Get access



  • Elizabeth M. Graninger CNM, MSN,

    Corresponding authorSearch for more papers by this author
    • Elizabeth M. Graninger received her bachelor of arts in medical anthropology from Hampshire College in Amherst, Massachusetts in 1991. She received her masters of science in nurse-midwifery from Yale University in New Haven, Connecticut in 1996. She presently works in Oakland, California.

  • William P. McCool CNM, PhD

    Search for more papers by this author
    • Bill McCool was educated as a nurse-midwife at the Medical University of South Carolina in Charleston, South Carolina. He is currently an associate professor of nurse-midwifery at the University of Pennsylvania School of Nursing in Philadelphia.

12521 Carmel Street, Oakland, CA 94602.


The use of epidural analgesia for labor and birth has risen dramatically in the United States, and nurse-midwives are caring for increasingly greater numbers of women who deliver under epidural analgesia. The authors of this investigation undertook a national survey by mailed questionnaire to explore the use of and attitudes toward epidural analgesia among certified nurse-midwives. A stratified, random sample of one-half of American College of Nurse-Midwives members was polled, and 1,605 (60.7%) questionnaires were returned. A slight majority of certified nurse-midwives (CNMs) (53%) reported a negative attitude toward the increased use of epidurals in CNM practice, and 64% reported concern over the increased number of their clients who desire epidural anesthesia. CNMs were almost evenly split on the issue of whether nurse-midwives should discourage the use of epidurals in nurse-midwifery practice. For those CNMs with epidural analgesia available at their primary birth site (87% of the sample), the mean CNM epidural rate was 26%. Various reasons for the increased use of epidural analgesia in CNM practice are explored, as are the possible implications of such increased use in contemporary nurse-midwifery practice. Suggestions for further research are offered. © 1998 by the American College of Nurse-Midwives.