EDITORIALSurvival - Through Consumer

Demand?

Few nurse -midwives could dis­agree with the premise that creatingconsumer demand should be a pri­ority goal of the ACNM - but how toaccomplish this task is the question.Consumer demand is based on con­sumer awareness of alternatives - it­self based on the CNM's visibility andaccessibility. One nurse-midwiferyservice quietly delivering a few babiesis neither highly visible nor widelyaccessible.

In most regions of the UnitedStates, advertising the services ofhealth professionals is not yet legal;however, its legalization could prob­ably save our profession! How ofteneach of us has heard: "Midwives. . .but, they don't exist anymore!" Wemay feel reluctant to go out and sellourselves or openly advertise; yet thismay be what is needed for our sur­vival.

Not only is the public unaware ofour role and function; they oftendon't even know that we exist! Howcan we sit back and expect that theconsumer will save us.. .that theymust demand our services? How canthey, when they're unaware of ourunique services? Consumer demandgrows over a period of many -years;and it grows very slowly when it isnot fertilized by frequent exposure tothe product in demand. Consumersmust become aware of alternativeproducts in order to make a choice.

A Multi·Faceted Campaign:Creating the Awareness

One way to increase the public'sawareness of nurse-midwifery is via amulti-faceted public relations earn­paign. Each facet should be focused

on a different target aud ience: physi­cians, consumers, prospectiveCNM's, nursing leaders, governmentofficials {at all levels}, and publichealth and hospital administrators.

Each part of the campaign mustdeal with the concerns of its audi­ence. For instance, the medical estab­lishment may be most interested inhaving CNM's where there are few orno doctors, such as in rural or inner­city clinics; many doctors are especi­ally concerned about ensuring medi­cally safe care . Consumers may bemore interested in the CNM's family­centered, non-interventionist atti­tudes - their willingness to listen topatients' concerns, to be flexible re­garding routine procedures and toallow patients to plan for and partici­pate in their birth experience. Pros­pective CNM's are concerned aboutthe expanded nursing role, the free­dom to use their own judgement,perhaps in out-of-hospital settings, orthe unique opportunity to offer theirclients continuity of care. We mustalso stop to consider why manyexcellent nurses are choosing to be­come Ob/Gyn Nurse-Practitioners,rather than nurse-midwives.

Public health and hospital admini­strators want to hear about cost-ef­fectiveness, quality of care or con­sumer attractiveness. Governmentofficials are concerned about lower­ing costs of health care by using pre­ventive medicine, shortening hospitalstays, paying specialists only whenthey are needed.

We cannot effectively reach ourpublic without classifying them into"publics" - and tailoring our effortsto their concerns. A single newspaperitem about how "nice" nurse-mid­wives are or about the novelty of

nurse-midwifery, will effectivelyreach only a small part of the publicwe must affect.

Consumers

Consumers are probably the easi­est to reach. Millions of housewiveswatch talk shows on television orlisten to them regularly on the radio .Childbirth is a popular subject forsuch programs, and nurse-midwivesshould appear on them frequently.Letters , press releases or phone callsdescribing a service or innovativepractice can bring requests for inter­views - sometimes months later ­when a program is planned aroundan appropriate topic.

Local newspapers are always inter­ested in stories for their women'ssections. Letters or press releases canbe addressed to the Women's Editor,Feature Editor, Health/Science Edi­tor, or any other writer who often dis­cusses women's health issues.

Women's magazines usually coverhealth issues in between the fictionand the clothing, and they are happyto receive letters suggesting possiblearticles.

Women's groups or clubs are oftenlooking for speakers; and nurse -mid­wives and their patients could effec­tively address such groups. Requestsfor nurse-midwives arrive frequentlyat ACNM headquarters from poten­tial employers as well as clients; thesepersons should be contacted andurged to more aggressively demandthe option of nurse-mldwilary care .

Most hospitals and universitieshave public relations departmentscapable of stimulating a great deal ofcoverage, if they're interested in

4 JOURNAL OF NURSE-MIDWIFERY. Vol. XXII, No. 3, Fa1l1~7

doing so . They have established con­tacts with the press; but they need usfor the interesting, exciting angleupon which to hang a nurse-mid­wifery story. Each nurse- midwiferyservice should work within its ownsetting to help increase general con­sumer awareness, utilizing estab ­lished channels as well as creatingnew channels of public relations.

Some states have recently enactedbills permitting various types of pro·fessionals to advertise, includingprices for certain services. Sjmilarlaws willperhaps be adopted in otherstates - but this will take time, nodoubt. Architects and accountantsmay be quicker to take advantage ofthis new freedom than will CNM's ­who seem to have the nurse-angel .martyr complex. Such legislationwould enable CNM's to expand theirindividual practices through advertis­ing in newspapers, magazines and"professional directories ."

Physicians and Adminstrators

The physician audience is muchmore difficult to reach. They are bestinfluenced by other physicians, fact­ual research or patient demand.Nurse-midwives in joint private prac­tice with obstetricians must write,study and publish. Physicians mustlose their fear of us. We must partlci­pate in some of their meetings,publish in their journals and practicewith them in the hospital as col­leagues.

Interorganizational activitiesshould receive top priority. It is onlyby working together, one MD gettingto know one CNM, that attitudesmay be changed. Nurse-midwivesmust be active in as many -organiza­tions as possible - from ASPO toNAACOG to regional public healthcouncils.

The A::NM annual conventionstimulates awareness among practic­ing nurses - perhaps the ACNMregions could sponsor continuingeducation workshops in their areasthroughout the year. These wouldreach MD's, obstetric and neonatalnurses and both nursing and medicalstudents.

In order to reach hospital andpublic health adrninstrators, we mustwrite and publish articles in the ap­propriate journals, speak at theirmeetings and participate in theirorganizations.

A major effort must be aimed atthe legislators in Washington, as wellas in the state capitals. They must be­come more aware of the advantageof nurse-midwifery, especially asother groups are spending millionson lobbying efforts to protect their"slice of the pie."

Supplying the Demand

Creating awareness and demandis all well and good; but we musthave the numbers to respond. Thereare so few of us! How can we enlargeor increase the number of ourschools, interest women in becomingnurses first and then nurse- midwives(despite the fact that it takes 4·7years) or attract more young nursesinto nurse-midwifery? And what shallwe do with the lay midwives? Theymay soon outnumber us. Help ingthem to become CNM's might be oneway to quickly enlarge our ownranks, as well as to create the divers­ity within nurse-midwifery that willrespond to all consumers' needs.

Nursing, medical and hospital ad­ministrators must be brought to un­derstand and accept the role of theCNM so that more services can beestablished. Many hospitals do notrealize that nurse-midwifery servicescould re-vitalize their shrinking ob­stetric units. Private physicians do notrealize what the addition of a nurse­midwife could do for their practices.There may develop a shortage ofobstetrical residents in the nearfuture. Nurse -midwives could takecare of many of those patients tradi­tionally relegated to the "non-pri­vate" maternity and family planningservices.

Of course there are obstacles to beovercome! A major one is the issueof third party reimbursement fornurse-midwives. We must becomeeligible for Medicaid reimbursement,and we must be included in the newnational health insurance bill -

whichever one is finally passed. If weview this as a major goal, we must actnow! Who in Washington knowsabout nurse-midwives as well asSenator Daniel Inouye? We have nolobbyists, as do the ANA and theAMA. The ANA is no doubt moreconcerned about its nurse-practition­ers than CNM's. After all, many of usdeny our practice is nursing. . .whyshould the ANA work for us? An­other obstacle is the image of the"granny" midwife, who still exists inreality in some areas - and as animage in the minds of many. It wouldtake many more articles on the"modern midwife" to overcome thisimage.

Getting The Job Done

There are many ways of organiz­ing a public relations campaign of themagnitude required to increase bothour supply and the demand for ourservices. Obviously priorities must beset! Funding is not unlimited - nor istime. The extremes range from hiringa public relations firm to letting oursmall volunteer committees handleall aspects of this plan. Perhaps apublic relations consultant could helpthe college define its top prioritygoals and work out a plan of attack.

Certainly, local chapters and re­gions could form their own commit­tees to try to follow this outline.Individual services can and muststimulate as much publicity as theycan, as should individual CNM's.Those who can write must do so.Liaison with interorganizationalgroups must be given higher priorityas well. Lobbyists can be hired, full orpart-time, or individual CNM's couldbe paid to perform this job - thoughthey would need training.

In view of the enormity of this joband the financial status of the Col­lege, the best plan would seem to beto increase the budget and member­ship of the public relations commit­tee, and permit them to hire a con­sultant. A part-time lobbyist must bemaintained in Washington - what­ever the cost - to get the job done.

Linda Baxter, CN.M., M.S.Associate Editor

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