A nurse midwife is a midwife who enters midwifery after first completing a full nursing program. All nurse midwives have their baccalaureates, and the great majority have Master's degrees as well. Contrast with direct-entry midwife, who enters midwifery directly, without nurse's training. Nurse midwives deliver perhaps ten percent of the births in the United States, and a roughly proportionate number in most other Westernized countries. Most operate only out of hospitals, as they are prevented by malpractice insurance rules and other concerns from performing home deliveries, though many would prefer to have the option of also working outside the hospital.
American nurse midwifery originated in the 1920s as a service for poor families in rural areas with little access to physicians. With passing time, they gradually shifted their focus to the inner city, which were becoming the locus of much of the poverty and poor medical care in America. At first nurse midwives were considered marginal members of the medical community, which considered delivering babies to be the exclusive domain of obstetricians, but with years of lobbying and shifting cultural mores, they have gradually been accepted as full partners in the enterprise of medicine. With this acceptance, however, came limitations; requirements that nurse midwives practice under the supervision of an obstetrician and meet restrictive insurance requirements prevent them from having the freedom in their practices that many would prefer.
The relationship between nurse midwives and direct-entry midwives has been generally stormy. Nurse-midwives feel that their direct-entry counterparts undermine the years of work they have done to have midwifery perceived as a fully legitimate and scientific enterprise, and are suspicious of their lack of formal college-level training. Direct-entry midwives, for their part, criticize nurse-entry midwives as having abandoned the values which make midwifery distinct from obstetric practice, and fear and resent the efforts which some nurse midwives have made to make the practice of midwifery without nurse's training illegal.