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ABSTRACT

Nurse-midwives have been practicing in the United States for almost 60 years. The last five years in particular have been a period of vigorous development and growth. Lack of practice opportunities is no longer a major limiting factor. However, we function in a complex society and are dependent upon support from a variety of groups with whom we are interdependent or whose goals support ours at least in part. Historically the main source of support for nurse-midwifery came from public health leaders and obstetricians who were concerned about an inadequate supply of maternity care. Now, however, there are many obstetricians, so this concern is no longer a source of support except as it relates to care of the poor. CNMs' willingness and ability to provide effective care for poor women has been our most important source of support, especially for the resources necessary to operate our educational programs. Consumers are an important source of support, although we still need to learn more about their preferences and why they either select nurse-midwifery care or don't. Our relative cost-effectiveness is also important, and we need to maximize it. Nursing is a large profession and has a powerful lobbying arm that supports us. As safe CNM care requires an association with medicine, the support of the physicians with whom we work is essential. Other midwives also provide support by expanding the market for midwifery. Organizations such as the Federal Trade Commission provide critical support for us in the context of their larger goals of promoting an open and fair society. In addition, the College itself is building a “safety net” of institutionalized supports for the profession.