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Midwifery is a blanket term used to describe a number of different types of health practitioners, other than doctors, who provide prenatal care to expecting mothers, attend the birth of the infant and provide postnatal care to the mother and infant. Nurse-midwives also provide gynecological care to women of all ages. Practitioners of midwifery are known as midwives, a term used in reference to both women and men (the term means "with the woman"). Most are independent practitioners who work with obstetricians when the need arises.They usually deal with normal births only but are trained to recognise and deal with deviation from the norm. If something abnormal is discovered during prenatal care, the client is sent to an obstetrician. Other midwives will deal with abnormal births, including breech birth.


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. 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 U.S.

There are two main divisions of modern midwifery in the United States, nurse-midwives and direct-entry midwives.

Nurse Midwives

In the United States, nurse-midwives are registered nurses with a bachelors degree in nursing who return to college for two additional years to specialize in midwifery and gynecological care of healthy women with none to low risk. Most nurse-midwives also have a masters Degree in nursing. Nurse-midwives practice in hospitals and medical clinics, and may also catch babies in birth centers and assist with home births. They are able to prescribe medications and provide care to women from puberty through menopause, not only during childbearing. Nurse-midwives 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 (http://www.midwife.org) 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 vary greatly in their training, certification and methods. 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 through the North American Registry of Midwives. The American College of Nurse-Midwives (ACNM) certification council also provides accreditation to non-nurse midwife programs as well as colleges which graduate nurse midwives. All midwives certified by ACNM must pass the same certifying exam. 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. Another organization (ACHI)Association for Childbirth at Home International. Also prepares Direct Entry midwives with a very detailed and technically competent program.

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 UK

In the United Kingdom midwives are practitioners in their own right, 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. One may become a registered midwife by completing an eighteen month course (leading to a degree qualification) following completion of nurse training, or by undertaking a 3 year degree in midwifery. All practising 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 for the woman for whom you are caring at all times, to know when to refer complications to medical staff, but also to act as the woman's advocate, to ensure that she 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.

Community midwives

As well as the midwives working in the hospitals there are also numerous midwives working in the community. Their roles include the initial appointments of pregnant women, the running of clinics, postnatal checks in the home and attending home births. Midwifery in Canada

Midwifery made a comeback as a viable birth option in Canda in the 1960's, along with other aspects of heath care reform that can 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 health care in the provinces of British Columbia, Alberta, Manitoba,Ontario,and Quebec.It will soon be legislated in Saskatchewan, Nunavut,and the North West Territories as well.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.Midwifery practice has become somewhat standardized in all of the regulated provinces:midwives offer continuity of care, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care.There are several provinces that now offer midwifery education, which consists of a four year baccalaureate degree in midwifery, usually based in a university setting.

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