Childbirth in the United States was controlled by women until the early 1900s. By 1925, however, childbirth was in the hands of physicians, the midwife was all but eliminated, and federal and state governments had begun establishing programs to improve maternal and infant health care. Nurse-midwifery began in this country with the establishment of services for the poor in rural and urban areas. By the early 1950s nurse-midwives were feeling the need to form a cohesive organization. After seeking to be a part of several other organizations, a group of nurse-midwives polled all of the nurse-midwives whom they could find and received a strong mandate to start a separate organization.