Nurse midwife; CNM
HISTORY OF THE PROFESSION
Nurse-midwifery dates back to 1925 in the United States. The first program used public health registered nurses who had been educated in England. These nurses provided family health services, as well as childbearing and delivery care, at nursing centers in the Appalachian mountains. The first nurse-midwifery education program in the United States began in 1932.
Today, all nurse-midwifery programs are at 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. Applicants for nurse-midwife programs usually must be registered nurses and have at least 1 to 2 years of nursing experience.
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 a larger role in delivering women's health care.
Many studies over the past 20 to 30 years have shown that nurse-midwives can manage most perinatal (including prenatal, delivery, and postpartum) care. They are also qualified to deliver most family planning and gynecological needs of women of all ages. Some may check and manage common adult illnesses, as well.
Nurse-midwives work with OB/GYN doctors. They either consult with or refer to other health care providers in cases beyond their experience. These cases may include high-risk pregnancies and care for pregnant women who also have a chronic illness.
SCOPE OF PRACTICE
The nurse-midwife is educated and trained to provide a broad range of health care services for women and newborns. Certified nurse-midwife (CNM) functions include:
- Taking a medical history, and doing a physical exam
- Ordering laboratory tests and procedures
- Managing therapy
- Conducting activities that promote women's health and reduce health risks
CNMs are legally allowed to write prescriptions in some states, but not in others.
CNMs work in a variety of settings. These may include private practices, 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
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, license requirements for CNMs can vary from state to state.
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 ACNM are eligible to take the certification exam given by the ACNM Certification Council, Inc.
American College of Nurse-Midwives. ACNM Position Statement. Midwifery/Nurse-Midwifery education and certification in the United States. www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000077/Certified-Midwifery-and-Nurse-Midwifery-Education-and-Certification-MAR2016.pdf. Updated March 2016. Accessed July19, 2019.
Thorp JM, Laughon SK. Clinical aspects of normal and abnormal labor. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 43.
Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.