Serving Women in Need: Nurse‐midwifery Practice in the United States

Declercq, Eugene; Williams, Deanne R.; Koontz, Ann M.; Paine, Lynn S.; Streit, Erica L.; McCloskey, Lois

doi:10.1016/s1526-9523(00)00091-x

Cited by 35 publications

(30 citation statements)

References 17 publications

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“…Midwives and physicians begin with their own set of learned assumptions about the nature of pregnancy, childbirth, and the maternal-fetal connection, and then proceed to perform prenatal care and nutritional counseling with a select group of clients or patients who themselves come with their own sets of beliefs and values. Midwives, and especially those who attend out-of-hospital deliveries, often find themselves serving a self-selected group of clients who are relatively motivated and often healthier to begin with than the population at large (Declercq, Paine, and Winter 1995;Declercq, Devries, et al 2001), though as home delivery grows in popularity, midwives report a rising rate of poor and disenfranchised women who are at higher risk psychosocially (Cheyney 2005;Declercq, Williams, et al 2001). Obstetricians serve a broader patient base that they see as struggling with "the typical American problems" of poor diet and low exercise levels.…”

Section: Downloaded By [University Of Liverpool] At 17:20 03 October mentioning

confidence: 99%

Nutritional Counseling in Midwifery and Obstetric Practice

Cheyney¹,

Moreno‐Black²

2010

Ecology of Food and Nutrition

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It is generally acknowledged that pregnant women require healthy diets. However, the cultural idea of "eating for two" and what constitutes an "appropriate" diet during pregnancy have been contested grounds of research as guidelines have changed over the decades. Using a grounded theory approach, we examine how research on pregnancy nutrition is incorporated into practice and translated to patients by obstetricians and 2 categories of midwives--certified nurse midwives (CNMs) and direct-entry midwives (DEMs). Five themes emerged from interviews: (1) food and exercise as "two sides of the same coin"; (2) "good food" and "food that harms" dichotomies; (3) nutrition as holistic prevention; (4) institutionalized barriers to nutritional counseling; and (5) food and the obesity epidemic. An exploration of the conceptual connections between these themes by provider type suggests mechanisms that we argue may be functioning to produce, reproduce, and perpetuate midwifery and medical models of care and associated provider-effects on nutrition-related complications.

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Section: Downloaded By [University Of Liverpool] At 17:20 03 October mentioning

confidence: 99%

Nutritional Counseling in Midwifery and Obstetric Practice

Cheyney¹,

Moreno‐Black²

2010

Ecology of Food and Nutrition

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“…It is known that nurse-midwives provide substantial amounts of care to vulnerable and underserved populations in the United States (Declercq et al, 2001) and that care is known to have outcomes equal to or better than that of other obstetrical providers (MacDorman & Singh, 1998;Rosenblatt et al, 1997). Limited data are available, however, regarding the nature of nurse-midwifery practice settings as well as compensation for services.…”

mentioning

confidence: 99%

A Profile of Colorado Nurse—Midwives

et al. 2008

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Nurse-midwives provide significant health care to underserved and vulnerable women, yet there is limited information about the nature of nurse-midwifery practices and compensation for services. This study reports the results of a Colorado statewide survey of nurse-midwives (N = 217). Electronic survey was utilized to detail practice in seven areas: demographics, type of practice, compensation, leadership, legislative priorities,teaching involvement, and practice satisfaction. Responses (N = 114) were analyzed using SPSS 13.0. Results found wide variation in compensation and practice types. Respondents largely worked in urban settings, cared for low to moderate risk patients, and were generally older and White. Restriction from medical staff membership, prescriptive authority constraints, and liability issues were practice limitations. While teaching a wide variety of learners, nurse-midwives do limited mentoring of nurse-midwifery students, a finding which is concerning given the decreasing numbers of nurse-midwives. Findings are compared to known national data, with implications for the provision of health care services detailed.

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“…In addition, a recent review article on midwifery care showed that midwives serve a high proportion of disadvantaged populations, including adolescents, racial/ethnic minorities, Medicaid beneficiaries, and women who are less educated, unmarried, or residing in rural areas or health professional shortage areas 6 . A large proportion of payments (44%) for CNM care is from Medicaid, which tends to have lower reimbursement rates 41 . Compared with other obstetric providers (obstetricians/gynecologists and family physicians), CNMs are paid a lower salary and are unable to offset lower insurance reimbursement with higher paying procedures such as surgery, 17,18,36 limiting their ability to absorb large increases in malpractice premiums.…”

Section: Resultsmentioning

confidence: 99%

Malpractice Liability Burden in Midwifery: A Survey of Michigan Certified Nurse‐Midwives

Lori

Siefert

et al. 2008

J Midwife Womens Health

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A statewide survey was conducted among 282 nurse-midwives in Michigan to examine the extent of their current medical liability burden. Two hundred ten responses were received for an adjusted response rate of 76.9%. Data from 145 certified nurse-midwives (CNMs) who were currently engaged in clinical practice in Michigan were used for this analysis. Sixty-nine percent of CNMs reported that liability concerns had a negative impact on their clinical decision making. Most CNMs (88.1%) acquired malpractice insurance coverage through an employer, whereas 4.9% were practicing "bare" due to difficulty in obtaining coverage. Thirty-five percent of the respondents had been named in a malpractice claim at least once in their career, and 15.5% had at least one malpractice payment of $30,000 or more made on their behalf. CNMs who purchased malpractice insurance coverage themselves or were going bare were significantly less likely to include obstetrics in their practice than their counterparts covered through an employer (70.6% versus 87.2%; P = .04). These findings among Michigan CNMs call for further investigation into the consequences of the current malpractice situation surrounding nurse-midwifery practice and its influence on obstetric care, particularly among women from disadvantaged populations.

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Serving Women in Need: Nurse‐midwifery Practice in the United States

Cited by 35 publications

References 17 publications

Nutritional Counseling in Midwifery and Obstetric Practice

Nutritional Counseling in Midwifery and Obstetric Practice

A Profile of Colorado Nurse—Midwives

Malpractice Liability Burden in Midwifery: A Survey of Michigan Certified Nurse‐Midwives

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