2 This program was for nurses who already had a degree in nursing (i.e., registered nurses), but was not a graduate program in the modern sense of the term. 3 Expanded preparation for nurse-midwives also influenced the practice of lay midwives. As the CNMs gained knowledge, they began to share it with the lay midwives. During this decade, minority nurses were also encouraged to become CNMs, albeit in segregated institutions. On March 13, 1942, “the first class of three Negro nurse midwives graduated from the midwifery school operated at the Tuskegee Institute under the auspices of the Macon County Health Department” ( Negro Nurse-Midwives, 1942, p. 705 ). Move Toward Natural Childbirth The renewed public interest in natural childbirth that stemmed from the women's movement was particularly beneficial to the practice of nurse-midwifery in the 1970s; the demand for nurse- midwifery services increased dramatically during that decade. In addition, sociopolitical developments, including the increased employment of CNMs in federally funded health care projects and the increased birth rate resulting from baby boomers reaching adulthood, converged with inadequate numbers of obstetricians to foster the rapid growth of CNM practice ( Varney, 2004 ). In 1971, only 37% of CNMs who responded to an American College of Nurse-Midwives (ACNM) survey were employed in clinical midwifery practice. By 1977, this number increased to 51%. Not surprisingly, the earlier pattern continued; most CNMs practiced in the rural underserved areas of the Southwest and southeastern United States, including Appalachia. At the national level, physician support for CNM practice became official. In 1971, the ACNM, the American College of Obstetricians and Gynecologists, and the Nurses' Association of the American College of Obstetricians and Gynecologists issued a joint statement supporting the development and employment of nurse-midwives in obstetric teams directed by a physician. The joint statement, which was critical to the practice of nurse-midwifery, reflected some resolution of the interprofessional tension that had existed through much of the twentieth century. However, it did not provide for autonomy for CNMs. Later in the decade, the ACNM revised its definitions
of CNM practice and its philosophy, emphasizing the distinct midwifery and nursing origins of the role ( ACNM, 1978a , b ). This conceptualization of nurse-midwifery as the combination of two disciplines, nursing and midwifery, was unique among the advanced practice nursing specialties. It served to align nurse-midwives with non—nurse midwives, thereby broadening their organizational and political base. Philosophically controversial, even within nurse- midwifery, the conceptualization created some distance from other APN specialties that saw advanced practice roles as based solely in the discipline of nursing. This distinction would continue to isolate CNMs from some APNs for the next several decades.
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