Practice profile of members of the American College of Nurse-Midwives. Findings of a direct mail survey.

The scope of practice of today's nurse-midwife is much broader than that of the stereotypical "someone who specializes in delivering babies." Today's nurse-midwife sees approximately 140 clients each month and is involved with providing care to the "total" client. This encompasses not only care related to pregnancy, but also well-woman gynecology, nutrition, mental wellness, and primary care. Although the majority of clients seen by CNMs are in their childbearing years, the practice of nurse-midwifery encompasses postmenopausal women as well. When comparing the results of this survey to responses to similar questions posed 3 years earlier, practice size, number of births attended per month, years in practice, and types of conditions treated were answered in a similar fashion. Although the percentage of CNMs reporting pregnancy care activities remains virtually unchanged, a trend toward an increasing CNM role in well-woman gynecology and primary care is seen. About 5% more CNMs now state that well-woman gynecology and primary care are part of their monthly practice than did in the earlier survey. The biggest change in the greater number of CNMs reporting prescribing autonomy and authority over the 3-year period. In the earlier survey, 51% of the polled CNMs reported full prescribing authority versus 84% who report full prescribing autonomy and authority in 1996. The prescriptions CNMs write each week reflect the diversity in their practice, ranging from those for antibiotics and antifungal agents to those for calcium supplements, antidepressants, and tranquilizers. For 19 of the 36 categories of pharmaceuticals included on the survey, at least half of all CNMs report having the opportunity to prescribe or order products during a "typical" week. In total, for these 36 categories, an average of 94 prescriptions/orders are written each week.