An honourable calling or a despised occupation: licensed midwifery and its relationship to distric nursing in England and Wales before 1948

Birth Attendants and Midwifery Practice in Early Twentieth-century Derbyshire

The 1902 Midwives Act introduced training and supervision for midwives in England and Wales, outlawing uncertified-and-untrained midwives (handywomen) and phasing out certified-but-untrained (bona fide) midwives. This paper compares the numbers and practices of these two different types of birth attendant with each other, with qualified and certified midwives and with doctors in early twentieth-century Derbyshire during this period of change, and examines the spatial and social factors influencing women's choice of birth attendant. It finds that the new legislation did not entirely eliminate continuity in traditional practices and allegiance, and that both social and spatial factors governed the choice of delivery attendant, with fewer midwives available in rural areas and a surviving network of untrained bona fide midwives in mining communities. Within this spatial pattern, however, although wealthier women were more likely to have chosen a doctor or a qualified midwife, familiarity and loyalty allowed bona fide midwives to maintain their case loads.

Midwifery training in post-conflict Afghanistan: tensions between educational standards and rural community needs

OBJECTIVE

To compare the performance of students selected for midwifery education by three methods: community mobilization in rural Afghanistan, a regional examination by the Institute of Health Sciences (IHS), and the National University Entrance Examination (NUEE).

METHODS

A retrospective survey was conducted in January 2009 on academic records of 178 midwives trained at the IHS in Herat, including 147 graduates from 2003-08 and the cohort of 31 final-semester students graduating in March 2009. An interview survey of the 31 final semester students was also conducted. Outcome variables included knowledge, skills and employment status, stratified by method of selection. Individual attributes including completion of high school, marital status, age and urban/rural residence were also assessed. Data analysis used STATA version 2009. Significance was measured by appropriate statistical tests. Findings were verified by key informant interviews.

RESULTS

Ninety-six per cent of midwifery graduates selected by communities were employed, compared with 74% chosen by the IHS and 82% by the NUEE. Sixty-three per cent of community-selected graduates were working in rural locations, compared with 43% recruited by IHS and 9% by the NUEE. While fewer midwifery graduates selected by communities had completed high school and their academic performance was slightly lower during training, there was no difference in their pass rates and acquisition of practical skills.

CONCLUSIONS

Community mobilization for local selection of trainees achieved significantly higher employment levels of trained midwives in high-risk rural communities than usual selection methods, without compromising quality of skills.

Choice, continuity and control: changing midwifery, towards a sociological perspective

In this paper sociological theories of the professions and the organisation of work are drawn on to explain current developments in the organisation of maternity care. Utilising the literature on the sociology of the professions and general trends in health policy and labour markets, possible reasons for the current renaissance in midwifery and some implications for midwives are discussed. Thus, whilst some women and midwives may be building a paradigm of 'woman-centered' practice based on an equal partnership, for other midwives, the result may be a divided workforce consisting of an elite core and casualised periphery based on the ability to give a full-time flexible commitment to work. The implications of excluding those midwives who are unable to combine full-time work with their own domestic commitments are discussed.