Despite the fact that the United States spends more money on maternity care than most other industrialized nations, it continues to have higher infant mortality rates than economically equivalent countries (Rooks, 1997). In addition, rising malpractice insurance costs and Caesarean sections in obstetrical practices are indicators that American approaches to childbirth need to be reevaluated (MacDonald, 2007; DeVries, 2001). Midwifery, which focuses on health care in pregnancy and birth, has been shown to be a successful healthcare approach for non-high-risk pregnancies (Rooks, 1997; Mander, 2001). Midwives are trained in a variety of childbirth-related practices and emphasize pregnancy and birth as normal. Although many midwives share views on how birth should be handled, midwifery has been divided into various schools of thought that range in their willingness to include medical interventions, affiliate with mainstream health care systems and incorporate alternative, homeopathic remedies into the practice.
This study was designed to acquire in-depth knowledge about how midwives choose to develop their practices. Four midwives with different training backgrounds who work in Ithaca, New York, were selected to participate in the study. Interviews were conducted in the workplaces and/or homes of the midwives and further information was acquired through follow-up questioning. The information from the interviews was analyzed within the context of the history and politics of midwifery in the US. In addition, special consideration was taken for the midwives? international training and work experience. Comparisons were drawn between midwifery models in the US and other countries such as Canada, Cambodia and England.
Analysis of the interviews revealed a complex relationship between the midwives? personal philosophies, training, workplace and practice. Each of the factors is inextricably tied to the other and influences how the midwives incorporate medical technology, female empowerment and spirituality into their care.
Because philosophy, training, workplace and practice are all crucial in developing a midwifery practice, limitations on any of these elements could be detrimental to the field. For example, the US sets strict limits on where certain midwives can work and how they obtain insurance. As a result, many midwives are forced to make sacrifices in their practice to compromise for the legal and political restrictions imposed on them. Other regions, such as Ontario, Canada, have designed models for midwifery that promote quality health care without relegating midwives to one specific workplace, training style, philosophy or practice. There is reason to conduct further research to compare US and Canadian models so that evidence-based changes to maternity care in the US can be made.