Women's Health

Connecticut midwife practices vary greatly in compensation and employment structures

The practice of certified nurse-midwives (CNMs) and certified midwives (CMs) varies in different locales and different health care systems. A 2005 survey revealed data about midwifery practices and compensation in Connecticut. Across the State, there appeared to be variations in practice freedoms and styles, income, benefits structure, job descriptions, and requirements for full-time work.

Full-time midwives in Connecticut worked an average of 77 hours per week and had a mean salary of $79,554, and 87 percent had on-call responsibilities. A "typical" Connecticut midwife had an average full-time work week consisting of two 24-hour call days and three 7-hour office days. These midwives saw 19 to 24 patients per office day, spent 1 hour educating professionals, had slightly more than 3 hours of administrative tasks, and did less than 1 hour of research.

Most CNMs had a Master of Science degree in nursing, worked in physician-owned practices, and attended births in hospitals or medical centers. Health insurance, paid sick time, and retirement plans were offered to most of them. Although nearly all CNMs provided gynecologic, antepartum, and postpartum care, few offered newborn care. There was significant variation in restrictions on midwives offering vaginal birth after cesarean and on length of scheduled appointments.

Of the 102 CNMs surveyed, 75 percent provided gynecology (GYN) care, antepartum (AP), and interpartum (IP) care; 16 percent offered AP/IP care but not GYN; and 6 percent offered GYN care without AP or IP. Less than 5 percent of CNMs provided only AP or IP care.

Some midwives expanded their practice, with 53 percent performing endometrial biopsies, 43 percent repairing third-degree perineal lacerations, and 21 percent acting as surgical assistant at cesarean births. Also, 20 percent of CNMs performed ultrasounds and 17 percent used vacuum extractors for mechanically assisted vaginal births. Only 6 percent performed external cephalic version (turning the fetal head to the down position) to correct breech presentation.

The study was supported by in part by the Agency for Healthcare Research and Quality (T32 HS00044).

See "Survey of Connecticut nurse-midwives," by Margaret L. Holland, M.S., and Eliza S. Holland, C.N.M., M.S.N., in the March/April 2007 Journal of Midwifery & Women's Health 52(2), pp. 106-115.

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