3: THE EVOLUTION OF ADVANCED PRACTICE NURSING ROLES ■ 81program (Catholic Maternity Institute) in New Mexico (Barger, 2005; Dawley, 2005).
Once established, the New Mexico program provided partial funding for the education
of black nurse- midwives in Tuskegee, Alabama (1941), as well as in the Flint Goodrich
Hospital Nurse Midwifery program (1942) in New Orleans. Racial tensions, however,
eventually resulted in closing the programs in 1946 (Burst & Thompson, 2003). By 1947,
the Medical Mission Sisters of Philadelphia established the first master’s in nursing
program for nurse- midwives at the Catholic University of America to respond to the
needs of underserved families in Washington, DC.
Despite the innovations in natural childbirth methods based on Dr. Grantly Dick
Read’s work developed after World War II, and with increasing public dislike of “twi-
light sleep,” 88% of women chose to deliver in hospitals (Rooks, 1997). During the 1950s,
25 university affiliated hospitals offered graduate nursing programs for maternal– child
nursing to provide leaders in teaching, education, and public health. Their socialization
was different from that of the nurse- midwife, because they were taught to follow physi-
cian standing orders, recognize abnormal labor, and call the physician to the labor room
when delivery was imminent. Midwifery was never part of these nursing programs.
In the meantime, MCA recommended moving midwifery education into recog-
nized universities and formulating standard admission requirements and curriculums
(Burst & Thompson, 2003; Rooks, 1997). In 1955, Columbia University opened the first
graduate nurse- midwifery education program with clinical training in an academic
medical center. Yale University opened its own program in 1956. By 1958, three of six
national midwifery education programs offered a master’s degree for nurse- midwives.
In 1954, 20 nurse- midwives attended the ANA convention and formed the
Committee on Organization because the National League for Nursing (NLN) and ANA
would not create a special niche for nurse- midwives (Rooks, 1997). In May 1955, the
Committee on Organization voted to form the American College of Nurse-Midwives
(ACNM) as a separate accrediting body to develop and evaluate nurse- midwifery stan-
dards, improve nurse- midwifery education, sponsor nurse- midwifery research, and
participate with the International Confederation of Midwives (Burst & Thompson,
2003).
The social changes of the 1960s were marked by the counterculture activities, rejec-
tion of authority, and the enactment of Medicare and Medicaid by President Lyndon
Johnson (Keeling, 2009). After Senator Robert Kennedy visited the Mississippi Delta in
1965, federal funding was established for the County Health Improvement Program for
Holmes County Mississippi starting in 1969. In addition, the Federal Division of Nursing
provided funding for nurse- midwifery education in the Department of Obstetrics and
Gynecology at the University of Mississippi School of Medicine. As the requirements for
admission initially included a bachelor’s degree in nursing, most nurses in Mississippi
could not participate. In response, the requirements were revised to allow non- degreed
nurses to obtain a certificate in midwifery (Keeling, 2009).
During the 1970s, the number of infants delivered by nurse- midwives dou-
bled, there was a shortage of physicians providing obstetric care to the poor, and the
concept of using a nurse- midwife for birth moved into the middle class (McCool &
Simeone, 2002). Nurse- midwifery educational programs increased from seven in 1960
to 19 in 1979, and nurse- midwifery became legal in most states. The National Health
Service Corps began to offer scholarships to nurse- midwife students willing to work in
underserved areas after graduation. In 1973, in response to the increased births and the
shortage of physicians, the University of Mississippi began a modular curriculum for
nurse- midwifery students, based on self- mastery learning that could be completed in
less time than traditional education. The modular program included a list of objectives