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Delivering a Better Childbirth Experience
Nurse-Midwives Provide An Important Alternative in Obstetric Care

Public Citizen's Health Research Group Consumer Guide to Nurse-Midwifery Includes Practice Descriptions for 414 Nurse-Midwifery Practices That Attend In-Hospital Births and 41 Freestanding Birth Center Practices

Every year about 4 million babies are born in the United States - almost all of them in a hospital with a physician in attendance. Increasingly, however, women are discovering a better alternative to the usual physician-provided obstetric care. They are seeking out certified nurse-midwives (CNMs), primary-care providers educated to give normal (which is to say, uncomplicated) maternity, newborn, and gynecological care. A report by Public Citizen's Health Research Group predicts that CNMs will likely be playing an increasingly important role in American obstetric care. The education and disposition of CNMs make them particularly well-suited to play a major part in the remedy of two notable difficulties in this area:--slow progress in improving the health status of newborns and the excessive use of costly, often unnecessary and sometimes dangerous medical interventions during normal births to low-risk women in hospitals.

The Public Citizen Survey of Nurse-Midwifery Practices

To take a closer look at nurse-midwifery care, in September 1994 we sent a mail survey to 1,600 nurse-midwifery practices across the country. We wanted to learn more about the impact of nurse-midwifery care on hospital cesarean section rates and on the type of care women receive during labor and delivery. The survey was also designed to elicit more information about the organization and structure of nurse-midwifery practices/services, the characteristics of women served by nurse-midwives, restrictions placed on nurse-midwives' practices, and how obstetric care received by nurse-midwifery patients may differ from the care received by non-CNM patients at the same hospital. A second survey was sent to freestanding birth centers (FBCs) to solicit similar information for practices that attend births in these facilities.

Benefits of CNM Care To Pregnant Women and Their Families

Focusing on childbirth as a normal event allows nurse-midwives to address more than just the medical aspects of childbearing. Women and their families are empowered to care for themselves and are given control over their own childbirth experience. Women attended by nurse-midwives can look forward to longer prenatal visits, greater emphasis on education and birth preparation during the prenatal period, and greater emotional support. Even though CNMs resist medicalization of childbirth, nurse-midwives are fully capable of recognizing any problems should they arise and understand the need for physician consultation or transfer to physician care if necessary.

Nurse-midwifery care is not "assembly line" care. Each woman can expect the individualized care that she deserves. Using a CNM for care allows women more choice in birth options including the option of birth setting. Very few physicians deliver out of hospital, but CNMs may attend births in a freestanding birth center or even the client's home.

What You Can Do

Consumers can expand access to nurse-midwives for themselves and others through the following actions:

• Consider choosing a nurse-midwife as your primary care provider for maternity services and gynecological care.
  
  If you are interested in CNM care, asking questions of nurse-midwives will help to ensure that you choose a CNM who is right for you. Important issues to discuss include the nurse-midwife's philosophy of care, the type of setting the nurse- midwife practices in (you should ensure that you will be able to deliver in the site--hospital, birth center, or home--that is most comfortable for you), what arrangements the nurse-midwife has with a consulting physician in case of complications, and whether your insurance company will cover the nurse-midwife's fees.
  
  
• Talk to your friends about nurse-midwifery care.
  
  Word-of-mouth is the best kind of advertising a nurse-midwifery practice can have. For some practices it is very important to their survival and continued growth.
  
  
• Ask your insurance company to cover nurse-midwifery services or include nurse-midwives in their network of preferred providers.
  
  If you work for a company that self-insures (pays its employees' medical bills itself), talk to your benefits manager about adding CNMs to the list of covered services for your health plan.
  
  Let the administrator of your local hospital know that you would like to see that nurse-midwives are given admitting privileges. Obtaining hospital admitting privileges is often difficult for certified nurse-midwives. Hospitals may say that there is no demand for CNM services in the community as an excuse to deny CNMs privileges. Once hospitals understand that women want CNM services, they may begin to see that it is to their competitive advantage to provide them.
  
  
• Write your state legislators.
  
  Because the practice of nurse-midwifery is regulated at the state level, the degree to which barriers to nurse-midwifery practice exist varies by state. If you are denied access to CNM services because of regulatory or industrial barriers, write to your state legislators and encourage them to support changes in the law that will ensure access to CNM care for all women.

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