Social and professional friction concerning female health workers has existed for centuries, particularly for issues concerning birth. Debate about the proper roles and responsibilities for lay midwives, certified midwives, certified nurse midwives and OB-GYN physicians is intense and ongoing. The laws and policies in most health care institutions in the United States today favor the authority of physicians over all the other health care professionals. Consumer choice and professional boundaries of all types of midwives have been restricted due primarily to the influence of organized physicians, hospital administrators and insurance companies. The United States lags far behind other industrialized countries in birth outcomes and other maternal-fetal health statistics. Not surprisingly, the higher-ranking countries utilize midwives effectively in their health care systems. Expanding the roles and availability of nurse-midwives may well improve the quality of care for women with normal pregnancies—resulting in better health outcomes throughout the country. To better understand the role midwives play, particularly in rural and underserved areas, this study was focused on the life and experiences of Lisa Goldstein, who has 53 years of experience as both a lay midwife and certified nurse midwife.
ABSTRACT from Midwifery in the Mountains: Lisa Goldstein's Care of Appalachian Women and their Families in Western North Carolina, Appalachian Studies thesis by Annmarie J. Anglim (2013)