Obstetricians' resistance to independent, private practice by nurse-midwives in Washington, D.C. hospitals

This paper examines obstetricians' explanations for the longstanding and current conflict between obstetricians and nurse-midwives in the District of Columbia over the struggle for independent practice for nurse-midwives. Based on extended interviews with obstetricians, this study shows they are reluctant to provide nurse-midwives with medical backup, a requirement of D.C. law for nurse-midwives to deliver babies in District hospitals. Obstetricians' concerns involve the boundaries of professional responsibility, and economic constraints. Obstetricians believe their more extensive training better qualifies them to handle difficult pregnancies, and they are concerned that nurse-midwives may not call for their help when it is needed. They argue that expanding the use of nurse-midwives will lead to a competition for healthy clients, a competition for paying clients, increased exposure to malpractice liability for obstetricians providing backup, and difficulty obtaining reimbursement from nurse-midwives for their services.