Nurse-Midwifery: The Birth of a New American Profession

Article excerpt

Nurse-Midwifery: The Birth of a New American Profession By Laura E. Ettinger (Columbus: Ohio State University Press, 2006) (269 pages; $74.95 cloth; $26.95 paper)

The question of how the hybrid profession of nurse-midwifery developed in the United States from its precursors in lay midwifery, public health nursing, and western European midwifery is one that is successfully addressed by Laura Ettinger's Nurse-Midwifery: The Birth of a New American Profession, the first book-length study of the topic. The author successfully weaves together her interests in the history of women, history of medicine, culture of childbirth, and gender of professions. She analyzes how nurse-midwives affected and were affected by larger childbirth trends in the United States; how bright, ambitious maternity and public health nurses in the early twentieth century became nurse-midwives and "created a space of their own in the face of many obstacles" (p. 3); the relationships between nurse-midwifery, nursing, and medicine; and the place that nurse-midwives occupied and continue to hold in the American access-to-care landscape.

Nurse-Midwifery is a story of the ways in which nurse-midwives negotiated with others in the maternity care system in the early twentieth century to develop and maintain their profession. Ettinger's primary thesis is that nurse-midwives developed strategies of accommodation in order to survive. One strategy was the cultivation of an outsider status in order to be less threatening to physicians and others in power in maternity health care. By limiting their practice to caring for patients who could afford to pay little or nothing for their health care, nurse-midwives carved out a place for themselves.

Ettinger's innovative use of labor terms as chapter titles keeps the reader focused on the work of midwives. In the first chapter, "Conception," Ettinger outlines her thesis and places nurse-midwifery in the larger context of changing childbirth practices in the United States. She emphasizes the medicalization of birth, the decline of traditional midwives, the public health nursing movement, increased interest in maternal-child health in the Progressive Era, and midwifery trends in western Europe. In "Early Labor Pains," Ettinger details the pre-World War II work of the two best-known early nurse-midwifery services: Mary Breckinridge's Frontier Nursing Service (FNS) in Eastern Kentucky and New York's Maternity Center Association (MCA). …