educated in both nursing and midwifery, and has evidence of certification according to the requirements of the American College of Nurse-Midwives.
Although the numbers of CNMs that attend hospital births in the U.S. has grown from 19,686 in 1975 to 196,977 in 1994, in Europe, midwives are the principal attendants for 75% of the births (Gabay & Wolfe, 1997, p. 386). The current need for more affordable maternity care by insurance providers and the public, has led to an increased demand for CNMs in the U.S. In response to this demand, the ACNM is committed to increasing the numbers of CNMs from 5,000 to 10,000; this would allow for CNMs to be present at 10% of U.S. births, by the year 2001 (Scoggin, 1996).
The ACNM initially certified only those candidates who were also nurses. The Midwives Alliance of north America (MANA) certified those who were not nurses (Draus, 1997, p. 44). Currently the Division of Accreditation (DOA) of the ACNM, is the accrediting agency for nurse-midwifery and midwifery education programs (Slattery & Burst, 1997, p. 325).
Nurse-midwifery is recommended as a needed solution for improving quality health care with lower costs. CNMs have been shown to have excellent success rates, high levels of patient satisfaction, and less use of interventions. Women who have poor access to health services or expect poorer outcomes are particularly benefitted by the CNM. In a population survey, in 1991, it was established that 3000 CNMs were in clinical practice, and 5.4 million visits to the CNMs included 20% that were not related to pregnancy, and 70% were from women and infants who had poor health care access or outcomes. It is concluded that these findings may be due to the tendency for federal support of nurse-midwifery education that favors programs where graduates practice in undeserved areas, or the tendency for regulation and practice barriers to be less problematic in these areas. These findings po...