members. In addition, the program maintains relationships with preceptors to provide students with patient care experience in their clinical assignments across the region.
The first class of CNM students, who entered in 1981, graduated in 1983. The program received full accreditation in 1984. Over 200 students have since graduated from the program. In 2011, the program admitted its first students to the Doctorate of Nursing Practice (DNP) program. The thirty-fifth class of OHSU nurse-midwifery students begins classes in the fall of 2016. The program consistently tops the list of the best nurse-midwifery graduate programs in the country.
OHSU, Midwives, and the Community
OHSU nurse-midwives have taken the lead in advocating for the visibility of the profession, as well as for the philosophy that guides nurse-midwifery practice. Alongside leadership activities in national organizations such as ACNM, program faculty and students have consistently sought to educate the OHSU and Oregon communities about the role that midwives can play in a collaborative birth team.
In addition, the nurse-midwifery program at OHSU continues to educate students to provide high-quality maternity care to underserved populations. In 1982, the program received its first Health Resources and Services Administration (HRSA) grant,with the aim of training nurse-midwives to practice in rural and medically underserved communities. Over the years, OHSU CNMs have helped to provide careto many women and families who would otherwise be without these services,through partnerships with community health centers such as the Virginia Garcia Memorial Health Center.
Today, nurse-midwives are prepared to practice in a variety of birth settings, both inand out of hospitals. Midwives have also taken a leading role in establishing free-standing birth centers, which emerged in the 1970s and 1980s as a safe alternative to hospital births. Graduates from the OHSU program go on to work in settings such as publicly-supported hospitals, private practice, as well as hospital-associated and non-hospital birth centers across the region.
Text and selections by Meg Langford, Public Services Coordinator
Many thanks to Dr. Carol Howe and to the faculty, students, and staff of the Nurse-Midwifery program at OHSU.