Nurse-Midwifery Education Today

Authors


There are certain values in life that do not change. They may be couched in sundry trimmings, but the fundamentals are still there shining out to all who have eyes to see them.

We, as nurse-midwives, dedicated to the whole broad field of protecting human life in its earliest beginnings, can be comforted by the security that these fundamental, unchanging values give us as we forge ahead in the very uncertain field of education and service.

Five of these anchors of stability seem to me eminently practical and essential if we are to succeed in our endeavors. I shall present them in the form of obligations, which indeed, they are.

  • 1We must be deeply convinced and appreciate the essential dignity and worth of the human person.
  • 2We must see in man — male and female — God's creative genius.
  • 3We must see our task as one in which we apply our faith, our knowledge, our skills for a particular purpose; namely, the conservation of human life in its natural source and early beginnings.
  • 4We must in justice to students, have well prepared teachers.
  • 5We must know wherein the rewards for our labor lie.

Sometimes we get so engrossed in minutiae that we lose sight of the overall view and as a result become confused and impatient, and are tempted to give up the struggle and drift into whatever deviating stream the current may carry us. This temptation will increase as life becomes more complex with faster motion around the globe and into space, and as the human mind is forced to stretch out and embrace an ever broader expanse of knowledge.

1. We must be deeply convinced of and appreciate the essential dignity and worth of the human person.

We may feel that we do firmly believe that every human being is created by God in “His own image and likeness,”1 “a little less than the angels.” Even though man is the lowest of the intellectual beings that God has created, still he is a rational being — a rational animal. We may believe that these human beings — each and everyone — are endowed with God-given rights to life, liberty, and the pursuit of happiness, but we are frequently tested in this belief. Our actions are apt to speak louder and much more convincingly than our words. Does it really concern us that prejudice is breaking the hearts and spirits of thousands of our people? Does it concern us that mothers are offered care not always according to their need, not according to their wishes, not according to their status as mothers per se? We must answer to this last question an emphatic “yes, it does concern us.”

If it concerns us, we should examine our present system of obstetric care and see why all mothers are not offered an equal standard of care. Wherein does the fault lie? What is the underlying cause that gives rise to this dilemma? The essential reason is, it seems to me, that we have not really believed that all men were created equal. We have drawn a line between the rights of the rich and the poor, the elite and the peasants. The pocketbook has been the measure of value, our human measure of what one is entitled. This is a denial of the essential worth of human life per se. It is wrong particularly and in a most dramatic way where obstetric care is concerned. Here we are dealing with the very source of natural life, the chief source of our national wealth and prosperity. How babies are conceived, brought forth, and nourished is most important. ALL babies, not just some of them. ALL mothers, not just a portion of them.

We say that all mothers deserve the best of obstetric care simply and solely because each individual is a human mother begetting a human infant — both of incalculable worth. However, there is reason to be somewhat skeptical when one begins to scan the statistical data that come out of our various states regarding perinatal morbidity and mortality. There are significant differences between the various racial and social groups. As an example of this, I would like to compare a maternal mortality rate of 2.6 per 10,000 live births among white urban mothers against 12.4 per 10,000 live births among Negro urban mothers. These mothers were all delivered in the same large city hospital over the same ten year period.1 Although these figures seem extreme, each of you could discover similar statistical evidence of substandard maternity care parceled out to underprivileged women in your own community or in the nation as a whole. No one questions the correlation between maternal mortality and good maternity care or that which exists between infant mortality and good maternity care, although, as we know, a number of other factors are closely related as well.

Many of you and I have worked in a maternity program where every effort was made to offer the very best maternity care we knew how to give, and to give it to all mothers irrespective of class, color, or creed. We know the satisfaction this brings to those who give the care and to those who receive it. Unfortunately, we have seen some of these same programs either extinguished or greatly hampered, not because of any dissatisfaction on the part of parents, not because there was inadequate statistical evidence of an effective job being done, but for the sole reason that these programs were not understood by our doctors as a group — some understood but could not stand the pressure from colleagues. It hurt nurse-midwifery. There was a choice made that overlooked the needs of parents and their babies.

We are working with an outdated and inadequate obstetric care system. As a part of the social revolution that is going on, we must find a way to provide appropriate care to all mothers.

Perhaps this means that obstetrics could be separated more distinctly from the realm of pathology and put into a clearer area of preventive medicine. Perhaps it means that available physicians would become experts in the management of abnormal obstetrics and that they would learn to recognize the greater aptitude of a differently prepared person for the management of normal obstetrics. There needs to be some serious thinking and planning. Maybe in this area, too, there is a new frontier ahead. If there was ever an area of professional health service that should be entirely independent of financial testing, it is the field of obstetrics. Professional people have had ample time to plan ahead for this one thing in life we know, without a doubt, will be needed. We have failed and unless we step up our efforts and produce something practical, those who are perhaps more objective will relieve us of our obligation. I mean this: Our political leaders are aware of the needs of their people and their people know how to put pressure where it is effective in obtaining what they want and need. Maternity care is clearly a matter of interest to good government. So long as professional people meet the need reasonably well they are left free to manage it. But when there is a large discrepancy between supply and demand, the government is obliged to step in. If this should happen, let us not say we are becoming socialistic or communistic. No. It is only because we have neglected our responsibility to act out our faith in the essential worth and dignity of the human person.

2. We must see in man — male and female — God's creative genius.

I want to make the point here that no matter how far science reaches out into the spaces of the unknown, it can never change the fundamental fact of God's perfection as it is manifest in the form and purpose of human creation. We must use every effort to understand the complicated mechanism of human behavior, human physiology, human psychology. At the same time, we must use the sensus communis that God built into us and avoid the fallacy of claiming that everything, in order to be true or dependable, must be proved by scientific research and human measurement. This is not only costly in time and money; it is costly in human welfare and professional competency. Nor do resources allow for such reliable study. We must use every human effort to discover God's plan and help it to perfect functioning. If we had paid attention to some of the findings of the anthropologists we would have seen the deep-seated advantages of keeping the newborn with its mother; of making the necessary effort to enable the newborn to get its nourishment from its mother's breast (and quite accidentally benefit from the regular rhythm of the mother's heartbeat!). If, even before the science of anthropology was defined, we had paid attention to the instinctive conduct and feelings of human mothers, we would have seen these same advantages grasped — not because of scientific discoveries but because they were natural. The purpose of God's creature was being fulfilled according to its nature.

We could enumerate a whole list of other very natural processes which were always there but which in our sophisticated generation we have seen fit to take away quite arbitrarily and then “give back” after our keen-witted experts have discovered a scientific reason for them. No sarcasm is meant here. I am merely pointing out the results of a pragmatic approach to professional obstetric care that has some decided disadvantages for both professional people and their clients.

When the bodies or minds of men and women fail to function as they were meant by God to function, professional scientists can and should search ways to help. But they are not free to interfere with this normal function and insofar as they do, they will pay dearly for it. On the contrary every effort to help the normal functions will be greatly rewarded.

3. We must see our task as one in which we apply our faith, our knowledge, our skills for a particular purpose; namely, the conservation of human life in its natural source and early beginnings.

Our knowledge of the physiology of reproduction should be thorough and our skills ever expanding to assure our mothers and their babies a safe pregnancy and a happy delivery, followed by good health in body and mind. Without this to offer, our profession has no meaning.

The reason parents have confidence in us as nurse midwives is based upon our knowledge of their needs. They believe that we know our business. They believe that through study and experience we have learned what is good for them and their unborn or newly born babies. We know, they believe, that we can evaluate their physical condition and their psychological approach to pregnancy and suggest the appropriate measures to rectify any deviations from what is beneficial. They look to us as nurse-midwives to seek medical help as it is needed when pathology is suspected or obviously present. As we work in a milieu of varied disciplines, the parents look to the group to put forth the arm best able to meet their specific needs at specific times. This is a serious responsibility and one that requires great virtue and integrity to fulfill. Perhaps some of you have seen this in action and have thrilled at the magnanimity, the honesty, the humility, that is manifest where all major interests are centered on the welfare of the clients.

Another important part of our task is to help parents to carry out their function of parenthood with readiness and generosity. By our words and actions we can “revive and stimulate the feeling and the love of the office of motherhood.”1

All of us have seen the happiness that pregnancy brings to couples who want the child conceived. We have seen too, those mothers and/or fathers to whom the pregnancy is a painful thing. The child is not wanted; it is a threat to their freedom, their pocketbook, or their atrophied source of affection. It is in these latter instances that we can perform a major service of direction. How effective our help will be is dependent on our knowledge and understanding of marriage, its rights and responsibilities, and above all our comprehension of love itself. The basis of all love is sacrifice. If there is no sacrifice, there is no love, and if love is present sacrifice is also there. Here again, the value of the human person comes to the fore. The essential value of an infant recently conceived is just as great as yours or mine. We wonder how many people really believe this when we know that today abortions are one of the leading causes of maternal death.

With materialism rampant, we cannot hope to be of any genuine help in the psychological-sociological-religious sphere with only scientific answers. We must appeal to faith (the hope of things unseen) and to the higher aspirations of the human heart.

4. We must in justice to students, have well prepared teachers.

Throughout the general field of nursing, we find today a short supply of educators. We find even a shorter supply of instructors who are properly prepared for their task both by education and experience. It is my own personal conviction that in general nursing we have separated education and practice by a chasm that is too wide to bridge in any practical way. We need to close that chasm as rapidly as possible. In our nurse-midwifery schools there is always the danger of this dichotomy. It seems to me that the very best teaching is done in the field of nurse-midwifery (obstetrics), when students see and participate actively and responsibly in an excellent program of maternity care. They should see their teachers day after day put into practice the principles they set forth in the conference room or lecture hall. We have a tradition of tutorial teaching in our American schools of nurse-midwifery. I think we should make tremendous efforts to preserve this.

We, as nurse-midwives, feel secure, I think, in our belief as to what our role should be. Nowhere has it been more beautifully nor more specifically stated than in the discourse given to the Italian Catholic Union of Midwives by the late Pope Pius XII entitled “The Apostolate of the Midwife.”1

We do not feel equally as secure about what our educational preparation should be for our role. This is manifest in the rather remarkable differences in the various educational programs. The length of the program is a case in point. We have six months, eight months, one year, one and one-half years, two years, set aside for our various programs. If we are going to have a clinician and an educator, that is fine. But let all attain the status of clinician irrespective of her other abilities or aims.

It seems necessary for our own welfare and for the security of the public and our professional colleagues, to create a public image of ourselves as nurse-midwives. For this, we are going to have to continue common planning. Our overall goals must be the same and our interpretation of those goals must be consistent.

We should decide, if we do not already know, what our nurse-midwives need in the way of knowledge and skills and then build a curriculum that will provide these. As I see it, we should do everything possible to prepare the nurse-midwife to function as a professional person, carrying nursing responsibilities and medical responsibilities insofar as these latter are applied to the non-pathologic maternity patient and her unborn or newly born infant. It is my own personal conviction that until we have legally constituted authority to carry out the usual procedures and select and administer the medicaments which have been proven by careful medical research to be useful, safe, and reliable in our own field of clinical specialization, we will not be able to go forward as fast as the need indicates. Perhaps, in order to do this safely, our program of education should be broadened. If so, let us broaden it. Until our schools have a common evaluation and accreditation and we have created an image of ourselves in the minds of the public and our professional colleagues, we cannot expect that a great number of nurses will be attracted to this field of specialization. We are pioneers. We know it. We have suffered the agonies of pioneers and we have felt the surge of challenge and fight that all pioneers feel. But this state of affairs cannot go on forever!

You will agree with me, that to do all these things and teach students to follow in our footsteps, we must be well prepared.

5. We must know wherein the rewards for our labor lie.

We are human and cannot ignore the need for some sensible reward for all our efforts. Our Lord has promised us a rich reward in heaven for all our sacrifices and hard work. We can certainly look forward to that reward. But we want something now! It is part of our nature to want it. From our own experience we know that the immediate reward is there — bursting forth in the tremendous satisfaction we get out of doing our tasks well and in the gratitude shown us by those for whom and with whom we work — our patients — our students — our colleagues. The quality of our efforts and work, cannot be measured by these satisfactions, but they do proceed from the thoroughness and generosity with which we give ourselves to the work at hand. It is the very nature of woman to give — to sacrifice — to love; and unless she does these things she is a contradiction to her very nature.

The financial reward nurse-midwives receive is important. They have financial responsibilities and rights to a living wage. Also prestige is important. Without it our influence will be negligible. But the genuine reward that will satisfy us is the deep and abiding satisfaction that comes from having done our level best to fulfill our vocation in life.

In closing, let me summarize my remarks with a note of congratulation to the valiant women who have had the foresight and perspicacity to inaugurate nurse-midwifery and nurse-midwifery education into the American scene. This has taken great courage and determination, humility and selflessness. Life could have been easier in some other way. Always they were aware that others must be prepared to replace them. Schools have struggled through numerous and gigantic obstacles. Up to now, we have not found a full solution.

Footnotes

  • 1

    Genesis, 5:1

  • 1

    Thompson, John Daniel, M.D. “Recent Trends in the Improvement of Maternity Care.” Paper given at the Third Annual Convention of the Georgia State League for Nursing, Inc., March 1961.

  • 1

    Pope Pius XII. The Apostolate of the Midwife. The Paulist Press, New York, 1952. p. 11.

  • 1

    Ibid.

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