THE IMAGE OF nurse-midwifery forms a barrier to utilization that is just as, if not more, formidable as laws restricting practice. In this paper, the issue of image for its impact on the practice of nurse-midwifery is analyzed. Historical, technological, consumer-oriented, and nursing-oriented factors that have affected midwifery's image and the profession's current status are explored. Recommendations to clarify the role and image, including political involvement, networking strategies, and research, are discussed. Although nurse-midwives, who emphasize cost-effective, quality, primary care, should be in the forefront of health care delivery, they are still widely misperceived, underutilized, and unrecognized as mainstream health care providers. In this era of health care reform, it is essential that the role and image of the nurse-midwife be clearly defined to the general public, maternity care consumer, fellow health care providers, and legislators.