This study of CNMs in rural Arizona indicated malpractice insurance has had a negative effect on the practice of nurse-midwifery. In 1987 a telephone survey was conducted to assess the effects on the practice patterns of Arizona's 21 rural CNMs, four of whom had had previous experience as licensed midwives. Results indicated 24% had been refused medical back-up by a physician. Although 10% were personally responsible for paying malpractice insurance premiums, they were not able to afford the cost and were going “bare.” Nearly 30% had changed their employment status from private practitioner to salaried employee, suffering a decrease in professional autonomy, flexibility of hours, quality of lifestyle, benefits, and income. Unless there are changes that result in lower malpractice insurance premiums or greater compensation and benefits, there likely will be a diminishing number of entries into an increasingly stressed profession.