In the past few years the concept of midwifery in the United States has been re-examined, re-evaluated and discussed by the medical community. Currently, ACOG and AMA have voiced support for the concept of midwifery as part of the obstetrical team, and some state legislatures have provided the recognition needed for professional status by defining requirements for state licensure of midwives. Discussions have evolved regarding the mechanism of certification and granting of licensure to midwives. Some urge the inclusion of midwifery as part of the nursing discipline, whereas others urge that midwifery be defined as a separate professional discipline. In my estimation, the delegation of granting licensure of midwives to the nursing discipline will hamper and stagnate the profession of midwifery. Midwifery has enough status to be considered and regulated as an independent and distinct profession.

To resurrect the midwife, an image of competence and commitment was necessary. The most expeditious method to acquire this image was to create the midwife from the nursing discipline which was held in the highest esteem. Moreover, the impetus for a separate discipline of midwifery arose from nurses themselves. However, as with every birthing process, it is time now to cut the umbilical cord.

With the advent of the nurse clinician, nurse obstetrician, paramedic, obstetrical technician, etc., the distinctive role and the unique potential of the midwife will become diminished, diluted, and devitalized.

Envisioning the role of midwifery to be one of woman's care — preconceptional, conceptional, interconceptional, and post-conceptional, the discipline must be independent to permit growth of this role. I forsee midwives as providing obstetrical and gynecological services to all women, and whenever necessary, referral to the medical discipline for conditions requiring their knowledge and expertise which are beyond the level of midwifery education and practice. To delineate the extent of services that midwives of the future will be trained to provide, is really immaterial to the discussion at this time. Most important is the identity crisis now confronting the profession. Is it essential to the midwife that she be a nurse first? Would the midwifery profession lose if a curriculum were established solely for the profession of midwifery? I think not. The creation of a distinctive curriculum, properly focusing on services to women, would enable more latitude in the educational process.

Stated simply the question is: Are midwives content to be an extension and expansion of the nursing role, or is it the desire of midwives to become a completely unique professionals, capable of delivering services to women by a discipline of education and training exclusively developed for a new profession? The time for decision is now, and the ultimate fate of midwifery rests with you.

Dolores E. Fiedler, M.D., M.P.H.11New York, N.Y.