Professional organization for Midwives:
Contributed by:
Leslie Ludka, MSN, CNM, and Lorrie Kline Kaplan, American College of Nurse-Midwives
Leslie Ludka, MSN, CNM, and Lorrie Kline Kaplan, American College of Nurse-Midwives
Who is a Certified Nurse-Midwife/Certified Midwife?
Certified Nurse-Midwives and Certified Midwives are primary health care providers who focus on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecologic needs of women. Certified Nurse-Midwives/Certified Midwives consult with, collaborate with, or refer to physicians as indicated by the health status of the patient.
Midwifery care is based upon a clearly defined philosophy, focused on prevention and education. Midwives view pregnancy and birth, menses, and menopause as normal physiologic processes rather than disease states. They are committed to providing compassionate, family-centered care that is culturally appropriate, respects the right to human dignity and self-determination, and encourages active participation in decision-making. Midwives incorporate scientific evidence into clinical practice. Although Midwives advocate for non-intervention in the absence of complications, technology and other interventions are used when indicated.
High quality midwifery practice is defined by the The American College of Nurse-Midwives’ Standards for the Practice of Midwifery and Core Competencies for Basic Midwifery Practice.
What does a Certified Nurse-Midwife/Certified Midwife do?
Certified Nurse-Midwives and Certified Midwives independently manage women’s health care. Their practice is different from that of a women’s health or obstetrics and gynecology (OB/GYN) nurse practitioner. In addition to the primary women’s health care that women’s health or OB/GYN nurse practitioners provide, Midwives have the ability to manage labor and delivery, write orders, and prescribe medications. Some Midwives have expanded their scope of practice to serve as first surgical assistant at cesarean sections, as well as perform circumcisions, colposcopy, ultrasonography, and other procedures. In addition to clinical practice, Midwives are members of university faculty in medical, nursing, and nurse midwifery education programs. They also work in public health fields.
Certified Nurse Midwives are less likely to use continuous fetal monitoring and epidural anesthesia. They are less likely to induce labor and perform fewer episiotomies. Women cared for by Midwives had 39% fewer cesarean sections than physician patients with no statistical difference in neonatal outcomes.(1)
The number of births attended by Nurse-Midwives has doubled since 1991. Midwives attend births in a variety of settings; 99% of births take place in a hospital and 1% in free-standing birthing centers or as planned home births.(2)
What education, training, and experience must one have to function as a Certified Nurse-Midwife or Certified Midwife?
A Certified Nurse-Midwife (CNM) has been educated in the two disciplines of nursing and midwifery; a Certified Midwife (CM) is not a nurse but has met the same standards for midwifery education and certification as the CNM. The certification of a CNM/CM is conferred through a national examination and verified by the American Midwifery Certification Board. To obtain certification, applicants must successfully complete a graduate program in midwifery from one of 40 schools of midwifery accredited by the The American College of Nurse-Midwives Division of Accreditation and pass a national certification examination. Beginning in 2010, entry into clinical practice will require completion of a master’s or doctoral degree.
How and by whom is a Certified Nurse-Midwife/Certified Midwife supervised?
Certified Nurse-Midwives and Certified Midwives practice independently and work collaboratively with physicians to provide the best possible health care to all women.
What are the typical day-to-day activities of a Certified Nurse-Midwife/Certified Midwife?
Certified Nurse-Midwives and Certified Midwives in clinical practice see patients during office hours; cover postpartum rounds; take call for labor and delivery; triage patients who come in for evaluation; and manage antepartum, intrapartum, and postpartum delivery of patients in their caseload. In addition, they often teach nurses, student nurses, residents, and midwifery students.
Must a Certified Nurse-Midwife/Certified Midwife be licensed or certified to function in his or her role as part of the health care team?
A Certified Nurse-Midwife/Certified Midwife must be certified nationally by the American Midwifery Certification Board and must be licensed by the state in which care is given. Certified Nurse-Midwives are licensed in all 50 states. Certified Midwives are licensed in three states: New Jersey, New York, and Rhode Island.
What types of patients would benefit from the care of a Certified Nurse-Midwife/Certified Midwife?
All females can benefit from the care of a Midwife.
How and when does a Certified Nurse-Midwife/Certified Midwife become involved in the care of a particular patient?
Patients self select midwifery care or may be referred by physicians or other health care providers.
(1) Rosenblatt RA, Dobie SA, Hart LG, Schneeweiss R, Gould D, Raine TR, et al. Interspecialty differences in the obstetric care of low-risk women. Am J Public Health 1997;87(3):344-351.
(2) Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S. Births: Final data for 2004. CDC National Vital Statistics Reports. 2006;55(1):1-101.
