The Nurse-Midwife on the Team

In this issue of the BULLETIN, devoted to nurse-midwifery as a clinical nursing specialty, it seems appropriate to give some thought to a definition of practice in this field. Does the nurse-midwife function in ways that are different from her nursing colleagues who have not had midwifery-education? If so, how? If not, is such special and rather lengthy preparation for nurses justified? Perhaps a look at the current maternity care picture and its challenge for the future can help answer these questions to some extent. Present day concepts of maternity care are no longer confined to the immediate goal of a live mother and a live baby. At its best, modern care encompasses a much broader approach and includes the education and emotional support of parents throughout the maternity cycle. These elements, plus advances in physical care of the mother and baby have far-reaching effects on the health and happiness of the entire family. But, maternity care at its best is limited at present to a fortunate few.

There are very good reasons why only a fraction of our population is receiving the kind of care which utilizes all the social and scientific knowledge now at our command. First of all, the number of obstetricians available to meet the needs of families is limited. Therefore, the largest share of responsibility for obstetric management is being carried by the general practitioner who, however well prepared and experienced, is necessarily occupied with a variety of medical problems. As a result, the management of mothers and babies through all phases of the maternity cycle is often delegated to the nurse. Yet, what preparation does the average nurse have for carrying out these responsibilities? A twelve week course in her basic curriculum, tucked into a three, four, or five year total program hardly qualified her to evaluate a woman's progress through pregnancy and the puerperium. Certainly emotional support and parent education cannot be given at their best when the nurse's interest is focused on physical management which, because it is not completely understood, is all absorbing.

The nurse-midwife with a broad deep background in obstetrics and related theory, and more important, repeated clinical experience in assuming direct responsibility for the management of all phases of the normal maternity cycle, is well equipped to function as an expert practitioner of maternity nursing. Unlike her nursing colleagues, she comes prepared to take responsibility, to appraise the normal, to carry out safe care, and to recognize her own limitations in situations which require immediate medical attention.

She can be a true professional partner of the doctor—a person upon whom, the patient and he can depend—working with him toward safer, more complete care for more families. Free to focus her entire professional attention and energies upon the normal maternity cycle, she can help define what is normal, describe how this is achieved, maintained, and promoted, and share her observations with both the medical and nursing professions.

Her understanding of normal obstetrics also gives the nurse-midwife a rich body of content upon which she can draw when teaching parents as well as professional students. Parents want and need instruction that is non-didactic, non-structured, geared to their current interests and concerns. Such instruction if given effectively, accurately, appropriately, calls for a depth of content and a grasp of principles which are not easily acquired through usual educational channels, even at the graduate level.

Perhaps, most important of all, the nurse-midwife who has been “in the shoes” of the doctor as well as in those of the nurse, is able to support and guide others in the establishment of service programs geared to the needs of families. Creating an atmosphere in which total needs of people are given priority entails more than a knowledge of those needs, more than skill in meeting them. It implies mutual understanding and respect, mutual confidences and security among all those involved in providing and receiving maternity services. The nurse-midwife is a most logical link between medical and nursing groups, the liaison person who can unify all efforts toward meeting the needs of families.