Origins of nurse-midwifery in the United States and its expansion in the 1940s.

This article reviews the origins of nurse-midwifery in the United States during the early decades of the 20th century and explores professional expansion between 1940 and 1950. Nurse-midwifery emerged from the vision of public health nurses, obstetricians, and social reformers concerned about high maternal and infant mortality rates at the turn of the century. Desirous of promoting child health, they provided prenatal care for pregnant women and assisted physicians, while also supporting women during labor and birth at home. Seeking to expand their specialty by introducing nurse-midwifery, they joined the campaign to eliminate traditional immigrant and African American midwives. By the early 1930s, there were only two sites for the practice of nurse-midwifery in the United States: Frontier Nursing Service and Maternity Center Association. Over the next 20 years, nurse-midwifery expanded in response to physician shortages, the emergence of a childbirth education movement, and women's demands for participation in birth. In the 1940s, the greatest expansion occurred in the South and Southwest in home birth, birthing centers, and an occasional community hospital.