Serving women in need: Nurse-midwifery practice in the United States

Objective: Nurse-midwifery practices in the United States were examined to study the relationship between certified nurse-midwives' (CNMs) demographic , work setting, and practice characteristics in terms of clientele, practic e size, and practice type. Factors that might influence the ability of CNMs to serve populations at risk for poor outcomes were given particular atten tion. Methodology: A total of 2,405 responses to a 1998 mailed survey of 6,365 nu rse-midwives ever-certified by the American College of Nurse-Midwives were analyzed. Results: Study results indicated that CNMs continue to serve a population w ho are, based on a social risk profile, disproportionately at risk for poor pregnancy outcomes, including women who are uninsured (16%), immigrant (27 %), adolescent (29%), and women of color (50%). It was also found that clie ntele varied according to practice settings: CNMs working in non-hospital, nonprofit settings served a clientele that was 65% nonwhite, 44% immigrant, 40% adolescent, and 29% uninsured; these CNMs received 61% of their client payments from Medicaid. CNMs working in private offices or for managed car e organizations were less likely to serve women with these characteristics. Conclusion: Study results, taken in conjunction with research that document s the safety of nurse-midwifery practice, reinforce policy recommendations that support expanded access to nurse-midwifery services. Findings also ind icate a need for further research in the areas of CNM workload and producti vity in managed care settings and the association between CNM race and ethn icity and the race and ethnicity of their clients. (C) 2001 by the American College of Nurse-Midwives.