• Conclusions: FMUs offers a home-like environment and complex midwifery support for women with uncomplicated pregnancies. Although emergency equipment is available as needed, FMU birth is considered a natural spontaneous process. Midwives' supervision over low-risk labors may provide many benefits, primarily related to lower medicalization and fewer medical interventions than in a hospital setting.

Courtot, Hill, I, Cross Barnet, C. & Markell, J. (2020). Midwifery and birth centers under state medicaid programs. Current limits to beneificiay access to a high-value model of care.  The Milbank Quarterly, 98(4). 1091 1113. https://doi.org/10.1111/1468-0009.12473

• CONCLUDED:  "Many of the barriers to midwifery and birth center care identified by the Strong Start evaluation are not new; regulatory and reimbursementrelated obstacles for these providers have been documented since interest in midwifery care increased in the 1980s and 1990s.31 However, the evaluation also found that midwifery care provided through birth centers resulted in better outcomes and lower costs. This presents an especially compelling case for scaling up this model of care, particularly in light of the fact that the typical (hospital- and physician-based) maternity care system has struggled to improve outcomes for mothers and newborns despite significant spending. Investments that increase access to midwifery and birth center care are critical given the current performance of the US maternity care system. If progress is made in addressing the barriers to the model of care identified in this study, both women and their infants enrolled in Medicaid would experience better birth outcomes, and the Medicaid program could reap significant savings."

DeJoy. (2020). A Public Health Ethics Analysis of the Criminalization of Direct Entry Midwifery. Journal of Midwifery & Women’s Health, 65(6), 789–794. https://doi.org/10.1111/jmwh.13144

• CONCLUDED: "In conclusion, criminalization of direct entry midwifery practice is ethically impermissible because it (1) places undue restrictions on individual liberty, (2) is disrespectful to pregnant persons and DEMs, (3) has insufficient data to support its effectiveness, (4) is a disproportionate response to the state’s interest in children’s welfare, (5) encourages waste of scarce health care resources, (6) reinforces the dominance of powerful stakeholders, and (7) upholds the status quo of a perinatal care system that yields suboptimal outcomes at a high cost. The sensible public health response is to redress these harms through midwifery licensure and regulation. This analysis has focused on the ethical impermissibility of criminalizing direct entry midwifery practice. However, mere decriminalization does not suffice as a solution. Midwifery regulations that require physician oversight or forbid non-nurses administration of life-saving medication hamper safe, independent practice and are licensing in name only.6,7,9 Model midwifery legislation that would address these burdens already exists.29 To promote a flourishing society,9 midwives and other public health stakeholders should advocate for the adoption of model midwifery regulation for all midwives meeting ICM standards in all US states and territories"

Ellmann, N. (2020) Community based doulas and midwives: Key to addressing the U.S. maternal health crisis.  Center for American Progress. Accessed https://www.americanprogress.org/issues/women/reports/2020/04/14/483114/community-based-doulas-midwives/

• CONCLUDED:  (material omitted) "It is crucial that policymakers recognize the importance of doulas and midwives and seek to incorporate their work in developing solutions to the maternal health crisis. Just as importantly, lawmakers must center the voices and follow the guidance of the individuals doing the work—most critically, those who are embedded in the communities most affected by the maternal health crisis—in any policy decisions that affect their practice and livelihoods."

Institute for Medicaid Innovation (2020). Improving maternal health access, coverage and outcomes in Medicaid. Accessed                            https://www.medicaidinnovation.org/_images/content/2020-IMI-Improving_Maternal_Health_Access_Coverage_and_Outcomes-Report.pdf

• Under-utilization of high-value, evidence-based care, such as the midwifery-led model of care, and over-utilization of unnecessary care, such as cesarean deliveries without indication, are gaining attention in the U.S. as the nation attempts to address growing concerns about maternal health. These concerns include rising rates of maternal mortality and morbidity, increased costs of care, poor or even traumatic patient experiences, workforce shortages, and decreases in access to care in some regions of the country. The alarming trends of racial/ethnic, geographic, and socioeconomic disparities are necessitating local, state, and national conversations. These concerns are compounded by increased awareness of the role that unmet social needs, implicit bias, and structural racism have on maternal and infant outcomes. The factors contributing to poor maternal and infant outcomes in the U.S. are extensive and complex. There will not be only one intervention that will address all of these factors. As the nation considers the combination of potential interventions, it is important to fully consider opportunities to implement a high-value, evidence-based maternal model of care such as the midwifery-led model, both in hospitals and in freestanding birth centers. Midwifery-led care might be a means to improve health equity and ultimately, maternal and infant outcomes for pregnant individuals enrolled in Medicaid.

Jewish Healthcare Foundation. (2020). Beyond Medicalization: Midwives and Maternity Care in America.  Accessed https://www.jhf.org/publications-videos/pub-and-vids/roots/372-beyond-medicalization-midwives-maternity-care-in-america/file 

• CONCLUDED:  (from intro) "Although the U.S. spends twice as much on maternity care as Australia, we don’t deliver the same safe care. Why did midwives virtually disappear in the U.S. even as they became fully integrated into the United Kingdom and European systems of maternal health? Why hasn’t access to the most advanced medical technologies and scientific/pharmaceutical inventions improved outcomes for American women? What does the evidence tell us about ensuring American women experience healthy pregnancies, births, and babies? And, is it time to redefine a successful pregnancy and take a more comprehensive approach?"

Kline, W. (2020). Coming home : how midwives changed birth . Journal of the History of Medicine and Allied Sciences, Volume 75, Number 2 https://muse-jhu-edu.webdb.plattsburgh.edu:2443/article/755064/pdf

• CONCLUDED: "No matter their route to the intimate and powerful work of delivering babies, midwives have endured a long history of outside skepticism about their competence. Ironically, studies have suggested that midwife-attended pregnancies and births are the safest, particularly ones where midwives have cultivated collaborative relationships with physicians and hospitals, even if the babies are delivered at home. This is welcome news in an era that has seen the unconscionable rise in maternal mortality rates over the last twenty-five years, particularly among African-American women. Evidence suggests that integrating midwives more fully into the healthcare system can reduce disparities and enhance the health and safety of all women. Kline’s book will undoubtedly convince readers that midwives should be at the center of delivering these better outcomes."

McFarland, A., Jones, J., Luchsinger, J., Kissler, K. and Smith, D. (2020). The experiences of midwives in integrated maternity care: a qualitative metasynthesis.  Midwifery 2020, Jan: 80:102544. DOI 10.1016/j.midw.2019.102544   Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087161/

• CONCLUDED: The findings indicated that integrated maternity practice affects the professional experience of midwives. Through a qualitative exploration, a clear process of deprofessionalization and deviation from the midwifery model of care is detailed. Midwives experienced decreasing opportunity to provide the quality woman-centered physiologic care that evidence shows benefits childbearing women.

Midwives Alliance of North America. (2022).  The midwives' model of care.  Accessed https://mana.org/about-midwives/midwifery-model

• From article: The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth.

]Midwives Alliance of North America. (2022). Types of midwives. Accessed  https://mana.org/about-midwives/types-of-midwife

• Gives overview of types of training and work settings.  Nurse-midwives are trained and work in hospitals mostly (following the medical model?) and direct entry are not nurses but fully qualified to provide care (follow midwifery model?)

Najmabadi, K. M., Tabatabaie, M. G., Vedadhir, A. A., & Mobarakabadi, S. S. (2020). The marginalisation of midwifery in medicalised pregnancy and childbirth: a qualitative study. British Journal of Midwifery, 28(11), 768–776. https://doi.org/10.12968/bjom.2020.28.11.768

• Results   The medicalisation of pregnancy and childbirth has marginalised midwifery. Midwifery, which should be at the heart of all low-risk pregnancies and childbirth, has deteriorated such that it has become disempowered in interdisciplinary relations.

Ockenden, D. (2022) Ockenden Report: Accessed  https://www.ockendenmaternityreview.org.uk/wp-content/uploads/2022/03/FINAL_INDEPENDENT_MATERNITY_REVIEW_OF_MATERNITY_SERVICES_REPORT.pdf

• CONCLUSION: from text "Even now, early in 2022 there remains concern that NHS maternity services and their trust boards are still failing to adequately address and learn lessons from serious maternity events occurring now. We recognise that maternity services have very significant workforce challenges and this must change. Clearly, workforce challenges that have existed for more than a decade cannot be put right overnight. However, it is our belief that if the ‘whole system’ underpinning maternity services commits to implementation of all the Immediate and Essential Actions within this report with the necessary funding provided then this review could be said to have led to far reaching improvements for all families and all NHS staff working within maternity services"

2019

Clements, B. (2019). Loew-risk moms face fewer complications with midwives.  Accessed https://newsroom.uw.edu/postscript/low-risk-moms-face-fewer-complications-midwives

• From article:  Pregnant patients with a low risk of birth problems who are cared for by a midwife will likely leave the hospital maternity unit having experienced fewer interventions and complications than if attended by an obstetrician, a new study has concluded. These findings appear this month in the journal Obstetrics & Gynecology.  

Georgetown University School of Nursing (2019). How does the role of nurse-midwives change from state to state. Accessed https://online.nursing.georgetown.edu/blog/scope-of-practice-for-midwives/

• In the United States, more expectant mothers are utilizing the expertise and care of midwives that ever beofre - more than 330,000 births were attended by nurse-midwives in 2014.  While this is almost thtree times the U.S. rate in 1989 it remains far lower than many European and Scandinavian countries where midwives lead care in about half of all births.In the United States, more expectant mothers are utilizing the expertise and care of midwives than ever before — more than 330,000 births were attended by Nurse-Midwives in 2014.¹  While this is almost three times the U.S. rate in 1989,² it remains far lower than many European and Scandinavian countries where midwives lead care in about half of all births

Lundgren, I., Berg, M., Nilsson, C. and Olafsdottr, O. (2018).  Health professionals perceptions of a midwifery model of woman-centred care implemented in a hospital labour ward. Journal of Australian College of Midwives.  Accessed https://www.womenandbirth.org/article/S1871-5192(18)30155-0/pdf

• CONCLUDED:  "The model was useful for all professional groups, except for assistant nurses. Further studies are needed in order to clarify the various professional roles and interdisciplinary collaborations in making the MiMo more useful in daily maternity care"

Scientific American Editors (2019). The U.S. needs more midwives for better maternity care. Accessed https://www.scientificamerican.com/article/the-u-s-needs-more-midwives-for-better-maternity-care/

• Despite the astronomical sums that the U.S. spends on maternity care, mortality rates for women and infants are significantly higher in America than in other wealthy countries. And because of a shortage of hospitals and ob-gyns, especially in rural areas, many women struggle to access proper care during pregnancy. Moreover, the rate of cesarean sections is exceedingly high at 32 percent—the World Health Organization considers the ideal rate to be around 10 percent—and 13 percent of women report feeling pressured by their providers to have the procedure.

Simpson, A. 2019). Rural America has a maternal mortality problem; Midwives might help solve it.  Accessed https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2019/08/16/rural-america-has-a-maternal-mortality-problem-midwives-might-help-solve-it

• Hospitals and obstetrics units are shutting down across rural America, creating a shortage of care that may be contributing to the country’s rising maternal mortality rate. The United States’ maternal mortality rate is higher than in Canada, Japan, or any Western European country — even higher than the rate in Saudi Arabia and Kazakhstan. And the mortality rate in rural areas tends to be higher than it is in cities and suburbs. Between 2011 and 2015, it was 23.3 deaths per 100,000 births in Tennessee and 19.4 in Kentucky.

2018

Johns Hopkins Nursing (2018). What nurses need to know: Midwifery and woman-centered care.   https://magazine.nursing.jhu.edu/2018/05/what-nurses-need-to-know-midwifery/

• Traditional obstetric medical care emphasizes the needs of the provider rather than the woman’s needs during pregnancy. Woman-centered care describes a philosophy that is based on the needs and preferences of the woman, emphasizing informed choice, continuity of care, active participation, best care practices, provider responsiveness, and accessibility

Vedam, S., Stoll, K., MacDorman, M., Declercq, E., Cramer, R., Cheyney, M., … Powell  Kennedy, H. (2018). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS ONE, 13(2), e0192523. http://doi.org/10.1371/journal.pone.0192523  Accessed  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192523

• CONCLUDED: "Results: MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state.  Conclusion:  The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes."

2017

Aune, I., Hoston, M. A., Kolshus, N. J., & Larsen, C. E. G. (2017). Nature works best when allowed to run its course. The experience of midwives promoting normal births in a home birth setting. Midwifery, 50, 21–26. https://doi.org/10.1016/j.midw.2017.03.020   Accessed https://www.sciencedirect.com/science/article/abs/pii/S0266613817302334

• From conclusion: This study provides insight into how midwives who work in a home birth setting promote a normal birth. In a planned home birth, the midwife is able to offer the woman continuity during pregnancy and childbirth. The midwives found it important to have faith in the normal birth process and emphasised the significance of transferring this belief to the woman. Being in a safe environment with a familiar midwife provides a good foundation for a normal birth.

National Association of Social Workers (2017) Perinatal Social Work Practice in Health Care Settings. Accessed https://www.socialworkers.org/LinkClick.aspx?fileticket=42IxNq6jEfU%3D&portalid=0

• Perinatal social workers need to advocate for leadership roles in healthcare teams to ensure patient/family-centered health outcomes are embedded in operational infrastructures. Perinatal social workers should advocate for diverse workforces in health care settings

Pennsylvania Department of State (2017). Maternal Mortality. Jewish Healthcare Foundation.  Accessed https://www.jhf.org/docman/resources/research-papers/357-maternalmortality-midwives-policy-brief-jhf-whamglobal/file

• Countries with lower maternal mortality rates have integrated midwives into their healthcare systems to a much greater degree than the U.S. Midwives are trained professionals with special expertise in supporting women to maintain a healthy pregnancy and birth. They offer individualized care, education, counseling, and support to a woman and her newborn. 

2016

Akileswaran, C. and Hutchison, M. (2016) Findings on Obstetrics Detailed by Investigators at University of California (Making Room at the Table for Obstetrics, Midwifery, and a Culture of Normalcy Within Maternity Care). (2016). Women’s Health Weekly, 2274–.   Accessed https://obgyn.ucsf.edu/sites/obgyn.ucsf.edu/files/Room%20at%20the%20Table.pdf

• CONCLUDED: "Despite tremendous variation in the care of childbearing women, the literature suggests that it is who cares for a woman that is the single most powerful determinant of the patient’s experience, particularly whether she will deliver by cesarean.25,26 This results not from differences in technical skill or access to the latest advancements, but how the balance is struck—culturally, operationally, and technically— between averting poor outcomes and encouraging normalcy. Although there have been marked historical shifts in whether obstetricians or midwives “own” the endeavor of childbirth, mothers and neonates in this country will be best served by making room at the table for both perspectives.

Dunham, B. (2016). Home Birth Midwifery in the United States: Evolutionary Origins and Modern Challenges. Human Nature (Hawthorne, N.Y.), 27(4), 471–488. https://doi.org/10.1007/s12110-016-9266-7 

• From abstract: Human childbirth is distinct in requiring—or at least strongly profiting from—the assistance of a knowledgeable attendant to support the mother during birth. With economic modernization, the role of that attendant is transformed, and increased access to obstetric interventions may bring biomedicine into conflict with anatomical, physiological, and behavioral adaptations for childbirth.

Sandall, Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). "Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 4(4), CD004667–CD004667. https://doi.org/10.1002/14651858.CD004667.pub5 

• CONCLUDED:    "This review suggests that women who received midwife‐led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable    adverse outcomes for women or their infants than women who received other models of care. Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and all fetal loss/neonatal death associated with midwife‐led continuity models of care." 

Thompson, & Varney, H. (2015). A history of midwifery in the United States: the midwife said fear not. Springer Publishing Company.  eBook is accessible for online reading or download at

• CONCLUDED: (from introduction)  CONCLUDED (from introduction:  The historical evolution of midwives as respected, autonomous health care workers and midwifery as a profession can be depicted by several important characteristics that are highlighted throughout this text. These characteristics include the close link between midwives and the communities where they live, their shared view of pregnancy and birth as normal life events that sometimes result in less-than-optimal outcomes, midwives’ desire to promote health and prevent sickness whenever they could, and their willingness to be “with women” wherever those women are and whatever the sacrifice  for the midwives themselves. However, the midwives’ desire to promote the health of women and families was often threatened and/or undermined by the increasing medicalization of childbearing care (medical monopoly) along with the midwives’ lack of a common identity based on education and practice standards, the lack of legal recognition to practice, and, more recently, reimbursement for autonomous midwifery services

2015

Karlström, A., Nystedt, A., & Hildingsson, I. (2015). The meaning of a very positive birth experience: focus groups discussions with women. BMC Pregnancy and Childbirth, 15(1), 251–251. https://doi.org/10.1186/s12884-015-0683-0  

• CONCLUDED: ": It is an essential part of midwifery care to build relationships with women where mutual trust in one another’s competence is paramount. The midwife is the active guide through pregnancy and birth and should express a strong belief in a woman’s ability to give birth. Midwives are required to inform, encourage and to provide the tools to enable birth, making it important for midwives to invite the partner to be part of a team, in which everyone works together for the benefit of the woman and child."

World Health Organization Europe. (2015).  Childbirth: Myths and Medicalization. Accessed https://www.euro.who.int/__data/assets/pdf_file/0007/277738/Childbirth_myths-and-medicalization.pdf

• CONCLUDED: "The awareness that rising C/S may have long term health problems for infants is a concern and the evidence indicates that the way to reduce unnecessary interventions in childbirth, without placing the mother or baby at increased risk, is to provide women with one to one midwifery care. This is best provided away from obstetric services in alongside or free standing midwifery units and should include the option for home birth." (material omitted)

2014

McDonald, S. D., Sword, W., Eryuzlu, L. E., & Biringer, A. B. (2014). A qualitative descriptive study of the group prenatal care experience: perceptions of women with low-risk pregnancies and their midwives. BMC Pregnancy and Childbirth, 14(1), 334–334. https://doi.org/10.1186/1471-2393-14-334

• Conclusion: Overall, women and midwives expressed a high level of satisfaction with their GPC experience. This study gained insight into previously unexplored areas of the GPC experience, perceptions of processes that contribute to positive health outcomes, strategies to promote GPC and elements that enhance the feasibility of GPC.

2013

Kaufman, K. and McDonald, H. (2013) Implementing Midwifery in Newfoundland and Labrador. Accessed https://www.gov.nl.ca/hcs/files/publications-midwifery-report-2014.pdf

• CONCLUDED: (from text) "We strongly support the establishment of midwifery in Newfoundland and Labrador as part of primary maternity care services.  Investing in the regulation, deployment and support of midwives will contribute to improved maternity care services and better health for mothers and infants.  We base this assertion on our knowledge of midwifery in many parts of Canada and elsewhere and on the specific situation of Newfoundland and Labrador.  This report summarizes that information and sets forth our recommendations for the implementation of midwifery."

Shaw, J. C. A. (2013). The Medicalization of Birth and Midwifery as Resistance. Health Care for Women International, 34(6), 522–536. https://doi.org/10.1080/07399332.2012.736569    Accessed  https://www.tandfonline.com/doi/full/10.1080/07399332.2012.736569

• CONCLUDED: "Although there is much written about the medicalization of birth in Canada and the subsequent reemergence of midwifery, there seems to remain a strict dichotomy around how medicalized birth and natural birth are conceptualized. Physicians and midwives who offer birth support are trained to care for women, and we ought to consider how they may work together through a mutually understood framework of woman-centered care. For this reason, more needs to be done in order to consider how midwifery and obstetrics may be fluid, rather than opposite, on the spectrum of perinatal care."

2012

Sutcliffe, Caird, J., Kavanagh, J., Rees, R., Oliver, K., Dickson, K., Woodman, J., Barnett-Paige, E., & Thomas, J. (2012). Comparing midwife-led and doctor-led maternity care: a systematic review of reviews: Comparing midwife-led and doctor-led maternity care. Journal of Advanced Nursing, 68(11), 2376–2386. https://doi.org/10.1111/j.1365-2648.2012.05998.x 

• CONCLUDED: "Results. Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified. Conclusions. For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care."

2011

Biro, M. (2011).  What has public health got to do with midwifery? Midwives role is securing better health outcomes for mothers and babies.  Accessed https://www.sciencedirect.com/science/article/abs/pii/S1871519210000429?via%3Dihub

• From article: Midwives provide care at the most critical times during the childbearing cycle, and as they become increasingly involved in all aspects of maternity care provision, their role in securing the overall health of mothers and babies needs to be made more explicit. It is timely to acknowledge the important contribution midwives make to maternal and infant health and to highlight that midwifery practice can and does have a profound impact on the health of the population.

• CONCLUDED: "The  results  of  our  study  imply that  fear  of  childbirth  does  not  so  much  originate  from  the characteristics  of  the  maternity  care  system, but  from  the  interpersonal  contact  between  the pregnant  women  and    the  care  provider.  Especially  obstetricians  should  be  more  attentive  to  the problem  of  fear  of  childbirth  and  try  to  anticipate  in  face-to-face  encounters  with  their  clients. In addition,  women  would  benefit  from  obstetricians  and  midwives  working  more  closely  together. Midwife  led  antenatal  care  alternating  with  consulting  an  obstetrician  might be  good  model  of care"

2010

Campo, M. (2010). Trust, Power and Agency in Childbirth: women's relationships with obstetricians. Outskirts: feminisms along the edge, (22), 3 Accessed: https://www.proquest.com/docview/756207457?pq-origsite=gscholar&fromopenview=true

• CONCLUDED: "This paper has argued that women who participated in this research trust their doctors but mistrust the birth process. The women interviewed enter into this relationship of trust based on their belief in the hegemonic medical model of birth and their social positioning and identity as middle-class, educated women. However, the inequality inherent within the woman/doctor relationship and the power of the medical model of birth renders the notion of mutual or voluntary trust problematic; therefore the relationship becomes more like one of dependence and the popular perception of women's agency or 'choice' in obstetric encounters is problematic. Moreover, women's understandings and expectations of birth often reflect medical ideology and are shaped by a culture of fear and ambivalence toward childbirth. These fears and beliefs are reinforced in individual interactions with obstetricians, again constraining women's options and experiences."

2008

Brodsky, P. (2008). Where have all the midwives gone?  Journal of Perinatal Education.   DOI https://doi.org/10.1624%2F105812408X324912  Accessed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582410/

• Abstract: "In past centuries, only women attended women in childbirth. Birthing women were in control, choosing who should attend them and where and how to give birth. Men were usually excluded unless they were needed for their strength and their tools if labor was obstructed. Eventually, with the medicalization of childbirth, male physicians became involved, introducing new techniques that interfered with the normal birth process and competed with midwives. By the 19th century, midwives struggled to hold onto their profession and advance through education. Midwives survived in Europe, but in America, they were eventually usurped in the early 20th century when birth began taking place in hospitals and as medical science and technology advanced. Midwives eventually rose again as educated nurse-midwives. Technology and obstetric interventions in normal childbirth continue, in spite of lack of evidence of their efficacy. Midwives are again in jeopardy because of rising malpractice insurance costs, women's trust in technology, and, most recently, renewed efforts by physicians to once again prevent midwives from practicing autonomously and outside the hospital environment in the United States"

Parry, D.  (2008). We wanted a birth experience, not a medical experience: Exploring Canadian women's use of midwifery.   DOI https://doi.org/10.1080/07399330802269451  Accessed https://pubmed.ncbi.nlm.nih.gov/18726792/

• Abstract: "In this study I explore Canadian women's use of midwifery to examine whether their choice represents a resistance to the medicalization of pregnancy/childbirth. Through my analysis of the data I identified eight ways the women's deliberate decision to pursue midwifery care represented resistance to medicalization. In so doing, I demonstrate how women actively assert their agency over reproduction thus shaping their own reproductive health experiences. The outcome of their resistance and resultant use of midwifery was empowerment. Theoretically the research contributes to understanding the intentionality of resistance and a continuum of resistant behavior."

2001

DESIGNING MIDWIVES: A COMPARISON OF EDUCATIONAL MODELS: Cecilia Benoit, Robbie Davis-Floyd, Edwin R. van Teijlingen, Jane Sandall, and Janneli F. Miller. (2001). In Birth By Design (pp. 157–183). Routledge. https://doi.org/10.4324/9780203902400-14   Accessed http://www.davis-floyd.com/wp-content/uploads/2016/11/CHAPTER8-EDUCATION.pdf

• CONCLUDED: (material omitted)."Our survey indicates a move away from nursing as a required part of the education of midwives. In the Netherlands, midwifery education has always been direct-entry. In the UK, it is moving in that direction. In Canada, it was set up that way from the start. And in the US, nurse-midwives themselves have opened their College to direct-entry members, have created one university-based direct-entry program, and are working on more. Why is it so important to these midwives to maintain their identity as such? Many women experience a spiritual calling to midwifery, viewing it as not just a profession but a sacred trust. Increasingly, midwives tend to agree on the unique nature of midwifery and its strong humanistic significance for today’s women. This commitment to the preservation of midwifery as a crucial alternative to obstetrics makes midwives unwilling to dilute their identity by coding midwifery as an advanced form of nursing."

2000

Davis-Floyd. (2000). Mutual accommodation or biomedical hegemony? Anthropological perspectives on global issues in midwifery. Midwifery Today (Eugene, Or.), 53, 12–19. Accessed: https://www.researchgate.net/publication/12140670_Mutual_accommodation_or_biomedical_hegemony_Anthropological_perspectives_on_global_issues_in_midwifery

• CONCLUDED: "In sum, the present policy of separating professional from traditional or community midwives has led to midwives’ integration into a hierarchical, intensely colonialist system that has doctors at the top, professional midwives in the middle, and community midwives at the bottom, with no power and very little government support. In this system, doctors have most of the power. Professional midwives, who are usually biomedically trained, often buy into this hierarchy, and work to impose biomedical models of birth on indigenous populations—a situation Australian midwife Leslie Barclay calls “midwifery hegemony.” The surest sign that such a system is in operation is when women who have birthed upright for countless generations are suddenly told by the midwife or doctor to lie down. Countless pages of scientific evidence now document the efficacy and superiority of upright positions for birth! Yet biomedicine in its arrogance insists that its way is best, and around the world is still working to eliminate the few remaining viable indigenous systems of birth, teaching even community midwives to make women lie down for birth, and replacing home with hospital wherever possible"

Feldhusen, A. (2000).   The History of Midwifery and Childbirth in America: A Time Line The Atlantic Accessed https://www.midwiferytoday.com/web-article/history-midwifery-childbirth-america-time-line/

• CONCLUDED  articles gives a timeline of midwifery from before 1750 - 1997 and identifies barriers

1993

Suarez. (1993). Midwifery is not the practice of medicine. The Birth Gazette, 9(2), 4–4.   Accessed https://openyls.law.yale.edu/bitstream/handle/20.500.13051/7178/16_5YaleJL_Feminism315_1992_1993_.pdf?sequence=2  

• CONCLUDED: "Although obstetricians worldwide use the same sophisticated technology and drugs in pregnancy and childbirth as American physicians, doctors in other countries use them differently.4 Doctors in the country with the lowest infant mortality rate, Japan, use little or no drugs and are much slower to interfere with the natural process of birth. 5 In the United States, the economic alliance between doctors and the producers of technological equipment has obstructed preventive maternity care. "Medical priorities are set by the medical industrial complex, which focuses on providing health care at a profit"

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