Midwifery & Nursing

But the development of the FNS mustiness be faceted in an even wider historical perspective. As O'Mara points prohibited (1999), it was non until the 1920s that the majority of middle class women were routinely giving birth in hospitals, attended by physicians. Indeed, until 1914, when questionable Twilight Sleep for the mother was introduced into the childbirth process, midwives attended around American childbirths in private homes, even in urban areas. (In 1915, by the way, the US led the industrial world in the number of childbirth deaths per 1,000. In 1932, when Twilight Sleep was unruffled the principal feature of hospital childbirth, that figure had risen.)

Even though urbanizing and ever-more-industrializing America began to make greater and greater use of physician-attended childbirths in hospitals in the 1920s, as a practical matter the women in rural areas of the US were a population markedly underserved by professional medical pity. Institutional health care was not merely unaffordable for women in remote areas but was inaccessible as well. Into this situation in 1925 came one Mary Breckinridge, a nurse-midwife proficient in England, who established what was called the Frontier Nursing Service in the Appalachian Mountains of southern Kentucky. According to Wasson (2000), Breckinridge was responding to found conditions: the shortage of physicians in rural Kentucky at the time. Her original vision was that a Family Nurse, superintend by an area

Breckinridge e'er "viewed nurse-midwifery as central to health care" (Frontier, 2000, p. 3). What that implied was a fealty to formal fosterage in the craft, especially in view of the fact that during the 1920s the medical specialty of obstetrics was gaining in prominence and began to see midwifery in competitive terms. Additionally, umpteen states "were beginning to establish minimum requirements with respect to the education and development of midwives and for the supervision and regulation of their practices" (Gabay & Wolfe, 1997, p. 390). Thus in the background of the seemingly straightforward statement that Breckinridge's service "began training midwives and stimu deepd the brass section of other midwifery schools" (Breckinridge, 1998, p.

145), was a rather more labyrinthine reality. Breckinridge was obliged to either send American Family Nurse recruits (on scholarship) to England for training as nurse-midwives or to recruit British nurse-midwives for service in rural Kentucky.

Arnold, E. (1999). Health teaching in the nurse-client relationship. Interpersonal Relationships: paid Communication Skills for Nurses. 3d ed. Elizabeth Arnold & Kathleen Undermann Boggs (Eds.). Philadelphia: W.B. Saunders Company/Harcourt Brace. 368-92.

Shindul-Rothschild, J., Berry, D., & Long-Middleton, E. (1996, November). Where have all the nurses bypast? American Journal of Nursing, 96, 25-39.

Embedded in this idea is overly the notion of cultural sensitivity, itself a feature of the tradition of benignant caring long associated with nursing. What is noteworthy about these general goals, however, is how oft they appear to depend on the pioneering work of nurse-midwives.

As of the late 1990s, the so-called medical model and the nurse-midwife model of obstetrical care have been differentiated, with statistics pointing to the fact that low-risk births under the latter model were no more likely to result in maternal or infant mortality than those of the former (Gabay &
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