Primary care in nurse-midwifery practice: a national survey

Providing primary health care is a relatively new addition to the scope of practice for certified nurse-midwives (CNMs)/certified midwives (CMs); thus, not much is known about how this component has been integrated into midwifery practice. The purpose of this descriptive study was to examine the type and extent of primary care education among CNMs/CMs and how various common health conditions are managed. In addition, perceptions of barriers to incorporating primary care into their practice were gathered. A small national survey was conducted among randomly selected members of the American College of Nurse-Midwives. No CMs participated. Although the sample size (n = 63) precludes generalizing the findings, 65% of CNMs reported lack of formal education in primary care. However, when asked about specific health conditions, more than 50% stated that they had some form of education in treating 30 of 37 common health problems. It is noteworthy that 54% of the CNM respondents indicated that they do not provide newborn care despite the fact that more than 85% of them received newborn education. Barriers such as lack of insurance reimbursement, institutional rules, and a lack of understanding of the CNM's scope of practice were cited by respondents as contributing factors. Unfamiliarity with primary care may be the most important factor in the reluctance of CNMs to incorporate primary care into practice.