During the 1970s, there were several individual efforts to have a forum for lay midwives to share birth stories as well as their own stories of struggles, successes, and barriers to working as a midwife in the community. The 1977 El Paso meeting, the First International Conference of Practicing Midwives, was viewed by many as the beginning of the Midwives Alliance of North America (MANA) organization, though much work was to follow until MANA became an official midwifery organization in 1982. Shari Daniels, a self-taught practicing midwife, established the National Midwives Association (N.M.A) in June 1977 following the First International Conference of Practicing Midwives. Certified Nurse-Midwives (CNM) support was a need expressed throughout the development of MANA as a midwifery association. One of the key decisions made at the first interim MANA Board meeting with interim officers in 1982 was the adoption of a draft statement of philosophy.

The Manhattan Midwifery School was the first school in the United States established expressly for the purpose of educating graduate nurses in midwifery. The Lobenstine/Maternity Center Association (MCA) Midwifery School was actually the result of a second effort made by the MCA to start a midwifery school for graduate nurses. Public health nurses who attended MCA Maternity Institutes were enthusiastic. There was an insufficient supply of graduates from the Manhattan Midwifery School and the Lobenstine/MCA School of Midwifery to maintain staffing of Frontier Nursing Service (FNS). The impetus for the start of the Tuskegee School of Nurse-Midwifery was the abysmal state of affairs in the provision and outcomes in maternity care in the state of Alabama. The Flint-Goodridge School of Nurse-Midwifery was also opened in 1942 in affiliation with Dillard University and Flint-Goodridge Hospital. Medical Mission Sisters and Catholic Maternity Institute (CMI) go hand in hand.

The American College of Nurse-Midwifery (ACNM) was founded in 1955. During the second annual meeting in 1957, the outgoing President, Hattie Hemschemeyer, proposed the creation of a commission on Curriculum and Accreditation. The primary issue with the National League for Nursing (NLN) was definitional and rotated around whether nurse midwifery was a specialty of nursing and how it differed from advanced maternity nursing. In 1994, the Division of Accreditation (DOA), at the direction of the ACNM Board, developed the criteria and process for the preaccreditation and accreditation of non-nurse basic midwifery educational programs. The National Coalition of Midwifery Educators (NCME) established the Midwifery Education Accreditation Council (MEAC) in 1991, a not-for-profit corporation sited in Taos, New Mexico. The first Interim Registry Board (IRB) was to be appointed during a Midwives Alliance of North America (MANA) Board conference call on December 29, 1986.

Throughout the early history of nurse-midwifery, the development and practice of midwifery depended on the largesse of physicians who supported nurse-midwives by providing consultative supervision, access to hospitals, and prescriptions. They were called backup physicians and it was mandatory that Certified Nurse-Midwives (CNMs) had backup physicians to cover their practice. The joint statement on maternity care was the first official American College of Obstetricians and Gynecologists (ACOG) recognition of the practice of nurse-midwifery. ACOG and the American College of Nurse-Midwives (ACNM) recognize that in circumstances in which obstetrician-gynecologists and certified nurse-midwives/certified midwives collaborate in the care of women, the quality of the practices is enhanced by a working relationship characterized by mutual respect and trust and professional responsibility and accountability. The principle of collaboration in the delivery of health care services by CNM is included in the ACNM definition of midwifery practice and in the standards for the midwifery practice.

The early nurse-midwifery education programs were all certificate programs. The development of nurse-midwifery education programs came in growth spurts. The American College of Nurse-Midwives (ACNM) has held several workshops on nurse-midwifery education. The first workshop was funded by the U.S. Children’s Bureau through the Maryland State Department of Health. The issues in nurse-midwifery education in 1992 were now the barriers to increasing the number of nurse-midwifery graduates. These barriers were interrelated with the barriers hindering the practice of nurse-midwifery. The workshops held in Mississippi in 1973 and 1974 were the genesis of what became the regular fall meetings of the Nurse-Midwifery Education Program Directors that started in 1976. In 1980, Helen Varney published the first edition of her book titled, at that time, Nurse- Midwifery. Nurse-midwifery was an early participant in the development of distance learning in the health professions.

The American College of Nurse-Midwives (ACNM) became inundated with proposed federal legislation in July 1977. In 2000, the Midwives-Political Action Committee (PAC) was formed in order to solicit voluntary contributions from ACNM members for strategic distribution as campaign contributions to federal legislators. The Midwives Alliance of North America (MANA) Legislative Committee was established during incorporation of MANA in 1982 with the express purpose of compiling information about midwifery legislation and litigation from all over North America. The National Association of Certified Professional Midwives (NACPM) received a small grant in 2007 to explore a federal initiative to obtain Medicaid reimbursement for Certified Professional Midwives (CPM) that would increase access to midwifery services for low-income women. Political activities of the Safe Motherhood Initiatives (SMI)-USA partners included monitoring legislative action at the federal level and providing support. The Affordable Care Act (ACA) is considered a victory for mothers, babies and professional midwives.

This chapter focuses on the voices of midwives throughout the centuries with an emphasis on the voices of midwives heard in the United States since the first colonies were established in the early 1600s and before nurse-midwifery. The voices of midwives in the United States are rooted in their communities and in public health as were the voices of predecessor midwives in antiquity. Prior to the Civil War, childbirth practice in the South for both Blacks and Whites was largely in the hands of traditional African midwives who had been brought to America as slaves, or their descendants who were still in slavery. Granny midwife is a generalized term used to describe midwives after the colonial, early American, and antebellum slave midwife voices had been silenced. With European immigrants came the immigrant midwives of the various immigrating ethnic groups.

The American College of Nurse-Midwives (ACNM) officially started exploring the possibility of involvement in direct-entry midwifery education in 1978. The first action of the Division of Accreditation (DOA) in 1990 in response to the Board charge was to start the process of identifying those nurse competencies that Registered Nurses bring with them to a nurse-midwifery education program. The Governing Board of the ACNM DOA wrote the criteria for preaccreditation and accreditation of basic midwifery education programs and accompanying guidelines for elaboration and documentation of the criteria in late October 1994. The Midwives Alliance of North America (MANA) Education Committee began with the founding of MANA in 1982 and was the prime mover behind setting standards for midwifery education regardless of practical learning pathway. There were twenty one individuals participating in the National Coalition of Midwifery Educators (NCME) group representing nine different midwifery education programs.