Who’s Your Midwife?
|June 19, 2012||Posted by myfr8796 under Pregnancy blogs|
Who’s Your Midwife? After a lengthy conversation today with a newly pregnant mother about what a midwife is, we recognized that we should step back and explore how women understand their maternity care options. We want to be sure that women understand midwives’ approach to maternity care, and the scope of knowledge and skills they bring to maternity care.
Although “Congratulations! You’re Pregnant!” provides a brief overview of different caregivers for women throughout pregnancy and birth, we want to explain more fully how the midwifery profession is defined, and what differentiates a midwife from other providers. The term Midwife literally means “with women”, or “woman who assists other women in childbirth.” Midwives have always assisted women in childbirth, long before there were doctors and hospitals. Nowadays, the term midwife includes a much broader scope of practice, in many different environments. But the heart of midwifery is to be ‘with women.’
This post will discuss the range of services midwives are authorized to provide, the different licensures and certifications U.S. midwives practice under and an overview of the professional organizations that represent each category of U.S. midwives. These include, American College of Nurse Midwives (ACNM), Midwives Alliance of North American (MANA) and North American Registry of Midwives (NARM).
American College of Nurse-Midwives (ACNM):
“The American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives and certified midwives in the United States. With roots dating to 1929, ACNM is the oldest women’s health care organization in the United States. ACNM provides research, administers and promotes continuing education programs, establishes clinical practice standards, and creates liaisons with state and federal agencies and members of Congress” (ACNM, 2012).
The link to ACNM, which provides an abundance of information on the education, certification and scope of practice for Certified Nurse Midwives (CNM) and Certified Midwives (CM) is: www.midwife.org. There is also a link provided on our site under frequently visited websites.
Midwives Alliance of North America (MANA):
”In 1982, the Midwives Alliance of North America (MANA) was established as a professional organization for all midwives, recognizing the diversity of educational backgrounds and practice styles within the profession. Its goal is to unify and strengthen the profession of midwifery, thereby improving the quality of health care for women, babies, and communities.
As a leader in midwifery, MANA has been at the forefront of developing midwifery credentialing and educational organizations. In particular, the North American Registry of Midwives oversees a competency-based certification process for midwives, granting the title of Certified Professional Midwife (CPM) to those passing rigorous written examinations and testing of clinical experience and skills” (MANA, 2012).
The link to MANA, which provides a wealth of information on midwifery practice as a whole, multiple definitions of different midwifery licensures, resources on where to find a midwife and detailed information on homebirth is: www.mana.org. This link is also provided on our site under frequently visited websites. Another wonderful resource and the most detailed on the Certified Professional Midwife (CPM) certification, education and scope of practice is: www.narm.org.
ACNM defines the Certified Nurse Midwife (CNM) and Certified Midwife (CM) scope of practice in this way:
“Midwifery as practiced by certified nurse-midwives (CNMs®) and certified midwives (CMs®) encompasses a full range of primary health care services for women from adolescence beyond menopause. These services include primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth and the postpartum period, care of the normal newborn during the first 28 days of life, and treatment of male partners for sexually transmitted infections. Midwives provide initial and ongoing comprehensive assessment, diagnosis and treatment. They conduct physical examinations; prescribe medications including controlled substances and contraceptive methods; admit, manage and discharge patients; order and interpret laboratory and diagnostic tests and order the use of medical devices.
Midwifery care also includes health promotion, disease prevention, and individualized wellness education and counseling. These services are provided in partnership with women and families in diverse settings such as ambulatory care clinics, private offices, community and public health systems, homes, hospitals and birth centers.
CNMs are educated in two disciplines: midwifery and nursing. They earn graduate degrees, complete a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass a national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM. CMs are educated in the discipline of midwifery. They earn graduate degrees, meet health and science education requirements, complete a midwifery education program accredited by ACME, and pass the same national certification examination as CNMs to receive the professional designation of CM.
CNMs and CMs must demonstrate that they meet the Core Competencies for Basic Midwifery Practice of the American College of Nurse-Midwives (ACNM) upon completion of their midwifery education programs and must practice in accordance with ACNM Standards for the Practice of Midwifery. ACNM competencies and standards are consistent with or exceed the global competencies and standards for the practice of midwifery as defined by the International Confederation of Midwives. To maintain the designation of CNM or CM, midwives must be recertified every 5 years through AMCB and must meet specific continuing education requirements” (ACNM, 2012).
Under these two licensures midwives are legal to practice in all 50 states amongst the various settings of hospital, birth center and home. CNMs and CMs are capable of normal vaginal birth, repair of vaginal tears, first assisting in cesarean sections and circumcision depending on the setting they are practicing in and the privileges obtained in that setting. You will find many CNMs in the hospital environment and clinic settings caring for women from the urban underserved populations.
Ruth Lubic, CNM is an excellent example of midwives serving underprivileged women. Her work has proven how the ‘Midwifery Model of Care’ saves money and lives through decreased deliveries by cesarean section and lowering rates of premature birth.
“ Ruth Watson Lubic (born 1927) is a nurse midwife and a MacArthur “genius” award winner who has championed personalized care during labor and childbirth for all women, particularly those in low-income neighborhoods. She co-founded the National Association of Childbearing Centers in 1983 and has helped establish more than 200 freestanding birth centers.
The MacArthur Foundation named Lubic a “genius” in 1993 and gave her $375,000 over five years to do whatever she wanted. She used the money to found the DC Developing Families Center in 2000, in one of the poorest neighborhoods of Washington, a city known for its high infant mortality rate. The developing families center includes a health and birth center, staffed with midwives and nurse practitioners. Lubic says that the center’s philosophy of “high-touch, low-tech” has resulted in a lower rate of C-sections and premature births than the city as a whole” (Wikipedia, 2012).
“My Friend the Midwife” recently had the privilege of meeting Ruth Lubic and speaking with her about her incredible work. We are hoping to be writing a blog about Ruth and her magnificent work in the near future.
The majority of CNMs and CMs work for the hospital or birth center that they are an employee of or the obstetrician through which they are employed by. There are others who practice independently as home birth midwives and a few who own their own birth centers or private practices. These midwives are privileged at a hospital and usually have the backing of an attending physician for high-risk consultations and/or emergent situations. The large majority of midwives practicing legally in the U.S. are licensed as CNMs.
The North American Registry of Midwives (NARM) defines the CPM scope of practice as being:
“A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.
Most CPMs own or work in private home or birth center based practices throughout the United States, Canada, and Mexico. Providing continuous care for women throughout their childbearing cycle, CPMs generally carry a relatively low client load (averaging 3-6 births per month) which allows for more personalized and comprehensive care than typical obstetrical practices. The scope of practice of the CPM is derived from the NARM Job Analysis, state laws and regulations, and individual practice guidelines developed by each midwife according to her skills and knowledge.
Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other healthcare providers when necessary. The key elements of this education, monitoring, and decision making process are based on Evidenced-Based Practice and Informed Consent” (NARM, 2012).
CPMs have legal recognition in 26 states, mostly on the West Coast and in the Midwest. As stated above they work mainly in the birth center and home birth settings. Many CPMs care for women in rural settings where care is scarce and very needed.
Ina May Gaskin, being probably the most widely known of midwives is a licensed CPM. She, along with many other midwives have made great strives toward bringing the midwifery model of care to the forefront in the U.S., with the goal of decreasing maternal and infant mortality rates.
“Gaskin has been credited with the emergence and popularization of direct-entry midwifery (i.e. not training as a nurse first) in the United States since the early 1970s. Between 1977 and 2000, she published the quarterly magazine Birth Gazette. Ina May’s Guide to Childbirth, her second book about birth and midwifery, was published by Bantam/Dell in 2003. Her books have been published in several languages, including German, Italian, Hungarian, Slovenian, Spanish, and Japanese.
Since the early 1980s, she has been an internationally-known speaker on maternity care independently and for the Midwives Alliance of North America (MANA), lecturing throughout the world to midwives, physicians, doulas, expectant parents and health policy-makers. She has spoken at medical and midwifery schools in several countries and at both the Starwood Festival and the WinterStar Symposium, discussing the history and importance of midwifery.
She is the founder of the Safe Motherhood Quilt Project, a national effort developed to draw public attention to the current maternal death rates, and to honor those women who have died of pregnancy-related causes during the past twenty years. She has appeared in such prominent films as Ricki Lake’s movies
Orgasmic Birth (2009) (directed by Debra Pascali-Bonaro) and The Business of Being Born (2008) (directed by Abby Epstein). She also appears in With Women: A Documentary About Women, Midwives and Birth (2006).” (Wikipedia, 2012).
“My Friend the Midwife” has many wonderful books written by Ina May through our website via the “On Our Bookshelf” tab.
In Conclusion, midwives play a significant role in women’s health and birth. This role extends as far back as anyone can remember and remains highly valued by many groups of women. In some cases midwives differ in philosophy and points of view, but “My Friend the Midwife” believes that ALL midwives are exemplary in their efforts to provide women and their babies with the best care possible.
In all settings the Midwifery Model of Care is practiced with the strong underlying belief in the normalcy and reliability of birth and women’s health. Midwives provide care with as little intervention as possible, relying on ‘best practice’ and the safest most effective care possible, sharing decision-making, and empowering women by respecting their rights and decisions during pregnancy and childbirth.
More and more research is proving that midwives in all birth settings are essential to safe and satisfying care. At the global level, midwives are known to provide pregnant women less invasive care, at less cost, and with excellent outcomes, and significantly contribute to decreasing the rate of premature birth and saving the lives of women and babies’. Midwives provide care worldwide that saves money and lives. Remember, ‘Peace on Earth begins with birth.’
It is your choice to inform and educate yourself on options for your care during your pregnancy and birth. We support the belief that every woman deserves a midwife. Even when some women also need a doctor for pregnancy problems, all women deserve the holistic support of an ongoing relationship with a midwife, who will be with them no matter what.
ACNM. (April 2012). About ACNM. In American College of Nurse Midwives. Retrieved June 8, 2012, from http://www.midwife.org/index.
International Confederation of Midwives. Essential competencies for basic midwifery practice 2010.http://www.unfpa.org/sowmy/resources/docs/standards/en/R430_ICM_2011_Essential_Competencie s_2010_ENG.pdf. Published 2011. Accessed October 10, 2011.
MANA. (2012). Definitions. In Midwives Alliance of North America. Retrieved June 8, 2012, from http://mana.org/definitions.html.
NARM. (April 2012). About NARM. In North American Registry of Midwives. Retrieved June 8, 2012, from http://www.narm.org.
Wikipedia. (June 6, 2012). Ina May Gaskin. In Wikipedia the Free Encyclopedia. Retrieved June 9, 2012, from http://en.wikipedia.org/wiki/Ina_May_Gaskin.
Wikipedia. (May 25, 2012). Ruth Lubic. In Wikipedia the Free Encyclopedia. Retrieved June 9, 2012, from http://en.wikipedia.org/wiki/Ruth_Lubic.
**Special Thanks To Jo Anne P. Davis for your assistance, love and support through the writing of this post***