100 Years of Modern Midwifery History in Florida
1920-2020
The following historical timetable was adapted from the NACPM Webinar: Midwives in Action provided by Sharon Hamilton, LM and 2017 Midwives Association of Florida Legislative Liaison on April 6, 2017 https://www.nacpm.org/wp-content/uploads/2017/04/Sharon-slides-4-NACPM-webinar.pdf. This presentation used "Mainstreaming Midwives: The politics of change" by Robbie Davis-Floyd and Christine Johnson as the primary reference.
1920: Approximately 4000 midwives were serving Florida families, including Seminole, Miccosukee, African American and poor rural white families (Fla. Health Dept. estimate).
1931: Florida passed the first state midwifery licensing law, “Florida Statute 485”, 1400 Grand Midwives became licensed.
Please Note: for the purpose of this historical timeline the term licensed “Grand Midwife” will be used in place of licensed “Lay Midwife” because the term is more widely accepted by the midwives who served in this era.
1933: Florida Midwife’s Manual was written for Grand Midwives (AKA: Licensed “Lay” Midwives).
Midwives attended parents in labor and birth.
Public health nurses provided prenatal care.
This manual was created under the guise of educating Grand Midwives, many of whom had been safely in practice for decades.
Grand Midwives were state sanctioned to practice by the state of Florida and County Health Departments until the 1960s.
1930s: The Florida Health Department recruited and trained midwives to take care of those families who did not have access to medical care due to poverty and segregation
This period was marked by the movement of middle- and upper-class white parents out of the home setting and into the hospital setting for childbirth.
This recruitment largely centered around Black and Indigenous Grand Midwives who were already providing exceptional care to Black, Indigenous, and indigent white families who were excluded from the option to birth in the hospital due to racial segregation or inability to afford a hospital birth.
Doctors and public health nurses of this era intentionally used Grand Midwives to provide them with the knowledge and skills that the Grand Midwives possessed, while undermining them within the community.
Public Health Nurses provided prenatal care while the Grand Midwives were expected to be on call to attend births in the family’s home.
Many Grand Midwives were paid in produce, canned foods, eggs, chickens, pigs and livestock, or with barter and trade, whatever the families could afford.
1950s-1980s: Gladys Milton, LM (1924-1999) Midwife to NW Florida families.
In the 1950s, the Walton County Health Department recruited Gladys Milton to be trained by physicians. Gladys was licensed to practice midwifery in Florida in 1959.
Gladys Milton delivered approximately 3,000 babies during her 40 years practicing midwifery (1959-1999). From 1959-1976 Gladys attended home births in NW Florida.
In 1976, Gladys opened the Milton Memorial Birthing Center, to provide a safe, family-oriented environment for low-risk parents who could not afford hospital care.
In the late 1980s, with help from the Florida midwifery community, Gladys successfully fought off a challenge by the FL DOH to maintain her midwifery license.
Gladys was inducted into the Florida Women's Hall of Fame in 1994.
Gladys’ daughter, Maria Milton, also a Florida Licensed Midwife, continues her mother’s work at the Milton Memorial Birthing Center.
1960s and 70s: Florida hospitals were desegregated, US Medicaid instituted - families once served by Grand Midwives became desirable to obstetricians.
The numbers of Grand Midwives begin to dwindle as the Florida Dept of Health and Rehabilitative Services notified Grand Midwives their services would no longer be needed, and they should turn in their licenses and receive a “certificate of appreciation” from the state.
This sudden requirement to turn in their licenses coincided with hospital birth becoming more widely available to Black, Indigenous, and indigent white families.
1969: The first Nurse-Midwife was licensed in Florida, under the Board of Nursing.
Many of these early Nurse-Midwives has been informally trained in the art of midwifery by the Grand Midwives, under the guise of the Public Health Nurses educating them.
1969: Health Department officials moved to eradicate the Grand Midwives and replace them with nurse midwives.
1960s-1970s: The majority of Florida Grand Midwives were retired by 1970.
Simultaneously, demand for midwives nationwide was on the rise, sparked by many factors, including the Lamaze movement (est. in U.S. 1960s), the Bradley method of natural childbirth (also known as “husband-coached childbirth) (1965), the book: Awake & Aware Childbirth by Irwin Chabon (1966), the Women’s Liberation Movement, La Leche League (est. 1956), the book: Spiritual Midwifery by Ina May Gaskin (1975), and The Farm midwifery (est. 1970).
In the late 60s and early 70s, general interest in natural childbirth began to grow. Many families wanted to be more educated about and more involved in their pregnancies and the births of their children. Fathers wanted to be part of the birth.
In 1964, 191 midwives hold Florida licenses. By 1974, that number drops to 54 midwives with a Florida license.
1970s: A law to license “Lay” Midwives was still on the books. To become licensed, midwives had to attend 15 births with a sponsoring physician and receive the endorsement of their County Health Department supervisor, usually a doctor.
Most County Health Department supervisors were doctors and refused to license Lay Midwives.
Several midwives challenged their refusals in state courts and received their licenses.
Florida DHRS actively encouraged the remaining Licensed “Lay” Midwives to retire in favor of Nurse-Midwives.
Simultaneously, the rate of homebirths in Florida delivered by “other” rose to a statistically significant level.
1978: Birthplace, an alternative birthing center is established by Byllye Avery and others in Gainesville, Florida.
Byllye later moved to Atlanta (1981) and started the National Black Women’s Health Project.
1979: Midwives Association of Florida (MAF) is formed, to keep direct-entry midwifery licensure available.
1979: MAF meets with FL DOL (Dept of Labor) people to propose an apprenticeship training program for Licensed “Lay” Midwives, which is ultimately rejected.
Lates 70s and early 80s: MAF secures bill sponsors and submits a bill to license midwives. The bill was introduced in 1979, 1980, & 1982.
1982: Florida Midwifery Practice Act, F.S. 467 passed
Required: 3 yr. “direct entry” midwifery education, 25 birth observes, 25 primary managements under supervision, and passing a state licensing exam.
Nursing is not a prerequisite.
Two-year “Sunset Review Study” is mandated.
1984: “sunset review” amendment added to Florida Midwifery Practice Act, F.S. 467 by opponents at the last minute.
1983: The North Florida School of Midwifery opens in Gainesville, seating its first and only class.
1984: The South Florida School of Midwifery opens in Miami, seating its first and only class.
1984: Sunset Review Study recommended continuation of licensing – study finds Licensed Midwives provide safe, effective care that meets a public need.
Despite study findings, opposition from the medical community forced amendment to F.S. 467 that closed off licensing to all non-nurse midwives except those currently licensed and students already enrolled in the two midwifery education programs. This action was called “The Meyers amendment”, as it was sponsored by Senator “Doc” Meyers of Sarasota, FL.
1986: Establishment of FABC (Florida Association of Birth Centers).
1988: Licensed Midwives and families worked to remove restrictions in the law.
Grassroots consumer groups organized throughout Florida.
Passage of law required private insurance companies to reimburse midwives licensed pursuant to 467 for maternity care.
1989: Florida Friends of Midwives was formed, under the leadership of Becky Martin.
1989: US Senator Lawton Chiles’ son and his wife had an unplanned preterm breech. delivery at home. Florida Licensed Lay Midwife who was also a paramedic was called in and successfully delivered the baby. Senator Chiles expressed gratitude that the midwife saved his grandchild’s life.
Lawton Chiles decided to run for governor as the Democratic candidate. Licensed midwives contributed to and worked in his campaign. Chiles was elected Florida governor in 1989 and re-elected in 1993.
1991: Passage of “Sunrise Report” by the Florida Legislature - called for reopening F.S. 467 to enable the education and licensure of new midwives.
1991: Governor Chiles’ daughter Rhea had the first of her 3 children in a birth center owned by a Licensed Midwife.
1991: Rates of homebirths and birth center births continue to rise.
1991: Senate HRS committee study finds Licensed Midwives’ safety record comparable to Certified Nurse Midwives and Physicians; and that the public could benefit from increasing the number of practicing midwives.
1992: New Licensed Midwife Law passed, licensure reopened.
1992: Educational and clinical requirements and scope of practice were revised.
Birth management requirements increased from 25 to 50.
Medicaid reimbursement mandated for Licensed Midwife services: prenatal and postpartum care, and birth center births. Homebirths excluded.
1992: Regulation moves from DHRS to DBPR. Midwives regulated by the Council of Licensed Midwifery, an independent council. Efforts to place the Council under the authority of the Florida Board of Nursing were defeated.
1992: Gov. Lawton Chiles’ Healthy Start Initiative passed and became law. The sunset review is abolished.
1993: Council of Licensed Midwifery Began Rules Development.
Council of Licensed Midwifery comprised 9 members: 4 LMs, 1 CNM, 1 OB, 1 pediatrician, 1 family practice physician and 1 consumer.
1993: Florida Dept of Education develops Curriculum Framework for state educational programs, levels midwifery at Associate Degree.
1993: Healthy Start Advisory Committee recommends 50% of healthy parents deliver with midwives by the year 2000.
1993: Miami Dade Community College became the only public institution in the U.S. to offer a degree for Licensed Midwives.
1993: The National School of Technology starts a midwifery program in Miami.
1995: The Florida School of Traditional Midwifery accepts its first class in Gainesville with Jana Borino leading the action. The NARM exam is officially adopted as the Florida state exam.
1997: Passage of the law mandating Medicaid Reimbursement for home birth provided by Licensed Midwives, linked with requirement that actively practicing midwives hold Liability (“Malpractice”) Insurance.
1998: Jennie Joseph, British midwife, became a Florida Licensed Midwife, started the The JJ Way® Patient-Centered model of care.
2008: Miami Dade College closed its Midwifery Program to new classes.
The last midwifery class graduates from Miami Dade College 2009.
2009: Jennie Joseph opens Commonsense Childbirth School of Midwifery in Winter Garden (central) Florida
2010: Federal Health Care reform legislation authorizes Medicaid reimbursement for all licensed practitioners in licensed birth centers
2006: Midwifery rules amended to enable LMs to provide HBAC with informed consent https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B24-7
2016: Successful resolution of ~ 20 years of efforts by members of FABC (Florida Association of Birth Centers) to change birth center rules so LM clients no longer require initial risk assessment by an OB or CNM to enter LM care – now finally in agreement with LM homebirth rules
2016: The district 12 ACOG chapter sends a letter to the Council of Licensed Midwifery declaring that legislative action will be taken to address Midwifery Practice Act CH 467. A revival of the long-dormant MAF and other LM professional organizations is underway.
2017: Establishing FLACPM – the Florida chapter of NACPM – to contribute national resources and connections to the state challenges and work collaboratively with the Midwives Association of Florida
2017: 14 midwives from all over the state converged on Tallahassee for Midwife Day March 29, 2017
Lobbyist set up 19 appointments with different legislators
Teams of 3-4 midwives visited each legislator
Sat in on legislative sessions
Efforts are made by FL ACOG chapter to open up CH 467 and attempt to regulate LM profession; these efforts are successfully delayed.
2018: Continued legislative action unfolds with lobbyists Louis Rotundo and Ron Watson, resulting in Adverse Incident Reports becoming legally required for OOH birth.
It is proven that LMs are not the only providers attending OOH birth, thereby ensuring that “adverse incident reporting” laws are written into general maternity care statutes, rather than limiting it to Ch 467 Midwifery Practice Act.
2018: A statewide LM meeting is held in Bartow, FL on February 28, 2018 to decide the next moves on a professional organization.
2019: The Florida School of Traditional Midwifery opens Cypress Grove, FSTM’s Miami campus and begins to accept applications to the program.
2019-2020: Lobbyists inform LMs that there is a bill that attempts to open up Ch 467 and threaten LM profession. Legislator sponsors are largely responding to negative press about OOH birth in Florida.
LMs successfully educate legislators on Statutes and Rules that are already in place to safeguard clients during care with an LM. No further legislative action is taken.
History of Florida Midwifery Resources
Davis-Floyd, R. & Johnson, C.B. (2006). Mainstreaming midwives: The politics of change. 211-260. Routledge: Taylor & Francis Group.
https://www.nacpm.org/wp-content/uploads/2017/04/Sharon-slides-4-NACPM-webinar.pdf Sharon Hamilton NACPM Webinar
https://www.smith.edu/libraries/libs/ssc/vof/transcripts/Avery.pdf
https://www.orlandosentinel.com/news/os-xpm-1989-12-14-8912132300-story.html
https://floridamemory.com/learn/exhibits/floridahighlights/midwifery/
http://diginole.lib.fsu.edu/islandora/object/fsu:185213/datastream/PDF/view
https://www.tallahassee.com/story/life/chronicle/2014/10/12/history-born-florida/17145247/
https://repository.law.miami.edu/cgi/viewcontent.cgi?article=2286&context=umlr
https://midwivesassociationofflorida.org/History-of-Florida-Midwifery