Midwifery is the term traditionally used to describe the art of assisting awoman through the process of childbirth. In the modern context, this term isused to describe the activities of these health care providers who are expertsin women’s health care, which includes giving prenatal care to expectingmothers. They attend the birth of the infant and provide postpartum care to theinfant and mother. Practitioners of midwifery are known as midwives,constituting a small but visible minority of the health care field.

Midwives are autonomous practitioners who are specialists in mattersregarding normal pregnancy, childbirth and postpartum. They generally work toensure that women under their care have a healthy pregnancy and natural birthexperience. Recognized by most of the field as primary care givers, midwivesare trained to recognize and deal with deviations from the norm. Obstetricians,on the other hand, are specialists in illnesses related to childbearing. Thetwo professions can be complementary, but are often at odds with each other,since obstetricians are taught to actively manage labor, while midwives aretaught not to intervene unless necessary.

Midwives refer a patient to an obstetrician when a woman requires carebeyond her area of expertise. In many jurisdictions, these professions worktogether to provide care to childbearing women, while in others only themidwife is available to provide care. Midwives are trained to handle just a fewsituations that are considered abnormal, including breech birth and posteriorposition, using non-invasive techniques. In many areas of the world,traditional midwives, called “traditional birth attendants” by the World HealthOrganization (WHO), are the only available providers for childbearing women. Inthe United States, they are divided into nurse midwives and direct-entrymidwives.

A nurse midwife is a midwife who enters midwifery after first completing afull accredited nursing education program. All nurse midwives have theirBachelor’s degree, and the great majority have Master’s degrees as well. Nursemidwives deliver about ten percent of the births in the United States, and aslightly greater percentage in most other Westernized countries. Most operateonly out of hospitals, since they are prevented by malpractice insurance rulesand other concerns from performing home deliveries. Many would prefer to havethe option of also being allowed to work outside the hospital.

American nurse midwifery originated during the Great Depression as a servicefor poor families in rural areas with little access to physicians. Theygradually shifted their focus to the inner city, which was becoming the locusof much of the poverty and poor medical care in America of that era. At first,nurse midwives were considered marginal members of the medical community atbest, which considered delivering babies to be the exclusive domain ofobstetricians. With years of lobbying and shifting cultural mores, they havegradually become accepted as full partners in the medical field. With thisacceptance has come limitations; there are requirements that nurse midwivespractice under the supervision of an obstetrician and meet restrictiveinsurance requirements preventing them from having the freedom in theirpractices that many would prefer.

Direct-entry midwives are a separate category. These are midwives who haveentered the practice of midwifery directly, without first passing throughnursing training. In the Western nations, direct-entry midwives handle only twopercent of all births, with the exception of a few European countries where thenumber is closer to twenty-five percent. Modern direct-entry midwives havetheir origins in the lay midwifery movement of the 1970s, but as they graduallyprofessionalized and gained a body of experience, many came to prefer the termdirect-entry as a profession in it’s own right.

Direct-entry midwives mostly deliver children in the home of the patient orin birth centers where they run their practices. Most direct-entry midwives arestill not allowed hospital privileges at all, and their practice remainstotally illegal in nine states in America, where they are liable to be arrestedfor practicing medicine without a license.

Direct-entry midwifery began as an organic response to the manycounter-culture movements in the late 1960s and 1970s, based on a distrust oftraditional procedure and unnecessary technology, and also the feminist callfor a more woman-centered worldview. Direct-entry midwife centers sprang upindependently in several different regions of the country, most notably inSanta Cruz, California, Vermont, and the commune known as “The Farm” inTennessee, which was the home of founding mother Ina May Gaskin. At that timeit was mostly an internal way of dealing with birth for drop-outs who had leftmost of the institutions of traditional society behind them to join the communeenvironment, but as those drop-outs began reintegrating themselves withmainstream culture in the 1980s and settling for the jobs and house in thesuburbs after all, they took the practice of midwifery with them, and thusbegan a long process of making midwifery a profession all on it’s own.

The controversy between nurse midwives and direct-entry midwives has beenpretty stormy. Nurse-midwives feel that their direct-entry counterpartsundermine the years of work they have done to have midwifery be accepted as afully legitimate and scientific enterprise, and they tend to be suspicious ofdirect-entry midwives’ lack of formal college-level training. Direct-entrymidwives, from their side of the issue, criticize nurse-entry midwives ashaving abandoned the values which make midwifery distinct from obstetricpractice. They also fear and resent the efforts which some nurse midwives havemade to make the practice of midwifery without nurse’s training illegal.

Nobody has said the word “monopoly” yet, but it’s clear that midwives andparticularly direct-entry midwives might feel that this is just what thechild-birthing industry suffers under. In the United States, midwifery is stillseen as a dodgy practice, and obstetricians range from acceptance to hotprotest. Considering that there are many fields in medicine, such asphysician’s assistants, where practice is also not allowed without directsupervision by a more educated overseer, many have asked what would be the harmin nurse midwives practicing under supervision as they have been doing. Thiscontroversy may yet reveal deep-seated animosity between political camps ofhealth care workers before it plays out.

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