Health care reform as an ongoing process.

Reform in maternal and infant health care is presented as an ongoing process. Three phases of reform occurring during the past 4 decades that have been initiated or involved nurses are discussed: the childbirth education movement, which signalled the beginning efforts of parents to regain responsibility and control of their birth experience; the acceptance of nurse-midwives as primary care providers working in concert with obstetrical specialists; and the free-standing birth center as a holistic environment for the practice of midwifery and the care of women anticipating a medically uncomplicated childbirth experience. These reforms represent a paradigm shift that fits all current proposals for reform of the health care system.