Nurse-midwives' use of and attitudes toward epidural analgesia

The use of epidural analgesia for labor and birth has risen dramatically in the United States, and nurse-midwives are caring for increasingly greater numbers of women who deliver under epidural analgesia. The authors of this investigation undertook a national survey by mailed questionnaire to explore the use of and attitudes toward epidural analgesia among certified nurse-midwives. A stratified, random sample of one-half of American College of Nurse-Midwives members was polled, and 1,605 (60.7%) questionnaires were returned. A slight majority of certified nurse-midwives (CNMs) (53%) reported a negative attitude toward the increased use of epidurals in CNM practice, and 64% reported concern over the increased number of their clients who desire epidural anesthesia. CNMs were almost evenly split on the issue of whether nurse-midwives should discourage the use of epidurals in nurse-midwifery practice. For those CNMs with epidural analgesia available at their primary birth site (87% of the sample), the mean CNM epidural rate was 26%. Various reasons for the increased use of epidural analgesia in CNM practice are explored, as are the possible implications of such increased use in contemporary nurse-midwifery practice. Suggestions for further research are offered.