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for social rather than medical reasons—i.e., in terms of their age, education, ethnicity, marital status, inner-city and rural residence and ability to pay for services.3 This patient profile suggests that midwives are primarily being used to fill health care gaps among the economically disadvantaged. New Medicaid reimbursement regulations could be partially responsible for this relationship,4 since Medicaid now reimburses for midwife services in all states.5 Besides the increased use of midwives among poor women, educated, middleclass women now appear to be using midwives more often than they did in the past.6 These women are probably selecting midwives for philosophical rather than economic reasons. Their philosophy stems from the women’s health movement of the 1970s, which emphasized reproductive freedom and the avoidance of excessive medical intervention.7 Such a “middle-class model” of childbirth is strongly linked to the mother’s level of education.8 To further study socioeconomic differences associated with use of midwives, this article uses source of payment and education as proxies for the mother’s socioeconomic status. The hypothesis is that women of low socioeconomic status (i.e., who pay for services using Medicaid) are more likely than higher-income women (i.e., who pay with private insurance) to Economic and Personal Factors Affecting Women’s Use of Nurse-Midwives in Michigan