“In crisis, cleverness is born.” Chinese Proverb
Our individual legacies as midwives are inscribed in the hearts and minds of the families we serve. Our collective legacy as a profession is transcribed for history in those documents we leave behind: the institutional policies governing practice, legislation at the state or national level, publications of the American College of Nurse-Midwives (ACNM), and articles published in the Journal of Midwifery & Women's Health (JMWH).
Historic records are more important now than ever before. As we start a new year, in a new century, change is evident in all aspects of our lives. September 11th, 2001 will impact maternal-child health services in unknown ways. Midwives, along with other health care providers, will learn how to provide care in settings that include heightened concerns about biologic threats, yet may suffer from decreased funding for the provision of care. How these changes will affect individuals, and the profession as a whole, is not clear. Yet, as alluded to above, the Chinese symbol for crisis is made up of two characters, one that means danger and one that means opportunity.
This issue of JMWH includes several features that highlight the uncertainties we face and nicely frame the issues that confront us.
Transition and/or change are central tenets within health care delivery today, and who best to express the experience of professional transition than students and new graduates? The student paper by Bennet is a thoughtful assessment of the tools used by midwives while Fenn, another student, astutely depicts “the art forms within the midwife.” The roundtable discussion of graduate nurse-midwives conducted by Lydon-Rochelle articulates the concerns of new graduates and provides a picture of the educational priorities they have identified. The Back Page, coordinated by Holly Kennedy, speaks to transition in a manner that does not require explanation.
Other articles featured in this issue focus on the characteristics of women who need maternity services and, in so doing, give us direction for how midwifery can best serve families. Davidson's article presents outcomes in women with high-risk pregnancies, an important part of the documentation supporting collaborative practice and midwifery services for women with medical complications during pregnancy. The article by Chandler addresses a known non-medical marker for poor medical outcomes: late entry to prenatal care. Chandler's research identifies some of the barriers to receiving care that are faced by women in a rural setting, thereby offering some fascinating implications for intervention. The review of vaccine efficacy and risk presented by Hackley is both informative and comprehensive. The question of whether or not to vaccinate children has always been a concern of parents; but today, it is a pressing worry in all of our minds. A summary of this issue and guide for providing informed consent within the midwifery model of care could not be timelier.
Finally, in addition to articulating the needs of students and families, the summary of the ACNM Certification Council Task Analysis by Oshio, Johnson, and Fullerton enlightens us about some very interesting changes in current midwifery practice, specifically an expansion into primary care activities and a reduction in responsibility for the care of newborns.
JMWH is the vehicle through which the art and the science of midwifery can be recorded. As the nation and profession of midwifery adapt to change, the material published in JMWH will document the process. Families seeing midwives for primary care or maternity services may have symptoms of stress above and beyond the normal stresses of illness or pregnancy. Changes in funding for maternal-child health programs may facilitate practice and research activities or restrain them. JMWH is poised to document and publicize the scope of midwifery practice as it continues to evolve.
It is important to remember that change provides opportunity. I am honored to join the editorial board at this time and look forward to facilitating the publication of high quality papers that address women's health. JMWH has its legacy to lean on, the support of an active editorial board, and a new editor-in-chief prepared to move into an unexpected future. Now, we need you to provide the written word.