Who Is Qualified to Supervise Pregnancy?

The only person fitted to give modern prenatal care is a specially trained physician or an expertly trained nurse-midwife who has the services of a qualified obstetrical consultant readily available.

When the word ‘midwife’ is mentioned in the United States, one immediately conjures up a decrepit, kindly, illiterate, often not too clean old ‘Granny’ type of woman, a creature whose only professional claim was the number of children she herself had had, plus a desire to be an obstetrix (female obstetrician). This variety of midwife, except for sex, has nothing in common with the nurse-midwife. These remarkable women are graduate nurses who have invested two years or longer in the special postgraduate study of obstetrics. They are relatively plentiful in Europe, especially in the British Isles, Scandinavia, and the Low Countries. In some areas of Europe nurse-midwives conduct almost all of the vaginal deliveries, receiving help from a physician only when a complication arises. Nurse-midwives are so well instructed that they can recognize both a complication and their own limitations in handling it. The latter phase of their work is quite clearly spelled out in governmental regulations under which they operate.

Here in the United States, even for much of the Deep South, the granny-type of midwife is becoming an extinct species. In most states none are being newly licensed and the old licensees are dying off. On the other hand, we are beginning to amass a small group of native trained nurse-midwives. They are being taught in three places: the Maternity Center, New York City; the Frontier Nurses Association in Kentucky; and the Catholic Maternity Center, Santa Fe, New Mexico. All three schools are presided over by highly motivated, competent faculties and are graduating very superior pupils who are distributed all over the world, largely in administrative posts in public-health agencies. A half-dozen are giving expert prenatal care to a large indigent rural population on the Eastern Shore of Maryland under the aegis of the State Health Department.

The future of the nurse-midwife in this country is unclear. There is desperate need for her in the rural areas which are too sparsely populated to attract the settlement of qualified physicians. Whether she will ever play an important role in our urban practice of obstetrics is difficult to prophesy. Certainly for the present her part in the cities is minirnal and can be totally discounted in private-patient care.