By tradition—and definition—nurse-midwives have managed “normal” mothers and babies. Settings for nurse-midwives have included community hospitals, maternity centers, and home. For many years, the “normal” category has included the majority of childbearing women. High-risk patients were the exception, requiring physician management. With advances in perinatal medicine, the ability to identify threats to mother or fetus, risk factors, has led to increasing numbers of women being labeled “at risk.” There is impetus to close small obstetrical services and concentrate care in perinatal centers with sophisticated technological capabilities to handle pregnancies at risk.
Nurse-midwives must reevaluate “normal” in light of perinatal advances and their own capabilities. Nurse-midwives have assumed management of adolescent mothers, previous infertility, nutritional anemia, and pregnant women over 35 years of age. These women are clearly at risk; however, the benefits of nurse-midwifery care override the label. These complicated obstetrical cases are complicated in the area of strength for nurse-midwives. Counseling, education, nutrition, family involvement, continuity, and close surveillance are specific attributes of nurse-midwifery. There are numerous other examples. In selected complicated obstetrics, the nurse-midwife is the indicated health care professional. To limit his/her practice to “normal” is to deny appropriate care to hundreds of at risk pregnancies.
This article addresses the nurse-midwife's role in complicated obstetrics, suggests appropriate patients, and proposes a method for making that determination. As a member of the health care team, the role of the nurse-midwife in medical education and the development of perinatal services for women at risk is also discussed.