American nurse-midwifery practice in 1976-1977: reflections of 50 years of growth and development.

Nurse-Midwifery was introduced into the United States in 1925 as a means of meeting the maternal and infant care needs of specific rural and urban poor populations. Four studies of US nurse-midwives conducted between 1963 and 1977 describe recent changes and practice in the profession. Approximately 1,000 nurse-midwives employed in the US responded to a questionnaire in late 1976; about 650 of them were in clinical practice. Of those in practice, two-thirds had graduated as nurse-midwives during the prior six years. At least 90 per cent of them provided prenatal care and family planning, and 85 per cent managed labor and delivery and performed postpartum physical examinations. Working collaboratively with physicians, most nurse-midwives manage the care of prenatal patients with some complications. However, relatively few manage multiple gestation or breech deliveries. The 78 per cent of clinical nurse-midwives who provide gynecologic care to non-pregnant women are likely to diagnose gynecologic conditions and treat common problems such as vaginal infections, gonorrhea, condylomata, and lower urinary tract infections. Those who work in small communities are more likely to assume greater responsibility for complicated deliveries and for care of the newborn from birth through infancy. (Am J Puiblic Health 1980; 70:990-996.)