3: THE EVOLUTION OF ADVANCED PRACTICE NURSING ROLES ■ 79their own unique history to shaping advanced practice nursing in the 21st century. We
have provided a lengthier analysis of nurse- midwifery, as its emergence as an advanced
practice role is often minimized in the broader nursing literature.
■ DEVELOPMENT OF THE NURSE- MIDWIFE ROLE
Although records of midwifery practice date back to the 370 to 460 BCE at the time of
Hippocrates, it was the midwives of the 18th and 19th centuries who shaped the evolu-
tion of nurse- midwives in the 21st century in the United States (McCool & Simeone,
2002). Midwifery skills among colonial midwives ranged from those formally trained
in Europe to illiterate women who became midwives in response to community need.
In addition to assisting with childbirth, bathing women after childbirth, and cooking,
most midwives also provided primary care to their communities. When the first boat
of African slaves arrived from West Africa, the first granny midwives began to practice
midwifery on plantations in the rural south for both White and Black women, which
was based on West African tribal folklore (Graninger, 1996; Morrison & Fee, 2010). The
safety and skill of midwives varied widely during the first 250 years in America because
there were no educational standards. Although some were well educated, others relied
on herbs and poultices (Manocchio, 2008). Most midwives were either self- taught or
learned by apprenticeship from others.
Dr. William Shippen, a protégé of Dr. William Smellie in England, established the
first formal educational program for midwives in Philadelphia in 1765 (Rooks, 1997).
Because illiterate women could not qualify for or afford the private education, and mid-
wifery was considered beneath the stature of educated women, Dr. Shippen limited the
education to men. By the end of the 18th century, colonial men traveled to England for
medical training, and returned to provide obstetric care to upper class women. Morally
outraged by men providing care for women, Dr. Samuel Gregory, a graduate of Yale
University, established the first formal midwifery education program for women at the
Boston Female Medical College in 1848 (Rooks, 1997). The 3- month midwifery program
graduated 12 midwives between 1848 and 1851, but was forced to close in 1874 due to
strong opposition from the Boston Medical Society (Rooks, 1997). By the late 19th cen-
tury, there was massive immigration into the United States from southern and eastern
Europe (Dawley, 2003). New immigrants were densely packed into urban areas and suf-
fered poor working conditions, long hours in factories, and overcrowding in tenements
(Keeling, 2009). High maternal– infant mortality was blamed on granny and immigrant
midwives, who managed 50% of all U.S. births. Public health nursing leaders, includ-
ing Carolyn Conant van Blarcom, who wrote the first obstetric nursing textbook; Lillian
Wald, the founder of the Henry Street Settlement in New York City; Mary Beard, who
developed prenatal care; and Mary Breckinridge, who founded the first midwifery serv-
ice in America, joined with obstetricians to eliminate lay midwives in the United States
(Dawley, 2005; Stone, 2000). These nursing leaders sought to combine public health
nursing and midwifery to create the nurse- midwife. Dr. Fred Taussig, a Missouri physi-
cian, is credited with coining the term nurse- midwife in 1925 (Stone, 2000).
The 1920s were framed by several pivotal events including:
- Middle- and upper-class women embracing “twilight sleep” (a combination of
morphine and scopolamine for childbirth analgesia and amnesia to decrease
and forget labor pain) - Physicians gaining higher esteem (because upper- and middle-class women
chose them for labor and pain management)