In 1975, only one percent of all births were attended by midwives. Certified Nurse-Midwives attended close to five percent of hospital births. In the 21st century, more hospitals are offering birth with midwives, and expectant parents are choosing alternative settings such as their own home or birthing centers, and these numbers are expected to increase as the positive results of midwife-assisted births are recognized. Midwives offer care for pregnant women birthing at home, birth centers or in hospitals. In the hospital setting, where most Certified Nurse Midwives practice, they work in under the supervision of obstetricians.
Midwives also offer contraception, gynecological services and menopausal care to women.
Candidates may earn either a Master's or a Certificate. The Master's degree may be required for teaching or positions of greater responsibility. Most Certified Nurse Midwives work in hospital or clinical settings, some establish birth centers or home birth services. All work in consultation with obstetrician-gynecologists. This background in both discliplines of nursing and midwifery was vital when caring for the impoverished pregnant women and children of this region who had a plethora of health and social problems.