The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts

"Changing childbirth" in the United Kingdom: lessons for U.S. health policy

This article examines the process that led to the "changing childbirth" initiative in the United Kingdom and its possible lessons for U.S. health policy making. Changing childbirth involves substantial changes in maternity care policy, including increased independence for midwives; greater choice for mothers of birthplace and attendant; and a narrower, more specialized role for obstetricians. Potential lessons for U.S. health policy include the following points: Even narrow, targeted reform is generally slow to develop, and bureaucracies continue to show ingenuity in delaying their response to initiatives; systematic research and control over problem definition powerfully shapes the policy debate (in the United Kingdom the debate focused on normal birth, rather than on the traditional inquiry into perinatal death); a few well-placed individuals (e.g., female legislators) can bring maternity care issues to the policy agenda; and politically skilled consumer groups (which in the case of maternity care essentially do not exist in the United States) can influence the process.

State regulation, payment policies, and nurse-midwife services

State regulatory and reimbursement policies continue to exert a strong influence on health workforce policy. Surveys conducted in 1991 and 1995 for the purpose of examining the impact of state regulation on the supply and practice of certified nurse-midwives (CNMs) showed that the single best predictor of the distribution and practice activities of CNMs was the degree to which state policies facilitated or restricted CNM practice.

A cross-national analysis of midwifery politics: six lessons for midwives

Research based on interviews and analysis of documentary sources on the politics of midwifery in Canada, Denmark, the Netherlands, the UK and the US, suggests six political lessons for midwives and the organisations that represent them. The lessons are: general health reforms represent both an opportunity and a threat to midwives' status, and midwives must learn to communicate in ways policy makers understand; research matters; coalition building is essential; the media cares (a little); it is much easier to defend the status quo than create new policy; it is essential to clarify who is to be considered a midwife. A constant grass roots awareness of and involvement in a country's political and policy making process is seen as a necessity if midwives are to prosper as a profession.