Creating a More Diverse Midwifery Workforce in the United States: A Historical Reflection.

INTRODUCTION: As nurse-midwifery practice expanded beyond areas surrounding early nurse-midwifery education programs, leaders in the profession wanted to establish a strong diverse, inclusive professional organization, a necessary step in creating a diverse workforce (defined here as open to nurse-midwives of all colors, ethnicities, and national origins) that would maintain standards, provide continuing education, and facilitate communication among nurse-midwives. This research presents historical context and organizational factors supporting and limiting development of a workforce reflective of communities served by nurse-midwives. METHODS: Searches in the National Library of Medicine Historical Collection, American College of Nurse-Midwives (ACNM) Collections, and the Rockefeller Archives Center, as well as recorded interview data, provided primary sources for analysis. Secondary sources include research and opinions in scholarly publications including journals and books released from 1930 to the present. RESULTS: Nurse-midwifery leaders developed relationships with well-respected philanthropists, as well as maternal and child health administrators in state departments of health and the US Children's Bureau, to implement initiatives to recruit and retain midwives of color. Continued interest in the goal of inclusion, work of midwives of color, and commitment to creating a diverse workforce led to the creation of the standing ACNM Midwives of Color Committee in 1990 and the Diversity and Inclusion Task Force, which released its report, "Shifting the Frame: A Report on Diversity and Inclusion in the American College of Nurse-Midwives,"1 in June 2015. DISCUSSION: Over the past 60 years, ACNM leadership and midwives of color have continued to explore new and effective means to create a workforce that reflects the communities in which nurse-midwives practice.

Focusing on maternal health beyond breastfeeding and depression during the first year postpartum.

Nursing experts reviewed publications between 2003 and 2013 to identify practices for the care of women during the recovery year after childbirth. They focused on maternal transition, role and function, and psychosocial support. Findings indicated that clarification of the psychosocial meanings of childbirth and motherhood and family support systems that strengthen or hinder optimal wellness and functioning are needed. In addition, evidence is required to promote healthy transitions during this transition year.

Using a pedagogical approach to integrate evidence-based teaching in an undergraduate women's health course.

BACKGROUND: Evidence-based practice (EBP) is promoted as a foundation for nursing practice. However, the 2005 U.S. survey of nurses revealed that they do not have requisite skills for EBP. PURPOSE AND GOALS: To evaluate a pedagogical approach aimed at (1) fostering undergraduate nursing students EBP competencies, and (2) identifying gaps in the literature to direct future women's health research. METHODS: A secondary analysis of data abstracted from required EBP clinical journals for an undergraduate women's health course in which students (n = 198) were asked to find evidence to answer their clinical questions. Content analysis was used to identify main themes of the topics of inquiry. RESULTS: Students identified 1,808 clinical questions and 30.3% (n = 547) of these could not be answered or supported by evidence in the literature. CONCLUSIONS: This assignment was an important teaching and assessment tool for EBP. Questions reflected critical thinking and quest for in-depth knowledge to support nursing practice. Some students lacked skills in searching databases and a significant number of knowledge gaps were identified that can direct women's health research.

Application of the Kessner and Kotelchuck prenatal care adequacy indices in a preterm birth population.

OBJECTIVES: Healthy People 2010 goals to eliminate racial and ethnic health disparities that persist in the utilization of prenatal care (PNC) highlight the importance of measuring PNC as a variable in maternal and infant health outcomes research. These disparities are significantly correlated to adverse infant outcomes in preterm birth (PTB), a leading cause of infant mortality and life-long morbidity. Currently the most extensively used PNC adequacy indices (Kessner and Kotelchuck) were developed to measure outcomes in populations consisting mostly of full-term births. It is unclear whether these PNC adequacy indices are reliable when pregnancy is truncated due to PTB (<37 weeks). This paper compares and demonstrates how they can be applied in a specific PTB cohort. DESIGN AND SAMPLE: This secondary analysis of a nested case-control study compares Kessner and Kotelchuck adequacy scores of 367 mothers of PTB infants. RESULTS: There were significant differences in the rating of PNC inadequacy ( p<.001) depending on the PNC adequacy index used. CONCLUSION: Critical evaluation is warranted before using these PNC adequacy indices in future public health nursing and PTB research.

Tailoring peripartum nursing care for women of advanced maternal age.

Births to women of advanced maternal age have increased dramatically over the last decade in both the United States. The majority of women who deliver their first baby after age 35 are healthy and experience positive birth outcomes. According to current research, primigravidas over 35 tend to be educated consumers. Their physical and psychosocial needs differ from those of the mother in her 20s, due to advanced age and factors related to difficulty conceiving and life circumstances. This paper presents (a) an overview of the possible risks to outcomes of childbearing for women over the age of 35; (b) a discussion of how women of advanced maternal age may differ from younger women related to developmental stage, stress or anxiety or both, decision making, and support systems; and (c) an exploration of tailoring nursing care strategies during the peripartum period specifically for this age cohort.

"My nurse taught me how to have a healthy baby and be a good mother:" nurse home visiting with pregnant women 1888 to 2005.

Nurse home visiting with pregnant women and new mothers in the early decades of the twentieth century was designed to improve birth and newborn outcomes, hasten Americanization of immigrant mothers, and improve their parenting skills. Today the Nurse Family Partnership home visitation program improves newborn and child outcomes by positively influencing maternal role attainment and significantly decreasing maternal smoking and other substance abuse, child abuse and neglect, and children's emergency room visits. It also improves life possibilities for vulnerable young women by decreasing the interval and frequency of subsequent pregnancies and reduces dependence on welfare by increasing workforce participation. This article reviews the history of home visits by nurses to pregnant women and demonstrates the benefits achieved by these programs today.

Doubling back over roads once traveled: creating a national organization for nurse-midwifery.

The quest for a new national organization began in 1940 and concluded in November 1955 in Kansas City, Missouri, with the founding meeting of the American College of Nurse-Midwifery. This article looks at the conflicts with organized nursing about the place and role of nurse-midwives in the newly reorganized American Nurses Association and the National League for Nursing. Discussions and disagreements within nurse-midwifery over the need for a nonexclusive national organization that would set professional standards are examined.

The American College of Nurse-Midwives and its antecedents: a historic time line.

In celebration of the 50th anniversary of the American College of Nurse-Midwives, this time line presents a chronologic history of the development of nurse-midwifery in the United States. It places the introduction of nurse-midwifery in American health care into its historic context and follows the evolution of the profession through early attempts at forming a national organization, the eventual formation of the American College of Nurse-Midwifery, and the subsequent merger with the American Association of Nurse-Midwives, to create the American College of Nurse-Midwives. The work of the College between 1955 and the turn of the 21st century is highlighted.

Origins of nurse-midwifery in the United States and its expansion in the 1940s.

This article reviews the origins of nurse-midwifery in the United States during the early decades of the 20th century and explores professional expansion between 1940 and 1950. Nurse-midwifery emerged from the vision of public health nurses, obstetricians, and social reformers concerned about high maternal and infant mortality rates at the turn of the century. Desirous of promoting child health, they provided prenatal care for pregnant women and assisted physicians, while also supporting women during labor and birth at home. Seeking to expand their specialty by introducing nurse-midwifery, they joined the campaign to eliminate traditional immigrant and African American midwives. By the early 1930s, there were only two sites for the practice of nurse-midwifery in the United States: Frontier Nursing Service and Maternity Center Association. Over the next 20 years, nurse-midwifery expanded in response to physician shortages, the emergence of a childbirth education movement, and women's demands for participation in birth. In the 1940s, the greatest expansion occurred in the South and Southwest in home birth, birthing centers, and an occasional community hospital.

Perspectives on the past, view of the present: relationship between nurse-midwifery and nursing in the United States.

Relationships between U.S. nurses and nurse-midwives developed during the Progressive Era around two major points: the knowledge that lower maternal and infant mortality in England and Europe was associated with well-educated midwives, and the desire of some nursing leaders to substitute nurse-midwives for traditional midwives. In the process, traditional midwives were labeled dirty and dangerous and the practice of nurse-midwifery was marginalized. At the same time, research on nurse-midwifery showed excellent maternal and infant outcomes at the only two demonstration sites where nurse-midwifery was practiced between 1925 and 1941. This data helped the Children's Bureau and MCA push the expansion of nurse-midwifery in the South and Southwest. As their numbers expanded, nurse-midwives organized nationally within the national public-health nursing association. When the association merged with other nursing organizations, however, nurse-midwives were denied their request to maintain an autonomous section on the grounds that they practiced medicine. This rejection caused a split between nursing and nurse-midwifery that continues to affect interactions between the two groups of professionals. In the 1970s, the ANA, which by now supported the nurse practitioner role, embraced nurse-midwifery as an extension of nursing practice. This permitted regulation of nurse-midwifery under nurse-practice acts in all but a handful of states. Unfortunately, in the majority of these states nurse-midwives were not named in statute and their practice became legally invisible. Today, many state boards require a master's of nursing for licensure even though research has shown no difference in certification exam scores between master's- and nonmaster's-prepared nurse-midwives. During the 1970s, middle-class women began to seek the services of a new group of apprentice-trained midwives, and, eventually, these midwives created their own national organization. In the early 1990s, the two national midwifery organizations met formally to craft recommendations for the education and certification of non-nurse midwives and a single standard of midwifery care. Although both organizations had developed processes for accrediting educational programs and certifying non-nurse midwives, the job of drafting a single standard of care remains incomplete. As a result, one of the major tasks facing U.S. nurse-midwives is the need to redefine their relationships with both nursing and apprentice-trained direct-entry midwives. Completion of this task holds the promise of boosting the public image of midwifery, elevating the place of midwives in the care of women and infants, and improving maternal and child health outcomes in America.