Nurse-Midwives on the Front Lines: Serving the Rural and Medically Underserved

Background: Access to affordable, quality healthcare is a problem across the globe - especially for those in rural and medically underserved areas. Midwives have the potential to fill a significant void in access to quality maternal care providers. Objective: The purpose of this study was to examine differences in the scope and nature of nurse-midwifery care when working in rural or medically underserved areas, thus providing insight into needed changes in education, practice and health policy. Design: This research used secondary data derived from a larger prospective descriptive workforce study of practicing nurse-midwives. Setting: Participants practicing as a nurse-midwife in one western state in the United States were recruited through the national certifying body, the American Midwifery Certification Board. Participants: All certified nurse-midwives (N=328) practicing in one large state in the United States were eligible to participate. The response rate was 32% (n=104) with 20% (n=21) of respondents working in rural or medically underserved areas of the State. Methods: A previously developed midwifery workforce survey was adapted for use. Following revision, the online survey was distributed and accessible for 3 weeks in 2014. RED CapTM was utilized for data management. Results: Nurse-midwives working in non-medically underserved areas had significantly more collaborative practice guidelines, formal obstetrician/gynecologist and maternal foetal medicine consulting relationships, and in-house collaborating physicians. Nurse-midwives in rural or medically underserved areas primarily worked for community health centres or large safety-net medical facilities. Conclusions: Healthcare systems are challenged to fully utilize nurse-midwives, eliminating practices that restrict them from working to their full-scope and excluding midwives from holding full medical staff membership. Strategies promoting long-term placement in rural and underserved areas also are needed.