SERVING WOMEN IN NEED: NURSE-MIDWIFERY PRACTICE IN THE UNITED STATES

Authors

  • Eugene R. Declercq PhD,

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    • Eugene R. Declercq, professor and associate chair of the Department of Maternal and Child Health at Boston University School of Public Health (BUSPH), Boston, Massachusetts, was co-investigator of the 1998 Nurse-Midwifery Practice Survey. Dr. Declercq is director of the BUSPH Women's and Perinatal Research and Policy Unit, and is a consultant for the Journal of Midwifery & Women's Health.

  • Deanne R. Williams CNM, MS,

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    • Deanne R. Williams, executive director of the American College of Nurse-Midwives was project director of the ACNM MCH Providers Partnership. She is an associate editor of the Journal of Midwifery & Women's Health.

  • Ann M. Koontz CNM, DrPH,

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    • Ann M. Koontz, associate director for perinatal policy in the Maternal and Child Health Bureau, Health Resources and Services Administration, was co-investigator of the 1998 Nurse-Midwifery Practice Survey.

  • Lisa L. Paine CNM, DrPH,

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    • Lisa L. Paine, professor and chair of the Department of Maternal and Child Health at BUSPH, served as consultant for the ACNM MCH Providers Partnership and co-investigator of the 1998 Nurse-Midwifery Practice Survey. Dr. Paine is editor-in-chief of the Journal of Midwifery & Women's Health.

  • Erica L. Streit MSW, MPHc,

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    • Erica L. Streit, MPH candidate in the Department of Maternal and Child Health at BUSPH, served as a research assistant for the 1998 Nurse-Midwifery Practice Survey.

  • Lois McCloskey DrPH

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    • Lois McCloskey, assistant professor of the Department of Maternal and Child Health at BUSPH, was co-investigator of the 1998 Nurse-Midwifery Practice Survey. Dr. McCloskey is a consultant for the Journal of Midwifery & Women's Health.


Women's and Perinatal Research & Policy Unit, Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, T5W, Boston, MA 02118–2526.

ABSTRACT

Objective: Nurse-midwifery practices in the United States were examined to study the relationship between certified nurse-midwives' (CNMs) demographic, work setting, and practice characteristics in terms of clientele, practice size, and practice type. Factors that might influence the ability of CNMs to serve populations at risk for poor outcomes were given particular attention.

Methodology: A total of 2,405 responses to a 1998 mailed survey of 6,365 nurse-midwives ever-certified by the American College of Nurse-Midwives were analyzed.

Results: Study results indicated that CNMs continue to serve a population who are, based on a social risk profile, disproportionately at risk for poor pregnancy outcomes, including women who are uninsured (16%), immigrant (27%), adolescent (29%), and women of color (50%). It was also found that clientele varied according to practice settings: CNMs working in non-hospital, nonprofit settings served a clientele that was 65% nonwhite, 44% immigrant, 40% adolescent, and 29% uninsured; these CNMs received 61% of their client payments from Medicaid. CNMs working in private offices or for managed care organizations were less likely to serve women with these characteristics.

Conclusion: Study results, taken in conjunction with research that documents the safety of nurse-midwifery practice, reinforce policy recommendations that support expanded access to nurse-midwifery services. Findings also indicate a need for further research in the areas of CNM workload and productivity in managed care settings and the association between CNM race and ethnicity and the race and ethnicity of their clients.

Ancillary