Childbearing and women's choice of nurse-midwives in Washington, D.C. hospitals
Langton, P.A.; Kammerer, D.A.
Women and Health 15(2): 49-65
1989
ISSN/ISBN: 0363-0242 PMID: 2781810 DOI: 10.1300/j013v15n02_05Document Number: 363081
A descriptive case study to explore women's choice of having a certified nurse-midwife (CNM) manage their hospital births was conducted in the District of Columbia (DC). Interviews were conducted in the fall of 1987 with 34 medical and administrative hospital personnel. Federal hospitals were excluded. 11 CNMs were interviewed. Hospital bylaws and legislative acts were studied. 1 of the questions asked dealt with the process of obtaining practice privileges in the hospitals. CNMs have practice privileges in 3 of the 9 DC hospitals offering obstetrical services (2 private hospitals and 1 academic health center (AHC). Thus, CNMs have made little progress in attaining admitting privileges. Most hospitals have revised their bylaws following enactment of the "Health Care and Community Residence Facility, Hospice Facility, Hospice and Home Care Licensure Act of 1983" (DC Law 5-48). This was effective February 24, 1984. Admitting privileges are given to CNMs in the AHC and 1 private hospital. The issue of collaboration is essential to granting hospital practice privileges. Collaboration refers to consultation between the CNM and the physician, with no requirement for the physician to be on the premises. Responsibility must be defined. Nurse-midwives did not apply for hospital practice privileges at once, but everyone who has applied for hospital practice privileges has been accepted. Women's choice of CNMs has been limited by economic factors. These include: 1) educational requirements, 2) regulation, and 3) the CNM/obstetrician-gynecologist (OBGYN) relationship. DC physicians feel that CNMs are welcome to practice in the hospital, but that they must work under direct supervision of an OBGYN.