80 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
- Physicians becoming more politically organized
- The increased use of intervention methods (forceps, episiotomies, scopolamine,
and morphine) recommended for all women by obstetrician Joseph Delee
(McCool & Simeone, 2002)
Despite the findings in several New York– and New Jersey– based studies, and the
1925 White House Conference on Child Health and Protection, that midwives had much
better maternal– infant outcomes than obstetricians, middle and upper class women felt
that the use of midwives should be reserved only for poor women who could not afford
the prestigious care of an obstetrician (Keeling, 2009; Rooks, 1997).
The Bellevue School of Midwifery opened in 1911 to train lay midwives, but was
forced to close in 1935 by the New York City Commissioner of Hospitals because he
considered midwifery superfluous in the current social climate as well as below cur-
rent medical standards (Varney, Kriebs, & Gegor, 2004). In 1923, the Maternity Center
Association’s (MCA) Hazel Corbin, RN, and obstetrician Ralph Lobenstine, MD, sought
to open a nurse- midwifery educational program in conjunction with Bellevue Hospital
in New York City, but they were thwarted by the New York City commissioner who
worried that well- educated nurse- midwives would be harder to eliminate than the lay
midwives (Dawley, 2003; Dawley & Burst, 2005).
In 1921, Mary Breckinridge conducted a maternal–child needs assessment and
lay midwifery survey in Leslie County Kentucky while she was studying public health
nursing at Columbia University Teachers College (Dawley, 2005; Dawley & Burst, 2005).
When Corbin and Lobenstin’s nurse- midwifery education program failed to open in
New York, Mary Breckinridge’s friend and colleague Carolyn Conant van Blarcom
assisted her with enrolling in an English midwifery school. On her graduation in 1925,
Breckinridge returned to Hyden, Kentucky, to establish the Frontier Nursing Service
(FNS). With the help of Louis Dublin, statistician from Metropolitan Life Insurance,
Breckinridge compiled statistics that showed positive outcomes among the first 10,000
births assisted by midwives and public health nurses from the FNS (Dawley, 2003;
Raisler & Kennedy, 2005).
In 1923, the Preston Retreat Hospital added a midwifery course, which continued
to operate despite dwindling enrollment until 1960 (Varney et al., 2004). In 1927, the
FNS and MCA joined forces to draft plans for developing a nurse- midwifery educa-
tional program and to examine state laws governing midwifery practice. By 1931, the
MCA opened its own home- birth service (Lobenstin Midwifery Clinic) and by 1932 it
opened an educational program, the Lobenstine Midwifery School (Burst & Thompson,
2003; Dawley & Burst 2005; Stone, 2000).
By the late 1930s, after the introduction of penicillin and sulfonamides, improved
nutrition, improved sanitation, and improved housing, the maternal death rate
dropped dramatically for all women in the United States (Rooks, 1997). Changes in
the U.S. health care system then influenced midwifery education after World War II
(Dawley, 2003). In 1943, the federal government established the Emergency Maternity
and Infant Care Program for the wives and children of returning servicemen who
could not otherwise afford a hospital birth. In addition, the Hill– Burton Act of 1946
provided funding for the construction of hospitals. Although 9% of all U.S. citizens
had health insurance in 1940, by 1950, the percentage had increased to 50%. However,
despite more widespread health insurance coverage, there was a shortage of obstetri-
cians providing hospital maternity services. In response to the shortage, there was an
accelerated increase in midwifery programs from 1940 to 1950. The Medical Mission
Sisters of Philadelphia designed and developed a midwifery service and educational