Nurse-midwifery: yesterday, today, and tomorrow

This article chronicles the dramatic changes in nurse-midwifery over the last 25 years. Presently, multiple models of midwifery education leading to certification exist, all within a competency-based framework. Accreditation of education programs and the certification process within nurse-midwifery remain examples to others. The consumer demand for certified nurse-midwives continues to rise, spurring the preparation for more professionals. However, the average woman in the United States still does not have access to a certified nurse-midwife/certified midwife for care. Several of the barriers to practice have been dismantled during the last quarter century; however, adequate reimbursement, relationships with various groups, and managed care are among the issues that will challenge midwifery in the new century.