THE BENEFICIAL ALTERNATIVE

THE NUMBER OF nurse-midwife-attended births in U.S. hospitals has jump ed tenfold in the last 20 years, rising from just 19,686 in 1975 to 19 6,977 in 1994, Certified nurse-midwives (CNMs) focus on childbirth as a normal event, emphasizing the educational and psychosocial aspects o f care and the judicious use of technological interventions. CNM care appears particularly well suited to help solve two difficult problems in U.S. obstetric care-our country's slow progress in improving the he alth status of newborns and the excessive use of medical interventions during childbirth. Despite the fact that CNM care has been found to b e safe and cost-effective, only a small fraction of those pregnant wom en who could benefit from CNM care use midwifery services, Lack of con sumer awareness Is part of the problem, but barriers also exist to acc essing CNM services. Sixty-four percent of CNM practices responding to a survey reported practice restrictions, most commonly due to state l aws, hospital policies, and inappropriately restrictive physician back -up, One state, Florida, is aggressively promoting the use of CNM care as the standard of practice for healthy pregnant women.