Midwifery: Difference between revisions
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==International definition== |
==International definition== |
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A ''midwife'' is a person who, having been regularly admitted to a midwifery educational |
A ''midwife'' is a person who, having been regularly admitted to a midwifery educational program, duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. |
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The midwife is |
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures. |
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The midwife has an important task in health |
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare. |
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A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units. |
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units. |
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==Midwifery in Canada== |
==Midwifery in Canada== |
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Midwifery was reborn as a profession 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]], [[Saskatchewan]], [[Manitoba]], [[Ontario]], and [[Quebec]], and in the [[Northwest Territories]] and [[Nunavut]]. Alberta does not publically fund midwifery. Midwifery is not yet legally |
Midwifery was reborn as a profession 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]], [[Saskatchewan]], [[Manitoba]], [[Ontario]], and [[Quebec]], and in the [[Northwest Territories]] and [[Nunavut]]. Alberta does not publically fund midwifery. Midwifery is not yet legally recognized in the Atlantic provinces of [[New Brunswick]], [[Nova Scotia]], [[Prince Edward Island]] or [[Newfoundland and Labrador]]. |
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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 |
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 practices, 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 experience deviations from normal in their pregnancies, midwives consult with other health care professionals. The women's care may continue with the midwife, in collaboration with an obstetrician or other health care specialist; her care may be transferred to an obstetrician or other health care specialist, temporarily or for the remainder of her pregnancy and birth. Woman as primary decision maker, informed choice, and choice of birth place are primary tenets of midwifery care in Canada. |
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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]]. In Ontario, the Midwifery Education Programme is offered at [[McMaster University]], [[Ryerson University]] and [[Laurentian University]]. In Quebec, the programme is offered at the [[Université du Québec à Trois-Rivières]]. |
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]]. In Ontario, the Midwifery Education Programme is offered at [[McMaster University]], [[Ryerson University]] and [[Laurentian University]]. In Quebec, the programme is offered at the [[Université du Québec à Trois-Rivières]]. |
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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 professionalisation process has resulted in a shift away from woman-centred, consumer friendly care to a more self-protective focus similar to the medical profession. A new consumer movement is arising to address this. |
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 professionalisation process has resulted in a shift away from woman-centred, consumer friendly care to a more self-protective focus similar to the medical profession. A new consumer movement is arising to address this. |
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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. |
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. Practices that were never seen in midwifery (e.g., induction of labor at 41 weeks [[gestation]]al age, administration of [[epidural]]s, sending women for routine [[ultrasound]]s, and administering [[antibiotic]]s 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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==See also== |
==See also== |
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Revision as of 13:08, 8 March 2006
Midwifery is the term traditionally used to describe the art of assisting at childbirth. In the modern context, this term is used to describe the activities of health care givers who provide prenatal care to expecting mothers, attend the birth of the infant and provide postpartum care to the mother and her infant. Practitioners of midwifery are known as midwives, a term used in reference to both women and men (the term means "with the woman") regardless of the educational background or legal status of the practitioner.
Midwives are autonomous practitioners who are specialists in normal pregnancy, childbirth and the postpartum. Midwives may also provide general women's health care. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions are complementary. Midwives refer to obstetricians when a woman requires care beyond her areas of expertise. In many jurisidciations, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives may develop areas of expertise, including breech birth. In many areas of the world, traditional birth attendant, also known as traditional midwives care for childbearing women.
International definition
A midwife is a person who, having been regularly admitted to a midwifery educational program, duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
Adopted by the International Confederation of Midwives, 19 July 2005
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.
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 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 (DEM) vary greatly in their training, certification and methods of practice. 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 (CPM) through the North American Registry of Midwives(NARM).
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges which graduate nurse-midwives. All midwives graduating from ACNM accredited programs must pass the same certifying exam administered by the American Midwifery Certification Board.
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. 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.
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.
Midwives may train to be community Health Visitors (as may Nurses).
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.
Midwifery in Canada
Midwifery was reborn as a profession 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, Saskatchewan, Manitoba, Ontario, and Quebec, and in the Northwest Territories and Nunavut. Alberta does not publically fund midwifery. Midwifery is not yet legally recognized in the Atlantic provinces of New Brunswick, Nova Scotia, Prince Edward Island or Newfoundland and Labrador.
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 practices, 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 experience deviations from normal in their pregnancies, midwives consult with other health care professionals. The women's care may continue with the midwife, in collaboration with an obstetrician or other health care specialist; her care may be transferred to an obstetrician or other health care specialist, temporarily or for the remainder of her pregnancy and birth. Woman as primary decision maker, informed choice, and choice of birth place are primary tenets of midwifery care in Canada.
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. In Ontario, the Midwifery Education Programme is offered at McMaster University, Ryerson University and Laurentian University. In Quebec, the programme is offered at the Université du Québec à Trois-Rivières.
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 professionalisation process has resulted in a shift away from woman-centred, consumer friendly care to a more self-protective focus similar to the medical profession. A new consumer movement is arising to address this.
Since obstetrics is the most 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. Practices 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 organization is legalization," are descriptive of what has happened to midwifery in Canada.
See also
External links
- EFN.org - 'The role of social support in midwifery practice and research', Melinda Cook, BHS, Hunter Valley Midwives Association Journal, vol 2, no 6 (November, 1994)
- Midwife.org - American College of Nurse-Midwives
- Australian College of Midwives
- MidwiferyToday.com - 'Midwifery Today, the Heart and Science of Birth'
- Mothering.com - 'Caretakers of Homebirth: Doctors Who Come to You', Wendy Correa Mothering (May/June, 2002)
- MyMidwife.org - '...everything you need to know about midwifery, pregnancy, and women's health', American College of Nurse-Midwives
- NMC-UK.org - 'Nursing & Midwifery Council: Protecting the Public through Professional Standards' (overseers of UK midwifery, by mandate of Parliament)