MIDWIFERY

the art and practice of attending upon women in childbirth. The profession of midwife must be one of the oldest, being clearly recognized in the earliest books of the Old Testament and an accepted element in the social structure in ancient Greece and Rome. But the old obstetrical learning, meagre as it was, disappeared in the Middle Ages, and the little that survived became adulterated by superstition. Childbirth in those days was associated with an appalling infant mortality and with grave danger to any mother who was unable to deliver herself expeditiously and unaided. In Europe in the 17th century a slow and hesitant movement for the training of midwives began. In the 18th century, maternity hospitals appeared in the larger cities and became training centres for midwives. It was not until the 19th century that the training and control of midwives' practice were put on a statutory basis. The Netherlands, Scandinavia, Germany, and France all made early progress in this regard. In Great Britain, the first Midwives Act (1902) set up a Central Midwives Board to prescribe the training of student-midwives in hospitals, examine and license candidates, and regulate the practice of all such certified midwives. This was a great advance, for at that time the great majority of births in Great Britain were home births attended by midwives. The Midwives Act resulted in a steady rise in the professional skill of British midwives, most of whom were trained as state registered nurses (S.R.N.) before becoming state certified midwives (S.C.M.). In the late 19th and early 20th century, advances in obstetrics and gynecology caused a great shift in childbearing from the home to the hospital in most Western nations. In the 1960s, however, a variety of economic and social factors spurred a renewed interest in the concerned, personal care provided by midwives and gave rise, in the United States, to the profession of nurse-midwife. A certified nurse-midwife (C.N.M.) is a registered nurse who has received professional training in midwifery and been certified by the American College of Nurse-Midwives. C.N.M.'s accept only those patients who can be expected to have a normal delivery. They do not perform operative deliveries, and if a delivery does prove difficult, a physician is usually called. C.N.M.'s deliver babies in hospitals, clinics, birthing centres, or, more rarely, at home. They provide prenatal and postnatal care, advise women about their reproductive health before and after pregnancy, and offer family-planning services and counseling. Lay midwives, by contrast, usually have no professional training in midwifery, are unlicensed, and deliver babies at home. In developed nations, they have traditionally worked in isolated rural areas, but in developing countries they are much more common. Midwives of all sorts deliver about three-fourths of all the infants born throughout the world each year.