Nurse-midwifery represents an interesting amalgam of old and new. There was a time when nearly all babies were born into the hands of a midwife, and then a period of time when the rise of obstetrics nearly drove out the practice. Today, midwifery has not only regained its footing, but it has also made its way into mainstream society as a trusted, organized and regulated profession.
Certified nurse-midwives effectively merge the midwifery and medical models by drawing from the ancient art of midwifery, while remaining firmly planted in the contemporary evidence-based practice of maternity care. In fact, many view nurse-midwifery as embracing the best of both worlds: the organized structure of medical care and the community-based, individualized care of midwifery.
Midwife vs Nurse-Midwife: Similar Professional Titles, Vastly Different Scope of Practice
The direct-entry midwife—an umbrella title that includes doulas, midwives, certified midwives (CMs), and certified professional midwives (CPMs)—describes a midwife without training in nursing.
Certified nurse midwives (CNMs), on the other hand, serve as licensed, independent healthcare providers with advanced practice nursing training and credentials. They enjoy a broad scope of practice, state recognition, and prescriptive authority.
All 50 states and U.S. jurisdictions recognize CNMs and authorize them to possess prescriptive privileges. Further, Medicaid reimbursement for CNM care is mandatory in all 50 states, and the majority of states mandate private insurance reimbursement for nurse-midwifery services.
These advanced practice nurses are trusted and recognized members of the healthcare team, most often providing their services in hospital obstetrics and gynecology departments.
According to the American College of Nurse-Midwives, there were 11,018 CNMs licensed to practice in the U.S. as of February 2015, compared with just 88 CMs. The vast majority of midwives in the United States are CNMs.
To become a nurse-midwife in the U.S., registered nurses must:
- Earn a master’s degree or other graduate-level degree in nurse-midwifery accredited by the Accreditation Commission for Midwifery Education (ACME)
- Take and pass the Certified Nurse-Midwife (CNM) examination through the American Midwifery Certification Board
- Apply for state licensure as a CNM through the appropriate state board of nursing
The Value of Nurse-Midwifery
Nurse-midwives have long been advocates for changes in the hospital setting, supporting such notions as partners and family members in the delivery room, the combined labor-delivery-recovery room, and early breastfeeding.
According to Amnesty International, the U.S. maternal healthcare system in the U.S. is in a state of crisis. The rates of cesareans, cost of delivery, infant mortality, and maternal mortality in the United States continue to outpace other developed nations.
As supporters of the normal birth process who advocate for the minimization of unnecessary medical interventions, CNMs play an important role in improving maternal health, and may very well be key to reversing these troubling trends.
In fact, the American College of Nurse-Midwives (ACNM) has reported that decades of research comparing nurse-midwifery care to physician care revealed so very interesting and telling findings. When compared to women of the same risk status, women under the care of CNMs statistically faired better than those under the care of physicians:
- Lower rates of labor induction and augmentation
- Lower rates of cesarean births
- Reductions in the incidences of third- and fourth-degree perineal tears
- Lower use of regional anesthesia
- Higher rates of breastfeeding
Similar studies found that patients of CNMs are more likely than patients of physicians to:
- Receive prenatal education focusing on health promotion risk reduction behaviors
- Enjoy a more hands-on approach and a closer, more supporting relationship with their provider during labor and birth
- Receive fewer technological and invasive interventions
The Nurse-Midwife’s Scope of Practice
CNMs in the U.S. work in a broad array of settings, including:
- Hospitals/health systems
- Private OB/GYN practices
- Community health clinics
- Women’s health clinics
- Birth centers
- Private midwifery practices
- Home births
According to the American College of Nurse-Midwives, nurse-midwifery encompasses a full range of primary health care services for women, from adolescence through and beyond menopause. CNMs are licensed to provide the following services:
- Primary care
- Gynecologic care
- Family planning services
- Preconception care
- Care during pregnancy
- Care during childbirth and the postpartum period
- Care of the normal newborn during the first 28 days of life
- Treatment of male partners for sexually transmitted diseases
It is therefore commonplace for the responsibilities and duties of CNMs to include:
- Diagnosing, monitoring and examining women during pregnancy
- Developing and evaluating individual programs of care
- Providing full antepartum care, including screening and laboratory tests in the hospital, community, and home
- Monitoring maternal and fetal health throughout the pregnancy
- Referring high-risk patients to doctors and other medical specialists
- Providing parenting and health education
- Offering support and advice following such events as termination, stillbirth, miscarriage, neonatal death, and neonatal abnormality
- Supervising and assisting mothers in labor, including monitoring the condition of the fetus
- Providing postpartum care
- Providing support and advice regarding the daily care of the baby
- Providing breastfeeding support
- Referring patients to other health and social care professionals to ensure continuity of care
- Providing routine gynecological care
- Performing annual examinations
- Prescribing medications (including birth control) and ordering tests
- Providing counseling and family planning services
- Providing counseling and care for menopausal women
- Referring patients to physicians when faced with more significant health problems
Key Organizations Involved in Education, Credentialing and Advocacy
- The American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives and certified midwives in the United States. The ACNM sets the standard for excellence in midwifery education and practice in the U.S.
- The American Midwifery Certification Board is the national certifying body for certified nurse-midwives and certified midwives
- The Midwives Alliance of North America is a professional membership organization that promotes excellence in midwifery and endorses diversity in educational backgrounds and practice styles.
- Citizens for Midwifery is the only national consumer-based group that promotes the Midwives Model of Care.