The transition from lay midwife to certified nurse-midwife in the United States.

This paper presents the results of a survey that was conducted between November 1992 and March 1993. Its target group consisted of midwives in the United States who began their careers as lay midwives and later decided to become certified nurse-midwives (CNMs). Questions address their demographic and socioeconomic characteristics to compile a profile that can be compared with other midwife populations. The survey elicited information regarding what motivated the decisions to change status and how these decisions have made an impact upon respondents' personal lives, family life styles, and income; identified how becoming a nurse-midwife changed the respondents' work in regard to their own community, the clientele they serve, and their style and site of practice, and how the change in identity affected their self-perceptions as midwives as well as their relationship to the health care system, the legal system, and the established midwifery system; it investigated how respondents viewed their preparation for midwifery and how they felt about the relationship of nursing to midwifery; and, it addressed how these midwives related to, were influenced by, and influenced the two major professional midwifery associations in the United States, the Midwives Alliance of North America and the American College of Nurse-Midwives. The results showed that, overall, the respondents valued their lay midwifery background, felt positive about their CNM educational programs, and showed a preference for direct entry and apprenticeship programs in which the RN is not a prerequisite.