THE HISTORY AND DEVELOPMENT OF NURSE-MIDWIFERY EDUCATION IN UTAH: 1965-1985 by Janis Louise Brugel and Lisa Jo Litton A thesis submitted to the faculty of The University of Utah in partial fulfillment of the requirements for the degree of Master of Science Department of Nursing The University of Utah August 1987 THE UNIVERSITY OF UTAH GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Janis Louise Brugel and Lisa Jo Litton This thesis has been read by each member of the following supervisory committee and by mCljority vote has been found to be satisfactory. � t Chairman: Bonnie C. Clayton� Ga i1 Evans THE UNIVERSITY OF UTAH GRADUATE SCHOOL FINAL READING APPROVAL To the Graduate Council of The University of Utah: n o B an a o Litton Ihave read the thesis of Ja is L uise rugel d Lis J in its final form and have found that (I) its format. citations. and bibliographic style are consistent and acceptable: (2) its illustrative materials including figures. tables. and charts are in place: and (3) the final manuscript is satisfactory to the Supervisory Committee and is ready for submission to the Graduate School. ��(Vj�_� Dalt: Bonnie C. clayt:� Member. Supen isory C ommiilee Approved for the Major Department Appruved for the Graduate Council B. Gale Dick Dean " " J he (iraduJI� Schuul Copyright ~ Janis Louise Brugel and Lisa Jo Litton 1987 All Rights Reserved ABSTRACT The Master of Science in Nursing, Parent-Child Program, Nurse Midwifery tract at the University of Utah was established in 1965. A review of relevant literature, written communications and extensive interviews with 13 faculty and graduates of the program reveals the following ingredients for its success. Aggressive development of clinical sites appears crucial to a strong nurse-midwifery program. Early difficulties with maintaining suitable clinical sites at the University of Utah were overcome by tenacious faculty and adaptive, assertive students. Curriculum had to keep pace with the expanding nurse-midwifery practice scope as well as unforeseen changes in the availability of clinical sites. Concomitant with these efforts faculty and graduates of the nurse-midwifery program lobbied effectively for state legislative reform; this allowed expanded employment opportunities, increased professional autonomy and the added benefit of more clinical sites for students as new graduates were able to initiate a variety of clinical sites in Utah. Other contributing factors included increased federal funding for nursing programs and a supportive administration. No areas of the program were evaluated as being conspicuously weak from the interviews, although concern about faculty turnover and the hiring of University of Utah graduates was expressed. Curricular shortcomings are inevitable in hindsight, and the graduates interviewed lamented the paucity of elective credits and the lack of instruction in areas such as establishing a practice, education theory and methods and public relations. The program has had a lasting impact on obstetric/ gynecologic nursing and medical care in the region and through the continuing efforts of both faculty and graduates will continue to shape the course of nurse-midwifery practice in the United States. v TABLE OF CONTENTS ABSTRACT ••••••••••••••••••••••••••••••••••••••••••••••••••• i v ACKNOWLEDGEMENTS ........................................... viii Chapter I. INTRODUCTION ......................................... 1 De fin i t ion s ••••••.•••..•••••••.•••••••••••.•.•.•••••• 4 II. REVIEW OF LITERATURE ••••••••••••.••••••••••••.•.••••• 8 The Decline of the American Midwife ••.••••.••••.••••• 8 Hi s tory of Mi dwi fery ••••••.•••.••.•.•.••••••.•.•••••• 14 History of Nursing................................... 17 Relationships Between Nursing and Nurse-Midwifery ••.• 21 The Introduction of Nurse-Midwifery Education ••••••.• 23 History: Nurse-Midwifery Practice •••.•.•••••••••.••• 26 Literature Review: Nurse-Midwifery ••.••••••••.•.••.• 29 III. METHODOLOGY ••••••••••••••••••••••••••••••••••.•••.••. 37 External Criticism in the Oral History Process ••••••• 40 Internal Criticism in the Oral History Process .•••••• 40 The Ora 1 Hi story Proces s ••••••••••••.••••.•••.••••.•• 42 Steps of the Oral History Process •••••••••••••••••••• 43 IV. RESULTS ••••••••.•••••.•••.•.•••••.••••••••.••••••.••• 53 Overview............................................. 53 Curriculum........................................... 60 Teaching Methods .••••.•.•.•••.•.•••••••••••.•.••••••• 69 Faculty: Recruitment, Responsibilities and Role Modeling........................................... 75 Clinical Sites •••••.•.••.•••..•••.••••••••••••••••••• 78 Students ....•.......•................................ 111 Legislation Affecting Nurse-Midwifery Practice ••••••. 123 V. CONCLUSIONS •••••••••••••••••••••.•••••••••.••••••.••• 134 Recommendations for Future Study •••••.••••••••••.•••• 149 Appendices A. CONSENT FORM/CONTACT LETTER ..........•..•........•.... 151 B. EVERETT L. COOLEY ORAL HISTORY PROJECT FORMS .....•.... 153 C. LIST OF INTERVIEWEES (KEY INFORMANTS) .•............... 158 D. RESOURCES IN THE ORAL HISTORY PROCESS FOR NURSES: ANNOTATED BIBLIOGRAPHy ....................... 162 E. FOUR TABLES: RESEARCH QUESTIONS WITH CATEGORIES FOR ANAL YSIS •.•.••..••..•••.•••..•••••.••••••••.••.••••• 165 F. LIST OF SIX MAJOR CURRICULUM CHANGES .......•.....•...• 170 REFERENCES •••.••.••••••••..••.••••••••.••••••••••••••••••• 172 vii ACKNOWLEDGEMENTS The authors would not have initiated this research project were it not for the fact that two different parties expressed a desire to see the history of the nurse-midwifery program at the University of Utah written. The first to excite our interest was the local chapter of the American College of Nurse-Midwives. The authors discovered in the minutes of a Region V Chapter 8 meeting that the chapter wished to encourage and support a graduate student to research the historical development of nurse-midwifery in Utah. While investigating the feasibility of doing so, the authors became aware that an oral history project was being undertaken at the University of Utah, directed by Dr. Gregory Thompson, to record, on tape, the histories of various departments within the university. We have received a great deal of encouragement and support from Dr. Thompson as well as much needed information about the oral history process. In addition, the transcription of tapes was paid for by the Everett L. Cooley Oral History Project, a cost which we would not have been able to assume. This service was an invaluable aid to the authors when attempting to analyze the data. Dr. Bonnie Clayton of the University of Utah College of Nursing has given much of her time, energy, and expertise to this project without which the authors would have floundered, perhaps irrevocably. Gail Evans, CNM, was instrumental in guiding us as we explored our, as yet, unformed ideas about what we wished to research and how the topic might be approached. Evans also provided information about the early history of midwifery in Utah as well as sharing her expertise on the history of nurse-midwifery in the state. Those individuals who consented to be interviewed and then shared not only their time but their valuable recollections and insights on the topic under study have made this whole project not only possible but exciting and stimulating to conduct. The authors relied heavily on primary sources of information from the personal collections of Dr. Joyce C. Foster and Dean Emeritus Mildred Quinn as well as from the archives of the University of Utah College of Nursing. We wish to thank Dr. Foster, Dean Quinn and the College for making these references available to us. Our spouses, Scott E. Morris and Rod Whittinghill, have endured months of separation, weeks of hardship and neglect, days of frustrated haranguing and endless hours performing thankless household tasks without assistance. Yet, they managed to continue giving support and encouragement (some might call it prodding) when our spirits flagged and inspiration wavered! We owe a debt of gratitude which they know we can never repay. ix CHAPTER ONE INTRODUCTION This study proposes to research the historical development and establishment of the oldest nurse-midwifery educational program west of the Mississippi. The University of Utah's graduate nurse-midwifery program within the College of Nursing has been the home of nurse-midwifery education for the state of Utah since 1965. There were "midwife" training programs in Utah prior to the turn of the century. The pioneer midwives of Utah were among the first educated in America. The distinction between midwives and contemporary nurse-midwives is important, both in education and practice. In 1985 the nurse-midwifery specialty of the Parent-child Graduate Program celebrated its 20th anniversary of quality education in nursing and nurse-midwifery. Officially accredited by both the National League for Nursing and the American College of Nurse-Midwives (ACNM) almost since its inception, the quality of the program is a symbol of the determination of faculty, students and staff to develop and maintain a program which would prosper, change and evolve with the times. How has the program evolved? What prompted its development? What is the status of nurse-midwifery education and its significance to consumers, the general public? These are some of the preliminary 2 questions that led to the development of the topic into an historical research study. The primary purpose of this study was