"Great news," a friend told me. "My obstetrician has hired a nurse-midwife. It's the first practice in my city to hire a nurse-midwife." While this is a wonderful improvement and a step in the right direction. Beware, this is a baby-step.

The good news is that the midwife is there for some women and that for well woman care, prenatal and postnatal, planned visits, patients will most likely have free-choice in scheduling appointments with the midwife. The midwife may also have a positive impact on how the physicians practice medicine. The opportunities for both physician and patient education are wonderful.

Here is the catch. If you are planning to birth with a group like this, be sure to inquire about maternity care coverage. Some hospitals refuse to grant nurse-midwives hospital privileges, and thus the midwives are barred from providing birthing care. Also in situations like this, even if the midwife attends births, you are likely to have the group provider on call when it is time to birth your baby. Unless the practice is small, one midwife can not possibly cover call for all of her patients. Because of this, it is very important to inquire about the birthing philosophies of the rest of the practice. Just because the doctors in the practice hire a midwife, it does not mean that they embrace the midwifery model of care. They may not even have trust in the ability of women to birth naturally. To many physicians, "natural birth" is equivalent to "vaginal birth" regardless of the number of drugs and interventions employed in the birth. Another big disadvantage is that the midwife does not have access to another midwife in the practice for consultation.

Because, of strong consumer advocacy, physicians are catching-on that hiring a midwife has marketing value. This is often the motivation behind the hire of a single nurse-midwife. Additionally hiring a midwife is a method of cost-reduction to the practice. Having a nurse-midwife cover a portion of the call pool is an economic advantage to the practice.

Maternity practices, consisting of a group of midwives with or without a physician, are a better option for consumers in search of the midwifery model of care for child birth. This structure more accurately reflects consumer need for midwifery care and for obstetrical back-up. Nurse-midwifery practices are required to have a formal back-up arrangement with a physician. The doctor needs to be accessible to the group but does not necessarily need to be in same practice as the midwives.