INTEGRATING LAY AND NURSE-MIDWIFERY INTO THE US AND CANADIAN HEALTH-CARE SYSTEMS

The integration of midwifery into the health care systems in the U.S. and Canada has invoked scholars to speak of a ''rise of midwifery''. D espite the gains that the profession of midwifery has made in both cou ntries, there are some interesting differences in how midwifery is org anized and practised in these two settings. Briefly, in the U.S. midwi fery currently exists as a profession divided between nurse- and non-n urse-midwives, or ''lay'' midwives, with greater acceptance and legiti macy garnered by the former, whereas midwifery in some jurisdictions i n Canada has gained legitimacy as a unified profession separate from n ursing. An analysis of the differences in the development and organiza tion of lay and nurse-midwifery in Canada and the U.S. highlights the importance of differences in the system of health professions in these two countries, the role of the state in this system, and the relation ship between feminism, midwifery and the state on the outcome of effor ts to integrate midwifery. (C) 1997 Elsevier Science Ltd.