Midwifery, 1977

On January 1, 1974, an autonomous midwifery service was formed at Roosevelt Hospital in New York City to provide an obstetric service to "private" patients. While the autonomy was complete, physician consultation and participation provided by the "full-time or senior resident" staff were always available. We are now aware that this plan as opposed to any other, provided the ingredient of consumer-desired empathy of the midwife coupled with instant obstetric expertise that assured every patient the availability of modern obstetric practice. Four hundred and fifty-four patients cared for by midwives were compared to a random sample of 500 patients cared for by attending obstetricians. A striking similarity in the two groups was evident. Certain items, such as operative deliveries, were higher in the private patient group. The midwifery group had a low incidence of complications, but the incidence of acute complications made it apparent that an operating room suite must be immediately available. It is eminently clear that a low-risk group can be identified but there is no possible way to identify a "no risk" population.     

Midwifery in France

Describes the scope of midwifery practice in France and outlines the program of study and requirements for registration. In France, midwifery is considered a medical profession. Under French law, the practice of midwifery includes all acts that are necessary to the diagnosis of pregnancy, prenatal care, psychoprophylactic preparation for delivery, supervision and care during delivery, and postnatal care of the mother and infant. Midwives may also prescribe some medications and conduct laboratory and radiographic studies. They practice in hospitals, clinics, private practices, and special programs. All of the 33 midwife schools in France are associated with a University Hospital Center. Before entering a midwife program, candidates must pass written exams on the level of a B.A. in Science. The midwife program is 3 years of full-time study; students are continuously tested. To be certified, a student must pass written and oral tests and must attend 40 deliveries, including 2 breech births. In 1983, an agreement became effective in France and throughout the European Economic Community (EEC) which enabled any midwife who obtained her diploma in the EEC to practice in any of its 9 member countries. This required the EEC countries to establish equivalents for the diplomas awarded by different nations. It is difficult for French midwives, who are considered medical professionals in their own country, to understand why midwives in other countries do not hold similar status since they have the same responsibilities and competence.