EDITOR I would like to thank Lily Hsia for her editorial, “Innovations in Nurse-Mid- wifery Education,” (JNM 34(2):63- 65, 1989), which among other things draws attention to the fact that there is an available source of experi- enced nurse-midwives who are trying to get back into the health care system, and have been prevented from doing so for a number of years.

Those of us who are foreign trained midwives, and others, who are American trained but have taken time out to attend to young families or other personal needs for a period of time, have been looking for a way to return to midwifery for some years.

Now, once again, the Frontier School of Midwifery and Family Nursing (FNS) is answering the needs of communities and has de- veloped a program for people such as myself. It is ideally suited to adult, self-motivated learners. It is stimu- lating, rigorous, personalized and nontraditional in its approach. I have every reason to believe that, when I graduate in May, I shall be as com- petent as the traditionally trained modem American midwife. In addi- tion, I bring to the profession added dimensions of experience in different fields and locations.

Nurse-midwifery in the United States is in desperate need of indi- viduals to promote the profession. There is too much to do and there are too few people to undertake it. I support and strongly encourage the ACNM to take notice of Ms. Hsia’s viewpoint. The development of pro- grams like the current one at the

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FNS will bring back into the work- force those of us who are ready, able and willing to return.

Rosalind Woodward Student at current FNS Precertifica- tion Course

EDITOR Ms. Hsia’s editorial, “Innovations in Nurse-Midwifery Education” (JNM 34(2):63-65, 1989) comes at a great time. The Community-Based Nurse-Midwifery Educational Pro- gram (CNEP) Council is preparing to accept their first group of students. Ruth Lubic and Kitty Ernst will prob- ably be contacting you to point out the omission of FNS, Case Western, and other programs in the commu- nity-based model.

I’m quite happy as a PhD student and faculty member at Frances Payne Bolton School of Nursing. Under Dean Fitzpatrick’s leadership and within the very supportive “in- novative” maternity and community health majors I feel we really do em- ulate the quality, rigor, and adven- ture you speak of in the editorial. I have always been quite challenged by the Dean to try out my ideas at faculty sessions and with students.

Teaching clinical judgement will probably become one of the “new” research waves for nurse-midwives. I’m interested in the different models but do feel a concern that so much of our education has become “medi- caliied.” I am struck by a passage in Nancy Daammans Social History of Frontier Nursing Service, when the Family Nurse Practitioner Program started, a physician was quoted as

having said, “We were finally able to teach the nurses how to think.” I be- lieve truer words were never spoken. Perhaps the FNS Historical Research we’re conducting now will uncover some of these changes.

Nurses thought very well prior to 1950-60s changes at FNS. The im- proved mortality and morbidity figures support this. If only we had had the opportunity to conduct clin- ical-decision making research in the 1930-40s I would have been inter- ested in the results. Would it have been as linear as the nurse-mid- wifery management process or perhaps more fluid? I would support a bayesian probability model of deci- sion-making as more representative of the progress.

I hope the editorial cracks the ri- gidity and fear about innovation- perhaps our own Vatican II?

Erica Goodman Frances Payne Bolton School of Nursing, Case Western Reserve Uni- versity

EDITOR As CNMS, we get so little time just to “kibbitz” about clinical issues. It’s so interesting to share different experi- ences and viewpoints. The Journal of Nurse-Midwifery’s inclusion of dis- cussion on clinical practice issues is quite informative and I personally hope to see more of this kind of sharing. There’s so little black and white in most practice situations.

Christine Kuhlman ACNM Regional Representative Region 1

Journal of Nurse-Midwifery ??Vol. 34, No. 4, July/August 1989

Copyright 0 1989 by the American CoUege of Nurse-Midwives 0091-2182/89/$3.50