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A History of Midwifery in the United States

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A History of Midwifery in the United States

SKU# 9780826125378

The Midwife Said Fear Not

Author: Helen Varney Burst RN, CNM, MSN, DHL (Hon.), FACNM, Joyce E. Thompson DrPH, RN, CNM, FAAN, FACNM

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Written by two of the profession's most prominent midwifery leaders, this authoritative history of midwifery in the United States, from the 1600s to the present, is distinguished by its vast breadth and depth. The book spans the historical evolution of midwives as respected, autonomous health care workers and midwifery as a profession, and considers the strengths, weaknesses, threats, and opportunities for this discipline as enduring motifs throughout the text. It surveys the roots of midwifery, the beginnings of professional practice, the founding of educational institutions and professional organizations, and entry pathways into the profession. Woven throughout the text are such themes as the close link between midwives and the communities in which they live, their view of pregnancy and birth as normal life events, their efforts to promote health and prevent illness, and their dedication to serving women wherever they may be and in whatever health condition and circumstances they may be in.

The text examines the threats to midwifery past and present, such as the increasing medicalization of childbearing care, midwifery's lack of a common identity based on education and practice standards, the inconsistencies in its legal recognition as a profession, and reimbursement issues for midwifery practice. Illustrations and historical photos depict the many facets of midwifery, and engaging stories provide cultural and spiritual context. This is a "must-have" for all midwives, historians, professional and educational institutions, and all those who share a passion for the history of midwifery and women.


  • Encompasses the most authoritative and comprehensive information available about the history of midwifery in the United States
  • Considers the strengths, weaknesses, threats, and opportunities for midwifery
  • Illustrated with historical photos and drawings
  • Includes engaging stories filled with cultural and spiritual content, introductory quotes to each chapter, and plentiful chapter notes
  • Written by two preeminent leaders in the field of midwifery

Product Details 

  • Publication Date November 04, 2015
  • Page Count 528
  • Product Form Paperback / softback
  • ISBN 13 9780826125378
  • EISBN 9780826125385

About The Author(s) 

Helen Varney Burst, MSN, CNM, DHL (Hon.), FACNM, is Professor Emeritus at the Yale University School of Nursing. When she retired in 2004, Yale University established the endowed Helen Varney Professorial Chair in Midwifery in the School of Nursing. Ms. Varney Burst practiced midwifery in a variety of in-patient and out-patient settings and birth locales, was a nurse-midwifery service director in two medical center tertiary hospitals, and was cofounder and president of a birth center. She directed three nurse-midwifery education programs (University of Mississippi Medical Center, Medical University of South Carolina, and Yale University) and served as a consultant to many others. She was the co-originator of the mastery learning modular curriculum design for nurse-midwifery education; developed the nurse-midwifery management process and the Circle of Safety; is a Consulting Editor (history) for the Journal of Midwifery & Women’s Health; and is the author of the first textbook for nurse-midwives in the Americas (1980), now in its fifth edition as Varney’s Midwifery, and used in a number of other countries. (The fourth edition was translated into Spanish.) Ms. Varney Burst has written numerous journal articles and given scores of speeches and presentations. She also wrote the Brief History of the Yale University School of Nursing (YSN) for its 75th anniversary (1923–1998) and updated it for YSN’s 90th anniversary in 2013.

Ms. Varney Burst served the American College of Nurse-Midwives (ACNM) in numerous capacities, including two terms as President (1977–1981), Secretary (1972–1974), Chair of the Bylaws Committee (1970–1972), Chair of the Work Group on Bylaws Revision (2007–2008), member and Chair (1975) of the Division of Examiners (1960s–1970s), and Chair of the Division of Accreditation during most of the 1990s. She was a member of the founding Board of Governors of the Fellowship of the ACNM (Fellows of the American College of Nurse-Midwives [FACNM]) in 1993, is a Distinguished Fellow, and served as Chair from 2005 to 2008. She also has served as the ACNM representative to the International Confederation of Midwives (ICM) as well as to many national interprofessional and interorganizational meetings and advisory groups.

Helen Varney Burst is the recipient of a number of awards including the ACNM Hattie Hemschemeyer Award (1982), the YSN Annie W. Goodrich Excellence in Teaching Award (1999), and alumni awards from all her alma maters: Yale University (MSN and CNM, 1963), University of Kansas (BSN, 1961), and Kansas State University (BSHE, 1961). In 1987, she received a Doctor of Humane Letters (honoris causa) from Georgetown University.

Joyce Beebe Thompson, DrPH, CNM, FAAN, FACNM, is Professor Emeritus at the University of Pennsylvania and Western Michigan University, and an international consultant in midwifery education, women’s health, and human rights. She has a BSN and MPH from the University of Michigan, a Certificate in Nurse-Midwifery from Maternity Center Association, a DrPH from Columbia University, and a certificate in bioethics from the Kennedy Institute at Georgetown University. Dr. Thompson practiced midwifery in a variety of settings, including birth centers and tertiary hospitals. She established the nurse-midwifery education master’s program and the nurse-midwifery private practice at the University of Pennsylvania School of Nursing in 1980, where she received the university’s Lindback Award for Distinguished Teaching (1997). Among the various alumnae and leadership awards were the ACNM’s Hattie Hemschemeyer Award (1987), Fellowship of the American Academy of Nursing (FAAN) and a founding member of the Fellows of the American College of Nurse-Midwives (FACNM; 1993), an honorary Doctor of Science from SUNY–Downstate Medical Center (1995), and an honorary Doctor of Laws from the University of Dundee, Scotland (2007), in recognition of her passion and commitment to the health of women globally.

Dr. Thompson has more than 50 years of midwifery practice in the United States and other countries and 40 years of leadership in various capacities within the ACNM, including two terms as President (1989–1993), and various roles on the Division of Examiners (1976–1987), Division of Accreditation (1975–1980), and the Ad Hoc Ethics Committee (1987–1988). In addition, she has more than 20 years of global leadership within the International Confederation of Midwives (ICM), serving two terms as Director of the ICM Board of Management (1999–2002; 2002–2005), was Vice Chair of the World Health Organization (WHO) Global Advisory Group on Nursing and Midwifery, Geneva, Switzerland (2001–2007), and continues as an international midwifery education consultant, most recently in Latin America and the Caribbean. She has authored or coauthored more than 50 peer-reviewed articles, several books, and book chapters, covering topics on ethics, the preparation of teachers, and ICM global standards and competencies for midwives. Most recently, Dr. Thompson authored a companion document for WHO’s Midwifery Educator Core Competencies (2014). She will be heading the team of international colleagues writing the history of the ICM in time for the 100th anniversary in 2019.

Table of Contents 






Definitions, Titles, and Credentials


Lay, Empirical, Community, and Direct-Entry Midwives

Midwifery and Midwives Through the Centuries

Midwifery Models of Care

The ACNM Midwifery Model of Care

MANA: “The Midwives’ Model of Care™”

Summary of Midwifery Models of Care


1. The Early Voices of Midwives

The Voices of Predecessor Midwives in Antiquity

The Voices of Midwives in the Colonies (1607–1775) and Early History of the United States (1776−Mid-1800s)

The Voices of Traditional African American Antebellum Slave Midwives (1619–1861)

The Voices of Granny Midwives (Late 1800s−Mid-1900s)

The Voices of Immigrant Midwives and Other Midwives in the Late 1800s and Early 1900s

2. Silencing the Early Voices of Midwives: 1600s to 1800s

Advances in Knowledge and Exclusion of Midwives and Women From Learning

Midwifery in Europe

Study Abroad for Physicians and Their Takeover of Midwifery in the United States

Development of Medical Schools and the Flexner Report

Women in Medicine

Professionalization of Medicine and the Specialty of Obstetrics

Pain Relief During Childbirth: Ether and Chloroform

3. Silencing the Early Voices of Midwives (Late 1800s–Early 1900s)

The “Midwife Problem”

Legislation/Rules/Regulations and the Practice of Midwifery

Nursing and Midwifery

The Bellevue School for Midwives

“Twilight Sleep”

Professionalization of Nursing, Nursing Education, and Public Health Nursing

Professionalization of Midwifery Needed to Survive

4. Silencing the Early Voices of Midwives (Late 1910s–Mid-1940s)

Closure of the Bellevue School for Midwives

Restrictive Legislation

The Continuing Move Into Hospitals

Silencing the Immigrant Japanese Sanba Midwives


5. Nursing Roots

Florence Nightingale

Public Health Nursing

Public Health Policies, Programs, and Public Health Nursing

Children’s Bureau

Prenatal Care

Maternity Center Association

Public Health Nurses as Midwives

Sheppard–Towner Act

6. The Nurse-Midwife Starts Practicing (1920s–Early 1950s)

Frontier Nursing Service

Lobenstine Midwifery Clinic

Practice of Early Nurse-Midwifery Education Program Graduates (1925–1954)

Family-Centered Maternity Care and Natural Childbirth

7. Early Education for Nurse-Midwives (1920s–1954)

Manhattan Midwifery School

Lobenstine/Maternity Center Association Midwifery School

Frontier Nursing School of Midwifery

Tuskegee School of Nurse-Midwifery

Dillard University Flint-Goodridge School of Nurse-Midwifery

Catholic Maternity Institute School of Nurse-Midwifery and Catholic University of America


8. Resurgence of Community Midwives

Consumer Demand for Out-of-Hospital Birth

Responses to Consumer Demands

Midwife Responses to Consumer Demands

Legal Responses to Consumer Demands

Organizational Responses to Consumer Demands

Variety of Lay Midwife Practitioners in the 1960s and 1970s

Communication and Networking

9. Early Education Pathways for Community and Lay Midwives (1970s and 1980s)

Apprentice Education: 1800s to 1970s


Early History of Apprentice Education in Medicine

Early History of Apprentice Education in Nursing

Apprentice Education in Midwifery During the 1970s and Early 1980s

Key Issues Related to Apprentice Education in Midwifery

Academic Models of Lay/Community Midwife Education

The Maternity Center at El Paso Training Program (1976)

Arizona School of Midwifery (1977)–Tucson

Seattle Midwifery School (1978)

Utah College of Midwifery/Midwives College of Utah (1980)—Salt Lake City

Northern Arizona College of Midwifery (1981)

Maternidad La Luz (1987)—El Paso

The Northern Arizona School of Midwifery (1988)—Flagstaff

The New Mexico College of Midwifery (1989)/National College of Midwifery (1991)—Taos


Introduction and Overview of Professionalism and Professionalization

Definition and Characteristics of a Profession

Key Characteristics of a Professional

Professionalism and Professionalization

 10. The American College of Nurse-Midwives

Predecessor Organizations

Founding of the American College of Nurse-Midwifery

Organizational Development


The Seal of the American College of Nurse-Midwifery/Nurse-Midwives


Bylaws and Structure


Headquarters/National Office


A.C.N.M. Foundation


Core Documents



Functions, Standards, and Qualifications

Core Competencies

ACNM Code of Ethics

Peer Review

Home Birth, Practice Settings, and Review of Clinical Practice Statement Documents

 11. Midwives Alliance of North America

Predecessor Organizations

First International Conference of Practicing Midwives (January 14–16, 1977)

National Midwives Association (June 1977)

Second International Conference of Practicing Midwives (March 17−19, 1978)

Meeting of CNMs and Non-Nurse Midwives (October 30, 1981)

Founding of Midwives Alliance of North America

Organizational Development

MANA Goals

First Convention and the MANA Process





Committee Structure

Statistics and Research Committee

Communication/Public Relations (Education) Committee

Communication/MANA News

Central Office

Essential (Core) Documents

Standards and Qualifications for the Art and Practice of Midwifery

Core Competencies for Basic Midwifery Practice

MANA Statement of Values and Ethics

MANA Position Statements

Descriptive Statistics


 12. National Association of Certified Professional Midwives

Early History and Founding

Organizational Development

Purpose and Aim

Board of Directors

Standards Committee

Practice Committee

Core Documents


Philosophy and Principles of Practice

Scope of Practice

The Standards of Practice for NACPM Members

Issue Brief: Certified Professional Midwives in the United States

NACPM Website



 13. Nurse-Midwifery Practice (1950s–1980s)

Nurse-Midwives Move Into Large City and University Medical Center Hospitals


Technological Advances and the Continuing Quest for Pain Relief

Nurse-Midwives Move Into Private Practice With Births Both In and Out of a Hospital

Nurse-Midwives Create the Modern Out-of-Hospital Birth Center

Practical Practice Help From the ACNM

Evaluation and Effectiveness Studies

Descriptive Studies

 14. Nurse-Midwifery Education (1955−1980s)

Types of Programs

Growth Spurts

Education Workshops

Developments in Education

Mastery Learning Using Modules

Directors of Midwifery Education

A Textbook for Midwifery

Distance Learning


 15. Direct-Entry Midwifery Education

American College of Nurse-Midwives (1978–1996)

ACNM Education Committee

ACNM Division of Accreditation

Midwives Alliance of North America (1983–1991)

MANA Education Committee

National Coalition of Midwifery Educators

Association of Midwifery Educators

 16. Credentialing of Midwives


Accreditation Commission for Midwifery Education and Predecessors

Committee to Study and Evaluate Standards for Schools of Midwifery

Committee on Curriculum and Accreditation

Committee on Approval of Educational Programs

Division of Approval

Division of Accreditation

Accreditation Commission for Midwifery Education

Midwifery Education Accreditation Council

Credentialing Committee

MEAC Incorporated

MEAC Criteria for Direct-Entry Midwifery Education Programs

USDOE Recognition

Early MEAC-Accredited Programs


American Midwifery Certification Board and Predecessors

ACNM Testing Committee

Division of Examiners

ACNM Certification Council/American Midwifery Certification Board

North American Registry of Midwives

MANA Interim Registry Board

Creation of the MANA Registry Examination

North American Registry of Midwives Incorporated

Conversion From Registry to Certification Examination

NARM Certification of Direct-Entry Midwives


Certified Nurse-Midwives and Certified Midwives

Legislation Committee

Political and Economic Affairs Committee/Government Affairs Committee

Lay and Direct-Entry Midwives

Licensure Debates

State Recognition of Lay Midwifery Practice Prior to 1982

State Recognition of Direct-Entry Midwifery Practice After 1982

Certified Professional Midwives

The Big Push for Midwives Campaign (2008)


 17. Federal Legislation Affecting Midwifery Practice

The American College of Nurse-Midwives’ Involvement in Legislation

Washington Task Force

Legislation Committee

Master Plan and ACNM Legislative Response Mechanisms

ACNM Lobbyist

Early Federal Legislation


Direct-Entry Midwifery Groups’ Involvement in Legislation

MANA Legislative Committee

MANA Legislative Conferences

MANA Legislative Lobbyist, 1994

NACPM and the Midwives and Mothers in Action Campaign

Collaborative Efforts in Maternity Care Legislation

Safe Motherhood Acts, 1996, 2002

Affordable Care Act of 2010

Coalition for Quality Maternity Care

 18. Midwives With Women and Childbearing Families

Consumers and Midwives Working Together for Safe Choices Among Childbirth Alternatives

Maternity Center Association

La Leche League, 1958, and La Leche League International, 1964

International Childbirth Education Association, 1960

American Society for Psychoprophylaxis in Obstetrics/Lamaze, 1960

National Association of Parents & Professionals for Safe Alternatives in Childbirth, 1975

Other Partnerships Supporting Safe Alternatives in Childbirth

Listening to Women

ACNM Ad Hoc Committee on Consumer Affairs

ACNM’s Listen to Women Campaign

Citizens for Midwifery, Inc.

Childbirth Connection 2005

Public Policy Agenda for Women

Midwives With Vulnerable Populations

ACNM Position Statements on Health Policy

American Public Health Association Policy Statements on Midwives and Women’s Health

Safe Motherhood Initiatives, USA

 19. Midwives (CNMs) With Physicians

Historical Evolution

Joint Statements


20. Midwives (CNMs) With Nurses and Nursing

Early Confusion With Identity of Nurse-Midwives

Nurse Practitioners, Physician Assistants, and ANA

National Federation of Specialty Nursing Organizations and ANA

ANA and Early Certification Efforts

ACNM’s Continuing Internal Struggle With Self-Identification and the Working Document

Nurse-Midwives and OB-GYN Nurse Practitioners

ANA Develops a Credentialing Center

ANA Defines Nurse-Midwives as Nurse Practitioners

ACNM Defines Nurse-Midwives

ANA Defines Nurse-Midwives as Advanced Practice Registered Nurses

AACN and Accreditation

Nursing Response to ACNM Involvement in Direct-Entry Midwifery

Nurse-Midwives Included in APRN Regulation

Self-Identification and Loss of Autonomy


 21. Midwives With Midwives: United States

Carnegie Meetings Stimulate Midwifery Dialogue in the United States

First Carnegie Meeting: July 16 to 18, 1989

MANA–ACNM Activities Between the Two Carnegie Meetings

Second Carnegie Meeting: July 22 to 24, 1990

The MANA-ACNM Interorganizational Workgroup on Midwifery Education

Carnegie Funds Awarded

Goals of IWG

Selection of Workgroup Members

The IWG Meetings

Factors Mitigating Against Achievement of Carnegie and IWG Goals

Different Organizational Processes

Words and Concepts Without Common Meaning

Philosophy of Inclusiveness

Level of Midwifery Education

University Affiliation for Midwifery Education

Misunderstanding on Who Develops Education Programs

Suspicions About IWG Activities

Final Outcomes of IWG Meetings

The Grand Midwife Statement

Midwifery Certification Document

Liaison Planning Document

Continuing ACNM and MANA Dialogue

The Bridge Club

ACNM–MANA Liaison Group

United States Midwifery Education, Regulation, and Association

 22. Midwives With Midwives: International

The International Confederation of Midwives

Brief History

Aim and Strategic Actions

Organization and Structure

ICM Activities and Documents

ICM International Definition of the Midwife

ICM Mission and Vision

ICM International Code of Ethics for Midwives

ICM Philosophy and Model of Midwifery Care

ICM Essential Competencies for Basic Midwifery Practice

ICM Global Standards for Education and Regulation

The Three Pillars of Education, Regulation, and Association

ACNM’s Role in International Midwifery