Midwifery is a health care profession in which providers offer care to childbearing women during their pregnancy, labour and birth, and during the postpartum period. They also care for the newborn through to six weeks of age, including assisting the mother with breastfeeding. Midwives may also offer interconceptional care including well-woman care.
A practitioner of midwifery is known as a midwife, a term used in reference to both women and men. (The etymology of midwife is Middle English: mid = with and Old English: wif = woman). In the United States, nurse-midwives are advance practice nurses (nurse practitioners]). In addition to giving care to women in connection with pregnancy and birth, they also provide primary care to women, well-woman care (gynecological annual exams), family planning, and menopause care.
Midwives are autonomous practitioners who are specialists in low-risk pregnancy, childbirth, and postpartum. They generally strive to help women to have a healthy pregnancy and natural birth experience. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery.[1] The two professions can be complementary, but often are at odds because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.[2]
Midwives refer women to general practitioners or obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many jurisdictions, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain situations that may be described as normal variations or may be considered abnormal, including breech births, twin births and births where the baby is in a posterior position, using non-invasive techniques.
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According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics):
A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to womens health, sexual or reproductive health and childcare, and to gain the knowledge to counteract the lack of pain relivers and antiseptics.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.[10][11]
In ancient Egypt, midwifery was a recognized female occupation, as attested by the Ebers papyrus which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.[3]
Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians.[4] However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus of Ephesus in the second century. He states in his work, Gynecology, that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child.[5] Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife.[6] A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.[6]
Midwives were known by many different titles in antiquity, ranging from iatrinē, maia, obstetrix, and medica.[7] It appears as though midwifery was treated differently in the Eastern end of the Mediterranean basin as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of obstetrician (iatros gynaikeios), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors.[5] One example of such a midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.[6]
However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.[5]
The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they may also have helped with other medical problems relating to women when needed. Often, the midwife would call for the assistance of a physician when a more difficult birth was anticipated. In many cases the midwife brought along two or three assistants.[8] In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the birthstool was a crescent-shaped hole through which the baby would be delivered. The birthstool or chair often had armrests for the mother to grasp during the delivery. Most birthstools or chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant would stand behind the mother to support her.[5] The midwife sat facing the mother, encouraging and supporting her through the birth, perhaps offering instruction on breathing and pushing, sometimes massaging her vaginal opening, and supporting her perineum during the delivery of the baby. The assistants may have helped by pushing downwards on the top of the mother's abdomen. Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord, and cleansed the baby.[6] The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.[5]
A second-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the vagina, as encouraged by Soranus.[6]
The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives. They may have been highly trained or only possessed a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine or the newer methods of professional parturition.[5] Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.
During the Christian era in Europe, midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law.[9] In Medieval times, childbirth was considered so deadly that the Christian Church told pregnant women to prepare their shrouds and confess their sins in case of death. The Church pointed to Genesis 3:16 as the basis for pain in childbirth, where Eve's punishment for her role in disobeying God was that he would "multiply thy sorrows, and thy conceptions: in sorrow shalt thou bring forth children." A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.[10]
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, but 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.
German social scientists Gunnar Heinsohn and Otto Steiger have put forward the theory that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion.[11] According to Heinsohn and Steiger's theory, the modern state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague (also known as the black death) which had swept over the continent in waves, starting in 1348.
They thus interpret the witch hunts as attacking midwifery and knowledge about birth control with a demographic goal in mind. Indeed, after the witch hunts, the number of children per mother rose sharply, giving rise to what has been called the "European population explosion" of modern times, producing an enormous youth bulge that enabled Europe to colonize large parts of the rest of the world.
While historians specializing in the history of the witch hunts have generally remained critical of this macroeconomic approach and continue to favor micro level perspectives and explanations, prominent historian of birth control John M. Riddle has expressed agreement.[12]
There are two main divisions of modern midwifery in the US: nurse-midwives and direct-entry midwives.
Nurse-midwives were introduced in the United States in 1925 by Mary Breckinridge for use in the Frontier Nursing Service (FNS). Mrs. Breckinridge chose the nurse-midwifery model used in England and Scotland because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the FNS, and reported a substantially lower maternal and infant mortality rate than for the rest of the country. The report concluded that if this type of care was available to other women in the USA thousands of lives would be saved, and suggested nurse-midwife training should be done in the USA. Mrs. Breckinridge opened the Frontier Graduate School of Midwifery in 1939 the first nurse-midwifery education program in the USA. The Frontier School is still educating nurse-midwives today but in a new way. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier School of Midwifery and Family Nursing faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1200 nurse-midwives. http://www.frontierschool.edu/. In the United States, nurse-midwives are variably licenced depending on the state as advanced practice nurses, midwives or nurse-midwives. Certified Nurse-Midwives are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition to licensure, many nurse-midwives have a master's degree in nursing, public health, or midwifery. Nurse-midwives practice in hospitals, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives may work closely with obstetricians, who provide 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 accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board.
A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not require prior education as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a private midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. At present, there are approximately 900 CPMs practicing in the US.
A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife (CPM) credential was available).
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York, New Jersey, and Rhode Island). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs.
The North American Registry of Midwives (NARM) is a certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). The CPM certification process validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university-based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.
Midwives work with women and their families in any number of settings. While the majority of nurse-midwives work in hospitals, some nurse-midwives and many non-nurse-midwives work within the community or home. In many states, midwives form birthing centers where a group of midwives work together. Midwives generally support and encourage natural childbirth in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state.
Midwives are practitioners in their own right in the United Kingdom, and take responsibility for the antenatal, intrapartum and postnatal care of women, up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional attending the majority of births, mostly in a hospital setting, although home birth is a perfectly safe option for many births. There are a variety of routes to qualifying as a midwife. Most midwives now qualify via a direct entry course, which refers to a three- or four-year course undertaken at university that leads to either a degree or a diploma of higher education in midwifery and entitles them to apply for admission to the register. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen-month post-registration course (leading to a degree qualification), however this route is only available to adult branch nurses, and any child, mental health, or learning disability branch nurse must complete the full three-year course to qualify as a midwife. Midwifery students do not pay tuition fees and are eligible for financial support for living costs while training. Funding varies depending on which country within the UK the student is located and whether they are taking a degree or diploma course. Midwifery degrees are paid for by the National Health Service (NHS). Some students may also be eligible for NHS bursaries.[13]
All practising midwives must be registered with the Nursing and Midwifery Council and also must have a Supervisor of Midwives through their 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. However, recent government proposals to require insurance for all health professionals is threatening independent midwifery in England.[14]
Midwives are at all times responsible for the woman for whom they are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains choice and control over her childbirth experience. Many midwives are opposed to the "medicalisation" of childbirth, preferring a more approach to care, ensuring a satisfactory outcome for mother and baby.[15]
Midwifery training is considered one of the most challenging and competitive courses amongst other healthcare subjects. Most midwives undergo a 32 month vocational training program, or an 18 month nurse conversion course (on top of the 32 month nurse training course). Thus midwives potentially could have had up to 5 years of total training. Midwifery training consists of classroom based learning provided by select Universities[16] in conjunction with hospital and community based training placements at NHS Trusts.
Midwives may train to be community Health Visitors (as may Nurses).
Many midwives also work in the community. The role of community midwives include the initial appointments with pregnant women, managingclinics, postnatal care in the home, and attending home births.[citation needed]
Midwifery was reintroduced as a regulated profession in Canada in the 1990s.[17] After several decades of intensive political lobbying by midwives and consumers, fully integrated, regulated and publicly funded midwifery is now part of the health system in the provinces of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, and Nova Scotia, and in the Northwest Territories and Nunavut. Midwifery legislation has recently been proclaimed in New Brunswick where the government is in the process of integrating midwifery services there. Only Prince Edward Island and Newfoundland and Labrador do not have legislation in place for the practice of midwifery.
Midwives in Canada come from a variety of backgrounds including: Aboriginal, post nursing certification, direct-entry and "lay" or traditional midwifery. However, after a process of assessment by the provincial regulatory bodies, registrants are all simply known as 'midwives', 'registered midwives' or by the French-language equivalent, 'sage femme', regardless of their route of training. From the original 'alternative' style of midwifery in the 1960s and 1970s, midwifery practice has become somewhat standardized in all of the regulated provinces: midwives offer continuity of care within small group practices, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care. When women experience deviations from normal in their pregnancies, midwives consult with other health care professionals. The women's care may continue with the midwife, in collaboration with an obstetrician or other health care specialist; her care may be transferred to an obstetrician or other health care specialist, temporarily or for the remainder of her pregnancy and birth. Founding principles of the Canadian model of midwifery include informed choice, choice of birth setting, continuity of care from a small group of midwives and respect for the woman as the primary decision maker.
Four provinces offer a four year university baccalaureate degree in midwifery. In British Columbia, the program is offered at the University of British Columbia.[18] In Ontario, the Midwifery Education Program (MEP)is offered by a consortium of McMaster University, Ryerson University and Laurentian University. In Manitoba the program is offered by University College of the North, which offers the only degree program exclusively for Aboriginal students; combining education in western and traditional Aboriginal midwifery. In Quebec, the programme is offered at the Université du Québec à Trois-Rivières. In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities. A Bridging program for internationally educated midwives is in place in Ontario at Ryerson University. A federally funded Multi-jurisdictional Midwifery Bridging Program is offered in Western Canada. Regulated provinces and territories admit internationally educated midwives to their regulatory body if they can demonstrate compentency through a Prior Learning and Experience Assessment (PLEA) process.[19]
The legal recognition of midwifery has brought midwives into the mainstream of health care with universal funding for services, hospital privileges, rights to prescribe medications commonly needed during pregnancy, birth and postpartum, and rights to order blood work and ultrasounds for their own clients and full consultation access to physicians. To protect the tenets of midwifery and support midwives to provide woman-centered care, the regulatory bodies and professional associations have legislation and standards in place to provide protection, particularly for choice of birth place, informed choice and continuity of care. All regulated midwives have malpractice insurance. Any unregulated person who provides care with 'restricted acts' in regulated provinces or territories is practicing midwifery without a license and is subject to investigation and prosecution.
Prior to legislative changes, very few Canadian women had access to midwifery care, in part because it was not funded by the health care system. Legalising midwifery has made midwifery services available to a wide and diverse population of women and in many communities the number of available midwives does not meet the growing demand for services. Midwifery services are free to women living in midwifery regulated provinces.
Midwifery regained its status as an autonomous profession in New Zealand in 1990. The Nurses Amendment Act restored the professional and legal separation of midwifery from nursing, and established midwifery and nursing as separate and distinct professions. Nearly all midwives gaining registration now are direct entry midwives who have not undertaken any nursing training. Registration requires a Bachelor of Midwifery degree. this is currently a three year full time programme but is in the process of being reviewed by the New Zealand midwifery regulatory authority.
Women must choose one of a midwife, a General Practitioner or an Obstetrician to provide their maternity care. About 78 percent choose a midwife (8 percent GP, 8 percent Obstetrician, 6 percent unknown.[20]). Midwives provide maternity care from early pregnancy to 6 weeks postpartum. The midwifery scope of practise covers normal pregnancy and birth. The midwife will either consult or transfer care where there is a departure from normal. Antenatal and postnatal care is normally provided in the woman’s home. Birth can be in the home, a primary birthing unit, or a hospital. Midwifery care is fully funded by the Government. (GP care may be fully funded. Obstetric care will incur a fee in addition to the government funding.)
Midwives are called vroedvrouw (female midwives), vroedmeester (male midwives), or verloskundige (general) in Dutch. Midwives are independent specialists in physiologic birth. In the Netherlands, home birth is still a common practice, although rates have declined during the past decades. In the period of 2005-2008, 29% of babies were delivered at home rather than in a hospital.[21] Midwives are generally organized as private practices, some of those are hospital-based. In-hospital outpatient childbirth is available in most hospitals. In this case, a woman's own midwife delivers the baby at the delivery room of a hospital, without intervention of an obstetrician.[22] In all settings, midwives will transfer care to an obstetrician in case of a complicated childbirth or need for emergency intervention.
Apart from childbirth and immediate postpartum care, midwives are the first line of care in pregnancy control and education of mothers-to-be. Typical information that is given to mothers includes information about food, alcohol, life style, travel, hobbies, sex, etc.[23] Some midwifery practices give additional care in the form of preconceptional care and help with fertility problems.[24]
Education in midwifery is direct entry, i.e. no previous education as a nurse is needed. A 4-year education program can be followed at four colleges, in Groningen, Amsterdam, Rotterdam and Maastricht.[25]
All care by midwiwes is legal and it is totally reimbursed by all insurance companies. This includes prenatal care, childbirth (by midwives or obstetricians, at home or in the hospital), as well as postpartum/postnatal care for mother and baby at home (kraamzorg).[26]
In Japan, midwives are licensed and regulated by the government. Only women are allowed to take the examination to become a midwife.[27]
When a 16-year-long civil war ended in 1992, Mozambique's health care system was devastated and one in ten women were dying in childbirth. There were only 18 obstetricians for a population of 19 million. In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. These midwives now perform major surgeries including Cesareans and hysterectomies. As the figures now stand, Mozambique is one of the few countries on track to achieve the United Nations Millennium Development Goal (MDG) of reducing the maternal death rate by 75 percent by 2015.[28]
"Midwives". Catholic Encyclopedia. New York: Robert Appleton Company. 1913. http://en.wikisource.org/wiki/Catholic_Encyclopedia_(1913)/Midwives.
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| Medical warning! This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead. |
MIDWIFE (Mid. Eng. midwif, mydwyf or medewife, from preposition mid, with, and wife, i.e. woman, in the sense of one who is with the mother, or from adjective mid, one who is the means of delivering the mother, a woman who assists other women in childbirth). As a class, midwives were recognized in Egypt in the time of the Jewish captivity. It was the universal practice in Europe until the middle of the r6th century, as it is to-day in the East, that women should be attended in confinement only by those of their own sex. From that period more attention was given to the practice of midwifery by the medical profession (see Obstetrics), while in continental Europe, towards the close of the 17th century, special schools were instituted for the proper training of midwives. But it was not until well on in the 19th century that any supervision or regulation was imposed on those who acted as midwives. Now in practically every European country midwives are under strict state control, they are required to undergo a course of thorough training, and their practice is carefully regulated by legislation.
In France midwives (sages femmes) are divided into a first and a second class. Those qualifying for both classes go through a two years' course of training and must qualify both in the theory and practice of midwifery, as well as in anatomy, physiology and pathology. A midwife of the first class has a superior status and can practise in any part of France, while those of the second class are restricted in their practice to the department for which the certificate was issued. Their qualifications allow them also to vaccinate and to prescribe certain antiseptic preparations. They are not allowed to use instruments and must call in a medical man in difficult cases. All cases must be reported to a central officer. In Spain midwives are allowed to practise on the result of an examination after studies covering at least four half-years. The diploma is issued by the director-general of public instruction. In Germany midwives are appointed, recognized and authorized by the state. They can conduct confinements independently and without the aid of a medical man. They must be provided with a certificate from the police authorities, and must reside in special districts assigned to them by the authorities. In Austria midwives before they are allowed to practise must pass a strict examination, after having followed a six months' course at one of the state schools of midwifery. They are subject to elaborate "instructions for midwives" issued from time to time by the ministry of the interior. In Italy a midwife must pass an examination and obtain a diploma from a recognized authority; but in order to obviate the difficulty which the poorer classes in the smaller communes would find in obtaining properly-authorized midwives, a certificate of permission to practise may be given to a certain number who have practised without the sanction of the law satisfactorily during a term of five years. These certificates are distributed by the prefect. In Russia matters pertaining to the appointment, transfer, dismissal and pay of midwives are under the charge of the medical department of the ministry of the interior. In each town of a province or region there is stationed one senior midwife and a number of junior midwives in proportion to the number of districts in the province. The examination of midwives and the issue of certificates of competency is carried out by the Medico-Chirurgical Academy and certain of the universities. A duly-licensed midwife, on presentation of her licence, is at once excluded from the tax-paying class to which she may have belonged. The general code of Russian laws lays down extensive rules for the carrying out of the duties of midwives. In Norway all midwives are licensed after examination and are under the control and inspection of the board of health. Provision is made for infirm and aged midwives. They are usually paid by the parish, but also receive fees according to the means of the person attended. In Sweden a certificate of competency and .of having passed an examination does not give a midwife a right to practise until a note has been made on the certificate that the oath of office has been duly taken. All midwives are under the control of the board of health. When a midwife takes up her residence in a parish, or moves from one place to another, she must announce the fact within a month to the nearest appointed doctor and exhibit her certificate. In towns a midwife must put up a notice board outside her residence; she must not absent herself from home without leaving word as to where she may be found and at what hour she will probably return. In the country a midwife may be paid out of the poor rate. In Denmark, also, midwives are recognized by the state, and the practise of midwifery is almost entirely in the hands of women. In Holland a certain number of candidates are given free training by the state in return for their practising midwifery in scattered country districts at a fixed salary. Many of the states of the United States have also passed laws for the registration of midwives.
In England alone there was no regulation of any kind so late as 1902. Any person, however ignorant and untrained, could describe herself as a midwife and practise for gain. Several societies made continuous efforts towards the close of the 19th century to obtain legislation. A select committee on midwives' registration reported in 1892 that the evidence they had taken showed that there was at the time "serious and unnecessary loss of life and health and permanent injury to both mother and child in the treatment of childbirth, and that some legislative provision for improvement and regulation was desirable." A similar committee reported to the same effect in 1893. Eventually a bill was drafted with the object of securing the examination and registration of midwives, but, although introduced several times into the House of Commons, it was not successful until 1902. The Midwives Act 1902 forbids any woman after the 1st of April 1905 to call herself "midwife" without a certificate, or to act as a midwife for gain without a certificate after the 1st of April 1910. Existing midwives (those who held certificates in midwifery from certain recognized institutions, or produced satisfactory evidence at the passing of the act that they had been for at least one year in bona fide practice as midwives, and bore good characters) were allowed to claim certificates within two years from the 1st of April 1903. The act created a central midwives' board, whose duties are, inter alia, to regulate the issue of certificates and the conditions of admission to the roll of midwives; to regulate the course of training and conduct of examinations; to regulate, supervise and restrict within due limits the practice of midwives; to publish annually a roll of duly certified midwives; to remove from the roll the name of any midwife who disobeys the rules and regulations laid down from time to time; to issue and cancel certificates, &c. There is an appeal to the High Court of Justice against removal of a name, but the appeal must be made within three months. Local authorities are required to exercise supervision over the midwives within their area; they must investigate charges of malpractice, negligence or misconduct; exercise the power of suspension and report convictions. They must supply the central board with the names and addresses of those practising within their area, and notify any death. The local authority must appoint a committee to carry out its powers or duties under the act, and may, if it think fit, delegate its powers to a lesser local authority, such as a district council. The act provides for penalties for obtaining a certificate by false representation or for wilful falsification of the roll. The act does not apply to Ireland or Scotland. (T. A. I.)
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Categories: MEU-MIL | Health and medicine
The two midwives mentioned in Ex. 1:15 were probably the
superintendents of the whole class.
what mentions this? (please help by turning references to this page into wiki links)
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