In Virginia, nurse-midwives have not won full privileges to practice at hospitals, except at Portsmouth Naval Hospital in Portsmouth.
Eleanor Smith, executive secretary of the Virginia Board of Nursing, said a joint committee of the state nursing and medical boards has set certain guidelines for nurse-midwives but has not addressed the issue of hospital privileges for nurse-midwives. Smith noted, however, that it is the prerogative of each hospital to decide who will be offered privileges.
Smith added that the joint committee has formulated a general policy that "all types of nurse practitioners be required to work under the direction and supervision of physicians . . . . But that doesn't necessarily mean the physician has to be right there at your shoulder."
In Northern Virginia, only one hospital reported any requests from nurse-midwives for hospital privileges.
Alexandria Hospital, according to a spokesman there, recently has received such requests from nurse-midwives. The requests are being reviewed, the spokesman said, although no action is expected until the issue of physician supervision is decided.
At Arlington Hospital, Dr. Simon Solano, chairman of the Obstetrics and Gynecology Department, favors extending privileges to nurse-midwives, according to a spokeswoman for Solano, and wants to study the experiences of other hospitals that have done so.
The spokeswoman said Solano believes midwife-attended births provide an alternative for pregnant patients. Hospital deliveries by patients who prefer a midwife also would reduce what Solano considers the higher risks of home births, according to the spokeswoman.
At Fairfax Hospital and the University of Virginia Hospital, spokesmen said there have been no requests for privileges from nurse-midwives so the issue is not under review.
At Fauquier Hospital, nurse-midwife Gloria Buck has "limited privileges" to deliver patients participating in a low-income maternity clinic program, according to Rodger Baker, the hospital's assistant administator. Buck handles normal pregnancies and has a physician available in the event complications arise, Baker said.
In the District, two of the three major teaching hospitals allow midwife-assisted births, both under the supervision of physicians.
Georgetown University, which offers a master's program for nurse-midwives, allows deliveries by midwives with the supervision of physicians as part of a city-sponsored health care program for pregnant teen-agers. In addition, midwife students at Georgetown get clinical experience, under the supervision of faculty members and consulting physicians, at D.C. General and several out-of-town hospitals, according to Judy Melson, assistant director of the program.
While George Washington University does not have a midwife training program, the hospital allows midwife-assisted births under the supervision of the patient's physician, a hospital spokeswoman said.
Howard University Hospital does not allow midwife-assisted births.
At the Portsmouth Naval Hospital, nurse-midwives may deliver under the supervision of a physician who is always available, but not necessarily present, Lt. Cmdr. Stephani Allen, head nurse, said.