recognition that any theory is a temporary, working draftof an idea about the world, exploration of new possibil-ities and different perspectives are encouraged.”

In my view, we must use our rich history, research,and current practices as a basis for a dialogue directed atexplicitly defining the domain of midwifery. This willresult in the emergence of new possibilities and perspec-tives that can assist in the solution of some of thepersistent problems facing the profession of midwifery.This is not work for physicians, anthropologists, or theleadership of nursing, but for midwives, who have em-bodied knowledge of midwifery’s art and science andwho must live with the consequences of concepts com-municated about our profession.

Leslie Cragin, CNM, MS

Palo Alto, California

REFERENCE

1. Visintainer M. The nature of knowledge and theory in nursing.Image 1986;18:32–8.

EDITOR:After reading Germano and Bernstein’s article, “HomeBirth and Short-Stay Delivery,” which appeared in theNovember/December 1997 (Vol. 42, No. 6) issue of theJournal of Nurse-Midwifery, I can appreciate the func-tion of midwives in the current health care system—promoting women’s health care issues and analyzing theeconomic influences on health care delivery. Germanoand Bernstein note that the heirarchy of professionals inwomen’s health have boundaries that come with finan-cial constraints that, in turn, question whether today’swomen should be able to choose their birth sites.

I applaud the authors’ stand on allowing women theright to choose where to have their babies. Germano andBernstein analyze and reinforce the role that financialfactors have on health care delivery changes in terms of:1) the increasing power of the medical profession, 2) thedesire of women to have pain-free childbirth, and 3) theperception of increased safety associated with hospital-based technology. I agree with the authors’ statementsregarding the movement of women’s health care andhow it has progressed through several stages influencedby economic restructuring, changing family needs, andthe expansion of health care programs across the UnitedStates.

The responsibility of the primary care giver is toprovide quality care. This article gained its momentumfocusing on economic factors, women’s health careissues, and the responsibility of the professional primarycare giver to understand the factors driving the healthcare systems. Why not raise a few more questions to thereader such as those that follow? Are we seeing a trendin homebirths now because they are better than before?

Are midwives gaining more power to motivate popularadvocacy movements to offer women the choice of birthsite and change the structure of reimbursement? Theproblem is clear that the economic system and healthcare system are linked together to succeed in deliveringhealth care at minimal cost. As a student working on amasters degree in nursing, and as a nurse practitioner,and as a primary health care provider of the future, I feelthat identifying the issues and becoming proactive in themovement is an essential strategy . . . great to say,tough to apply, and part of our everyday life.

Theresa Galakatos, BSN, MSW

St. Louis, Missouri

EDITOR:Congratulations on the March/April issue of the Journalof Nurse-Midwifery (Vol. 43, No. 2, 1998)! I wasgratified to see how this issue followed as a naturalextension to Part 3 of the Primary Care for WomenHome Study Series (Vol. 42, No. 6, November/Decem-ber 1997), for which I served as guest editor and whichfocused on the public health and population-based per-spectives of women’s primary care. Just one day prior tothe arrival of the issue, our department held its researchretreat, wherein my colleagues (including faculty mem-bers who are not midwives) and I continued our devel-opment of a women’s and perinatal research agendathat can both contribute to and be enhanced by the factthat a majority of our department faculty are midwives.Imagine my surprise when I discovered that the contentsof the issue were entirely in line with what we haddiscussed the day before—everything from large mid-wifery database collaborations, urban/rural compari-sons, and technology assessment, to bacterial vaginosis,an increasingly important factor in preterm labor. Again,it is particularly gratifying as a midwife not only to seesuch a wide range of maternal and child health coverage,but also to note the range of professionals who arepublishing in and reading the Journal. Perhaps the timehas come that the world is finally listening to midwives,and thereby, listening to women!

Lisa Paine, CNM, DrPH, FACNM

Associate Professor and ChairDepartment of Maternal and Child HealthBoston University School of Public Health

EDITORI would like to applaud Laura Zeidenstein for her incred-ibly well-done editorial on Birth Language (JNM March/April 1998). I was most attentive to my use of birthlanguage when I planned my own homebirths and beganattending births at home in the late 1970s. To gainrespect as a new CNM, however, I was guilty of usingone set of words for women and midwives and another

Journal of Nurse-Midwifery • Vol. 43, No. 4, July/August 1998 311