Midwifery: A career for men in nursing

It may not be a common path men take, but how many male midwives are there?

By Deanna Pilkenton, RN, CNM, MSN, and Mavis N. Schorn, RN, CNM, PHD(C)

Every year, faculty at Vanderbilt University School of there are so few men in this profession. In fact, these Nursing reviews applications to the school’s nurse- conversations often lead to the unanimous sentiment midwifery program. The applicants’ diversity is always that men shouldn’t be in this specialty at all. Scanning of interest. A wide spectrum of age is common. A pleas- the web and reviewing blog discussions on this topic ant surprise has been the gradual improvement in the confirms that it’s a controversial idea, even among Eethnic and racial diversity of applicants. Nevertheless, midwives themselves. male applicants are still rare. It’s common knowledge that the profession of nurs- Many people wonder if there’s such thing as a male ing is female dominated, and the challenges and com- midwife. There are male midwives; there just aren’t plexities of this have been explored at length. many of them. When the subject of men in midwifery is Midwifery, however, may be one of the most exclusive- discussed, it usually conjures up perplexed looks. The ly and disproportionately female specialties in the field very idea of men in midwifery can create quite a stir, of nursing and it’s time to acknowledge the presence of and most laypeople don’t perceive it as strange that male midwives, the challenges they face, and the posi-

www.meninnursingjournal.com February 2008 l Men in Nursing 29 tive attributes they bring to the pro- 1697, is credited with innovations fession. Let’s highlight a growing on the shape of the forceps.2 He dialogue which aims to foster an delivered women fully draped, environment accepting of all mid- unable to see his own actions wives, regardless of gender. beneath the cloth, and he encour- aged his male students to wear What history tells us According to the dresses to births. The disguise The ancient occupation of midwifery most recent reduced suspicion and controversy, was the exclusive domain of women. survey of certified but also provided ample room to During the time of Hippocrates (460 nurse-midwives, hide instruments, such as forceps, to 410 BC), it was thought that mid- which were experimental and ill- wives in Athens should be required The American favored.2 by law to have had children them- College of Nurse- The increasing use and develop- selves.1 During the seventeenth and Midwives found ment of surgical instruments during eigthteenth centuries, the advent of this time marks the beginning of surgical instruments and institution- that 0.6% of obstetrics as we know it today. It al medical training brought many its members also coincides with developments changes to midwifery and medicine are men. in anesthesia, and the propagation in general. Initially, barber-surgeons, of exclusively male educational who carried with them destructive institutions. Men who were interest- surgical instruments, were called to difficult births by ed in attending childbirth became obstetricians. Female midwives in a desperate attempt to save the life of the childbirth attendants, largely excluded from educational birthing woman.2 This role evolved in seventeenth-cen- institutions (and thereby prohibited from using surgical tury Europe into what was termed the “man-midwife,” instruments), would remain practicing empirical mid- the predecessor of the obstetrician.2 These doctors who wifery. Hence, midwifery and obstetrics would be divid- attended births were controversial from the onset. Their ed along gender and philosophical lines for many years motives were questioned and they were often viewed as to come.2 deviant, improper, and scandalous. Some men were cer- In recent decades, women have overcome many bar- tainly curious about birth; most men had never wit- riers to practicing medicine and now make up a large nessed one. However, there are clear accounts that proportion of obstetricians. It’s generally socially accept- man-midwives went to great extremes to respect mod- able for either male or female obstetricians to attend esty and reduce embarrassment by all.2 When a man- births. The same can’t be said for midwifery, which until midwife was called to a birth, he would often drape the this day has largely remained the exclusive terrain of woman, tying the long cloth around his own neck, so women. that his eyes couldn’t see what his hands were doing. There are some accounts of man-midwives sneaking into Modern day midwifery a room, completing a difficult birth, then exiting without According to the most recent survey of certified nurse- ever being noticed by the laboring woman.2 Other anec- midwives (CNMs), the American College of Nurse- dotes suggest that the male birth attendant should be Midwives (ACNM) found that 0.6% of its members are unsightly himself, in order to offset any jealousy by a men.3 Although this number is reflective of members of husband or improper thoughts by the laboring woman.1 the college, one can easily see that men account for a The motivation of any man to attend a birth was often miniscule number of CNMs nationwide. The percentage questioned, and the opportunity for a man to witness a of male student nurse-midwives is even lower.3 Diversity birth was rare, if at all. in American midwifery is limited on many fronts. Nearly Despite the controversy during this time, prominent 90% of CNMs are white females.4 Recognizing this homo- men were making great strides to further the science of geneity, attention has recently been devoted to under- midwifery and what would later become the practice of standing why there’s such a lack of diversity, and what obstetrics. At the Hotel-Dieu in Paris, men were being can be done to remedy it. book-trained in midwifery and the use of surgical instru- The midwifery model of care holds that all women of ments for delivery.2 William Smellie, born in Scotland in all backgrounds deserve safe, effective, satisfying care

30 Men in Nursing l February 2008 www.meninnursingjournal.com throughout their lifetime. A guiding woman relationship is character- philosophy is respect for diversity, ized as nurturing, intuitive, patient, human dignity, and individuality.5 sensitive, and understanding. Midwives, more than ever, are serv- Midwifery care focuses on the inti- ing women and families from diverse mate, intensely personal aspects of backgrounds, socioeconomic levels, Male midwives pregnancy and childbirth, along race and ethnicities, and sexual pref- with well-woman care. Many believe erences.6 Midwives aim to serve the may also offer that a man would be unable to bond needs of these women and families unique attributes with a woman in this way. He could with personalized, attentive care. to the never understand what a woman Truly achieving this goal, requires a was going through. A man couldn’t diverse, culturally competent popu- childbearing cultivate this relationship. lation of midwives. family’s As was the case centuries ago, Clearly, a better mix of midwives experience some find men’s motivations sus- from varying racial, ethnic, and cul- precisely because pect. Why would any man want to tural backgrounds is needed. The be a midwife? Could the interest be gender gap, however, is also signifi- they’re male. sexual in nature? The male presence cant. In recent decades, much atten- would be off-putting or embarrass- tion has been given to increasing ing to a woman. The woman’s part- diversity in nursing, including diversity of gender. The ner may be intimidated or jealous of the bond between ideas of gender bias and sexual stereotyping in nursing her and the male midwife. The underlying assumption is are complex and widespread, surely not uncommon to that men’s involvement in midwifery is questionable and readers of this journal. In midwifery, these phenomena problematic. And that it’s simply socially inappropriate are deeply entrenched and have undoubtedly con- for a man to identify himself as a midwife. Midwives tributed to the low number of practicing male midwives. themselves are some of the most vehement proponents of this view.4 There are few professional spheres where It’s midwife, one can continue to voice such harsh sentiments based not midhusband entirely upon sexual stereotype and bias. In the United Kingdom, men were legally prohibited from practicing midwifery until a legislation abolishing sexual The actual experience discriminations was passed in 1983.7 The legal battle for Recent articles and Web-based discussions document men to enter midwifery faced much opposition. Men the experiences of male midwives. Despite the theoreti- presently make up slightly less than 1% of the midwifery cal opposition we have described, many encounters that workforce in the United Kingdom.8 In the United States, these men describe are remarkably positive.4,7-9 Re- there has been no legal prohibition to exclude men from peatedly, male midwives and the women they serve midwifery, yet the percentage of male midwives is com- described the quality of care given, and not the gender parably low. The overwhelming presence of men in of the provider.4 One male midwife succinctly stated obstetrics demonstrates the social acceptance of men in that “gender is very rarely an issue for clients.”8 Many childbirth. The issue isn’t so much about men in child- women reported being initially hesitant about having a birth, as it was in the seventeenth century, but of men in male midwife, but once rapport was developed, gender midwifery. Midwifery remains female territory, largely was no longer a consideration. Furthermore, one woman due to the commonly held belief that midwifery, in reported that her male midwife was “much more caring essence, is about a female relationship. and sympathetic” than her female midwives.7 Another The belief is that women seek out a midwife in the midwife explained that if you have “the skills and attrib- hopes of building a close, trusting relationship with utes that midwives need, it doesn’t matter what your another woman. Midwives themselves have stated that gender is and its usually pretty easy to convince women midwifery is about “woman-to-woman” care.4 Much of of that.”7 The overall theme is that gender isn’t necessar- the public believes that a midwife by definition is a ily related to caring practices, and men in midwifery female provider. People have asked, “What would a male credit the women they serve with the ability to discrimi- midwife be called, a midhusband?” This woman-to- nate the difference.4 www.meninnursingjournal.com February 2008 l Men in Nursing 31 Men’s motivations for choosing women. However, refusal is rare, midwifery are also discussed. One and one male midwife reports being man reported a long family history rejected only once or twice in 10 of involvement in midwifery; as a years of practice.7-9 Reasons for result, caring for pregnant women refusal include extreme embarrass- came naturally to him.9 Others ment around the opposite sex, reli- choose the profession precisely Midwifery faculty gious prohibitions, cultural because of the relationship it allows and preceptors ideologies, or a past history of the provider to form with the have been abuse or trauma (sexual, physical, patient: the patient-provider rap- challenged to or emotional). All of these reasons port, continuity of care, and the are equally valid and male midwives opportunities for teaching.8,9 In create an respect these women’s choices.7-9 addition, evidence suggests that environment A woman’s experience of preg- men in nursing tend to specialize in supportive of all nancy and childbirth, along with her areas of high acuity.8 Some men may healthcare in general, is layered simply enjoy the critical care aspect midwives—male with intimate personal, psychologi- of labor and delivery. Clearly, the and female. cal, and sociocultural factors. A fun- motivations are multiple and varied damental quality of any midwife is just as they are among female mid- the ability to facilitate an environ- wives. ment in which a woman feels safe, secure, and at ease. If a male midwife’s presence interferes with this environ- Unique contributions ment, a female attendant is obtained. Male midwives Male midwives may not only possess the essential quali- advise not to take the request personally.9 Instead, the ties of a midwife, but may also offer unique attributes to rejection is used as an opportunity to display culturally the childbearing family’s experience precisely because competent care, respecting the woman’s individuality they’re male. Women appreciated and in some cases pre- and freedom of choice.9 ferred a male midwife because of his “open” approach to pregnancy and childbirth.4,7 They shared encounters Essential qualities sought where male midwives displayed less “emotional bag- The term midwife simply means “with woman,” and the gage” than some of their female colleagues. These midwifery model of care transcends gender.4 With the women recognized that male midwives lack precon- essential qualities of a midwife present, gender can fade ceived ideas based on their own childbirth experi- to the background. These qualities include proper skills ences.4,7 and training, a desire to serve women, and the ability to Additionally, rather than feeling jealous or intimidat- empathize and communicate. Even more critical, mid- ed, husbands and partners were instead relieved to have wives must be good listeners. The quintessential mid- another man in the room.9 One male midwife found that wife listens to women in order to cultivate a relationship most men “seem to find his presence comforting.”9 It that prioritizes their individualized needs. was suggested that the male midwife may explain things It’s this same philosophy of respect for diversity and differently and relate to men more “on their level.”9 Male individuality that underscores the need for a more midwives may also showcase the quality of gentleness accepting environment for male midwives. Recently, a that impacts how fathers view their role in the context qualitative study on diversity in midwifery found that of the new family.4,7 Rather than being problematic, male midwives encounter unique adversity, and may some qualities of being male were viewed as distinctive be singled out by women and other midwives as being attributes. “different.”4 Men interviewed in this study reported a sense of heightened personal awareness and increased Facing rejection respect for individuality due to their own minority sta- Much of the argument against men in midwifery focuses tus. Being male was a facilitator to culturally compe- on the occasions when women demand female pro- tent care. The authors concluded that these male viders. Male midwives (along with male obstetricians midwives displayed the precise qualities and philoso- and gynecologists) have no doubt been refused by phies that all midwives wish to embody.4 Findings from

32 Men in Nursing l February 2008 www.meninnursingjournal.com this study were presented at the 2003 ACNM Annual their own unique history and perspective to the child- Meeting. Although the response from the midwife audi- bearing family. The midwifery community will be a ence was varied, the professional dialogue on gender stronger one when all voices, including those of men, diversity has begun. are heard. References Steps to success 1. Nicopoullus JDM. Midwifery is not a fit occupation for a gen- tlemen. J Obstet Gynaecol. 2003;23(6):589-593. Midwifery faculty and preceptors have been chal- 2. Casssidy T. Birth: The Surprising History of How We Are Born. lenged to create an environment supportive of all mid- New York, N.Y.: Atlantic Monthly Press; 2006:131-137. wives—male and female. There still exists, however, 3. Schuilling KD, Sipe TA, Fullerton J. Findings from the analysis many barriers for men much like that for men in nurs- of the American College of Nurse-Midwives’ membership sur- veys: 2000-2003. J Midwifery Womens Health. 2005;50(1):8-15. ing in general. In a recent article in this journal, Fenki 4. Kennedy HP, Erickson-Owens D, Davis JAP. Voices of diversity described barriers to recruitment of male nurses, in midwifery: a qualitative research study. J Midwifery Wom- detailing societal stereotypes and gender bias.10 He ens Health. 2006;51(2):85-90. also discussed recruitment strategies, new educational 5. American College of Nurse-Midwives. Philosophy of the Amer- frameworks for varied learning styles, and mentoring ican College of Nurse-Midwives. Silver Spring, Md.: American College of Nurse-Midwives; 2004. 10 programs for men entering nursing. An expert from 6. Barger MK. Midwifery practice: where have we been and the Royal College of Midwives agrees that recruitment where are we going? J Midwifery Womens Health. campaigns and media images inclusive of male mid- 2005;50(2):87-90. wives will encourage men to view midwifery as a valid 7. The Mid-Person. Available at: http://www.menstuff.org/issues/ byissue/malemidwives.html. Accessed January 23, 2008. and worthwhile career.7 These images will also raise 8. Armstrong F. Not just women’s business: men in nursing. Aust public awareness. Nurs J. 2002;9(11):24-26. Many believe that in this day and age, men can prac- 9. UK Midwifery Archives. Available at: http://www.midwifery. tice in any area of nursing.8 Male midwives cite the org.uk/malemidwife.htm. Accessed January 23, 2008. importance of finding mentors—either male or 10. Fenki EA. Where are all the men? Men in Nursing. 2006;1(6):37-40. female—who will help them through challenges, both About the authors 7 clinical and social. Midwifery programs could aid in At Vanderbilt University School of Nursing, Nashville, Tenn., this by ensuring that these mentors are available. Deanna Pilkenton is an instructor in the nurse-midwifery depart- Faculty members, previous students, or clinical ment, and Mavis N. Schorn is an assistant professor and program director of nurse-midwifery. instructors could all serve in this mentoring role. Midwifery programs are also challenged to innovate teaching styles and modify laboratory experiences to Call for manuscripts ensure that male students receive equivalent learning experiences as their female classmates. Prospective Men in Nursing is seeking manuscripts on topics that are strategic to the success of men in nursing—includ- male students may find it helpful to request an inter- ing career planning, new technology, gender-balanced view in order to more fully assess a program’s open- work teams, men’s health issues, hot clinical topics, ness. The on-site interview gives the applicant an and human interest stories focusing on remarkable men in nursing. opportunity to get a feel for the school and the support We accept feature articles up to 10 double-spaced that’ll be available. It also allows applicants to person- pages in length, which can be followed by references, ally explain why they’re interested in the profession tables, and figures (when appropriate). and to present the characteristics that’ll make them an Number references consecutively in the body of your manuscript and place reference citations at the exceptional student and midwife. end of the article. Do not reference commonly held opinions and perceptions unless their history is the Evolving career path article’s principal topic. Follow the standard practice Midwifery is a profession with ancient roots, but has for legal citations. Your work must not have been previously pub- evolved considerably over time. Modern CNMs may still lished elsewhere or currently be under consideration attend childbirths in private homes, but also employ for publication. fast-paced, high-tech skills in major medical centers. The Submit your manuscript to http://www. face of midwifery will continue to change in the future. lwwesubmissions.com. For more detailed author guidelines, visit As we have described, male midwives are making a posi- http://www.meninnursingjournal.com. tive impact on childbearing families everyday. Men bring www.meninnursingjournal.com February 2008 l Men in Nursing 33