A Model Of Exemplary Midwifery Practice: Results Of A Delphi Study


  • Holly Powell Kennedy CNM, PhD, FACNM

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    • Holly Powell Kennedy is the director of the Graduate Program in Nurse-Midwifery at the University of Rhode Island (URI), Kingston, Rhode Island, and the URI Center for Midwifery at Memorial Hospital of Rhode Island. She received a master of science degree specializing as a family nurse practitioner from the Medical College of Georgia in 1978, a certificate in midwifery from the Frontier School of Family Nursing and Midwifery in 1985, and a PhD from the University of Rhode Island. She received the ACNM Region 1 Award of Excellence in 1996 and was one of the first recipients of the ACNM Foundation/ ORTHO-McNeil Pharmaceutical Fellowships for Graduate Education which provided the majority of the funding for this study.

Holly Powell Kennedy, CNM, PhD, FACNM, College of Nursing, White Hall, University of Rhode Island, 2 Heathman Road, Kingston, RI 02881.


What is unique and exemplary about the midwifery model of care? Does exemplary midwifery care result in improved outcomes for the recipient(s) of that care? These are the questions that the profession of midwifery grapples with today within the context of a changing health care arena. Exemplary midwives, and women who had received their care, came to consensus about these issues in a Delphi study.

A model of exemplary midwifery care is presented based on the identification of essential elements aligned within three dimensions: therapeutics, caring, and the profession of midwifery. Supporting the normalcy of pregnancy and birth, vigilance and attention to detail, and respecting the uniqueness of the woman, were several of many processes of care identified. The critical difference that emerged was the art of doing “nothing” well. By ensuring that normalcy continued through vigilant and attentive care, the midwives were content to foster the normal processes of labor and birth, intervening and using technology only when the individual situation required. Health care, whether in the gynecologic setting or during pregnancy, was geared to help the woman achieve a level of control of the process and outcome. The ultimate outcomes were optimal health in the given situation, and the experience of health care that is both respectful and empowering. The model provides structure for future research on the unique aspects of midwifery care to support its correlation with excellent outcomes and value in health care economics.