"January 14, 1796: Snowd. I was Calld at 7 hour Evening to see Mrs. Mathews who is in Labour. I tarried all night. Slept none."

The phrase "tarried all night" is often repeated in the remarkable diary of Martha Ballard, a Maine midwife who recorded her life and work from 1785 to 1812. On Jan. 15, 1796, she recorded that Mrs. Mathews gave birth to a daughter at 6 a.m., and that it was the 612th birth she had attended since 1777.

Armed with experience and patience - as well as homemade salves, pills, syrups, teas and ointments - Ballard crossed the Kennebec River in all seasons to attend births, illnesses and deaths. (To read more about her story, see "A Midwife's Tale" by Laurel Thatcher Ulrich).

While much has changed in the training of midwives and the delivering of babies since early American times, one thing has not: Today's certified nursemidwives still tarry all night with many of their patients.

"If a woman in labor needs me sitting at the bedside, then that's where I am," said Kim Baraona, CNM, MN.

Research has shown that women who are attended throughout labor and delivery have better outcomes, according to the American College of Nurse-Midwives, the professional organization that sets the standards for certification and accredits nurse-midwifery programs.

Nurse-midwifery was established in the early 1920s in response to alarming U.S. infant mortality rates (124 in every 1,000 births) and maternal mortality rates.

Mary Breckinridge brought nursemidwives from England to Appalachia and founded the Frontier Nursing Service in Kentucky. Public health nurses on horseback brought prenatal and maternity care to patients in isolated areas.

In 1955, Hattie Hemschemeyer helped develop the first national nursemidwifery organization.

The popularity and acceptance of nurse-midwives grew dramatically in the 1970s and 1980s. In 1970, Elizabeth S. Sharp, CNM, Dr.P.H., who had been teaching in the nurse-midwifery program at Yale University School of Nursing, established the Nurse Midwifery Service, jointly sponsored by the Emory University School of Medicine and Grady Memorial Hospital.

Serving the indigent population of two counties, Grady's residents were treating an increasing number of patients. Drs. John D. Thompson and W. Newton Long, who had seen the effectiveness of nurse-midwives at Johns Hopkins Hospital, believed that nursemidwives and residents would work together well as team.

"I saw it as a wonderful opportunity to practice nurse-midwifery for many patients and to start an educational program. Grady turned out to be one of the best places to work as a nurse-midwife," Sharp said. "I knew there was a real need and that we made a contribution."

Sharp witnessed the growth of nursemidwifery into private OB/GYN practices. She's also seen today's health care environment - with managed care and capitated reimbursement - make it harder for nurse midwives and obstetricians to practice.

"Nurse-midwifery has always been rooted in helping women and the family, " Sharp said. "I always felt that my participation with a couple was in helping them start out as parents and be a family. I felt like we did a fine job in providing continuous care and education - the things we stood for - and it was very rewarding."