Certified Nurse Midwife

Answer 1

A Certified Nurse Midwife provides care to pregnant women under the supervision of a obstetrician or obstetrician-gynecologist. These nurses undergo in depth training that covers all aspect of prenatal care as well as labor, delivery and postpartum care. Much like a Licensed Practical Nurse, a Certified Nurse Midwife can prescribe medication and evaluate lab results. Most Certified Nurse Midwives work in a professional practice or hospital setting. However, some will also work in birthing centers or as lay midwives where they provide services in the patient’s home.

Certified Nurse Midwifes are in high demand due to the personalized care they provide. Midwivery is an ancient tradition that involves more than just the medical practice of delivering infants. A midwife is also expected to perform moral and emotional support during the labor and delivery process that is not commonly found with doctors. Because of this more natural approach to child bearing, many women who prefer an unmedicated birth turn to the Certified Nurse Midwife in the practice for assisting them during labor and delivery. Certified Nurse Midwives are not just for the mother attempting an unmedicated child birth, however most midwives will turn to the doctor if the need for serious intervention, such as a cesarean section delivery, should arise.

Certified Nurse Midwives must obtain a Master’s level degree, and most of the accredited universities that offer a nurse midwivery program require the student be a licensed Registered Nurse for admission consideration. The master’s program requires intensive study on care of a pregnant patient, as well as hands on clinical sessions in a hospital maternity ward. After completing the master’s degree program, midwives must pass a certification exam to obtain the title of Certified Nurse Midwife. To maintain this certification, ongoing continuing education requirements must be met.

The average Certified Nurse Midwife is employed by an Obstetrics and Gynecology practice where they handle routine pregnancy exams. The majority of states do not permit a Certified Nurse Midwife to deliver infants outside of a hospital setting. Some more populated areas will have Certified Nurse Midwives that work directly for the hospital instead of a private practice that has hospital practice rights. The American College of Midwives reported that the median salary for certified nurse-midwives in its 2007 survey was $79,093 to $89,916.

Answer 2

Alternative Names

Nurse midwife; CNM

Information

HISTORY OF THE PROFESSION

Nurse-midwifery dates back to 1925 in the United States. At that time, Mary Breckenridge developed the Frontier Nursing Service in Kentucky. The program used public health registered nurses, who had been educated in England, to staff nursing centers in the Appalachian mountains. The centers offered family health care services, as well as childbearing and delivery care, to residents in the area.

The first nurse-midwifery education program in the U.S. began in 1932 at the Maternity Center Association of New York City. The program enrolled public health nurses, and awarded its graduates a certificate in nurse-midwifery.

Today, all nurse-midwifery programs are in colleges and universities. Most nurse-midwives graduate at the Master's degree level. These programs must be accredited by the American College of Nurse-Midwives (ACNM) in order for graduates to take the National Certification Examination.

There are almost 40 ACNM accredited nurse-midwifery programs in the U.S. Applicants for nurse-midwife programs usually must be registered nurses and have at least 1-2 years of nursing experience. As with the nursing profession in general, most certified nurse-midwives (CNMs) are women. However, in recent years more male nurses have chosen to become nurse-midwives.

Nurse-midwives have improved primary health care services for women in rural and inner-city areas. The National Institute of Medicine has recommended that nurse-midwives be given more responsibility for delivering women's health care.

Many studies over the past 20 - 30 years have shown that nurse-midwives can manage most perinatal (including prenatal, delivery, and postpartum) care, and most of the family planning and gynecological needs of women of all ages.

Nurse-midwives work together with OB/GYN doctors. They either consult with or refer to other health care providers in cases that are outside of their experience (for example, high-risk pregnancies and pregnant women who also have a chronic disease).

See also: Types of health care providers

SCOPE OF PRACTICE

The nurse-midwife is educated and trained to provide a broad range of health care services for women and newborns. CNM functions include diagnosis (taking a medical hystory, doing a physical assessment, ordering laboratory tests and procedures), managing therapy (outlining care, providing prescriptions, coordinating consultations and referrals), and activities that promote women's health and reduce health risks.

Although most of the CNM practice focuses on childbearing, family planning, and gynecological care for well women, CNMs may also check and manage common illnesses in adults. All services are done together with the patient.

As with the nurse practitioner profession (NP), CNMs are legally allowed to write prescriptions in some states but not in others. CNMs provide independent health care management, consultation or co-management, and referral services.

PRACTICE SETTINGS

Certified nurse-midwives work in a variety of settings, including private practices (either by themselves or together with a physician), health maintenance organizations (HMOs), hospitals, health departments, and birthing centers. CNMs often provide care to underserved populations in rural areas or inner-city settings.

REGULATION OF THE PROFESSION

As with many other professions, certified nurse-midwives are regulated at 2 different levels. Licensing occurs at the state level and falls under specific state laws. As with other advanced practice nurses (such as nurse practitioners), license requirements for CNMs can vary from state to state. The current trend is to require a master's degree and national certification.

Certification is done through a national organization and all states have the same requirements for professional practice standards. Only graduates of nurse-midwifery programs accredited by the American College of Nurse-Midwives (ACNM) are eligible to take the certification exam given by the ACNM Certification Council, Inc.

References

ACNM Position Statement - Midwifery Certification in the United States. American College of Nurse-Midwives. March 2009. Accessed July 16, 2009.

Johnson TRB, Gregory KD, Niebyl JR. Preconception and prenatal care: Part of the continuum. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 5.

Avery MD, Howe C. The DNP and Entry Into Midwifery Practice: An Analysis. J Midwifery Womens Health. 2007;52:14-22.