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Nurse Midwife

• Certified Nurse Midwives provide well woman gynecological and low-risk obstetrical care including prenatal care, labor and delivery, and post-partum care.
• There are approximately 7400 nurse midwives in the United States
• There are currently 50 ACNM accredited nurse midwifery education programs in the U.S.
• Nurse midwifery is legal in all 50 states and the District of Columbia. 29 states mandate private insurance reimbursement for nurse midwifery services and Medicaid reimbursement are mandatory in all 50 states.
• Certified Nurse Midwives have prescriptive authority in 33 states.
• Approximately 68% of certified nurse midwives (CNM) have a masters degree, and 4% have a doctorate degree.
• Average salary in 1992 was $43,636 (ANA, 1993)
• Studies indicate CNM‚s provide safe and cost effective services such as average epidural rate of 14.6%, episiotomy rate of 30.1%, cesarean section rate of 11.6%, and a vaginal birth after cesarean section of 68.9% (national MD rates for cesarean section 23.3% and vaginal births after cesarean section of 24.9%). Infant mortality rates for nurse midwife were 4.1 per 1000 and the national average is 8.6 per 1000.
• Of all visits to nurse midwives 90% are for primary, preventive care. 20% are for care outside the maternity cycle, such as annual examines and reproductive heath reasons.
• The typical nurse midwife spends about 40 minutes on the new client visit and 20 minutes on the return visit.
• In a survey that asked women 25-34 years old with college degree and income of approximately $20K per year who were planning to have children in the future report that they are likely to use a nurse midwife.
• Over half of all nurse midwives work primarily in an office or clinic environment under a physician's supervision.
• The majority of women who receive care by a nurse midwife report to be very satisfied.

Links

Philosophy of Nurse Midwives

Standards of Practice

Education

References

Other Good Sites
 

Philosophy of American College of  Nurse Midwives

"Nurse Midwives believe that every individual has a right to safe, satisfying health care with respect for human dignity and cultural variation." (ACNM, 1989)

They support and believe:

• A person's right to self determination
• An individual has the right to be completed informed and have active participation in aspects of their care.
• Normal processes of pregnancy can be enhanced through education, health care, and supportive interventions.
• Encourages continuity of care
• Emphasizes safe, competent clinical management
• Advocates non-intervention in normal processes
• Promotes health education for women throughout the life cycle

They are focused on needs of the individual:

• For physical care
• For emotional support
• For social support
• For active involvement of patient and significant others

For further information: www.acnm.org/about/philosop.htm

Standards of Practice
Certified nurse midwives practice in accord with the Standards for Practice of Nurse Midwifery, as laid out and defined by the American College of Nurse Midwives.

"The nurse midwife is committed to maintaining a high standard of professional care, to participate in the education of nurse midwives, and to promoting the concepts of nurse midwifery practice in the community." (ACNM, 1993)

Standard #1: Qualified practitioners provide Nurse Midwifery care.

The practitioner must be certified by the ACNM approved certifying agent, and they must be in compliance with the legal requirements of the state in which they practice midwifery. They must show evidence of continuing education and competency.

Standard #2: Nurse Midwifery care supports individual rights and self-determination within the boundaries of safety.

The certified nurse midwife must practice in accord with the philosophy and code of ethics of the ACNM. They must provide their clients with a description of their scope of practice. They must provide information and refer clients to other providers when care required is not in their scope of practice. They also promote involvement of support persons in the practice setting.

Standard #3: Nurse Midwifery care is comprised of knowledge, skills, and judgment that should foster the delivery of safe and satisfying care.

The certified nurse midwife collects and assesses client care data, develops and implements a plan of management and then evaluates the outcome of the care. They practice within the ACNM Standards for Practice of Nurse Midwifery, and within the policies of the agency or institution in which they practice.

Standard #4: Nurse Midwifery care is based upon knowledge, skills, and judgment that is reflected in written practice guidelines.

The certified nurse midwife describes the parameters for the practice for nurse midwifery management, physician management, and collaborative management, and they establish practice guidelines for each specialty area.

Standard #5: Nurse Midwifery care is provided within a safe environment.

The certified nurse midwife demonstrates knowledge and utilizes federal and state guidelines that apply to a practice environment and infection control. They demonstrate appropriate management of an emergency situation and they promote adequate staffing in their clinical setting.

Standard #6: Nurse Midwifery care occurs within the health care system of the community using appropriate resources for referrals to meet the patient's needs.

The certified nurse midwife uses community services. They also demonstrate knowledge of family factors that may affect care, and use safe mechanisms for obtaining those consultations, collaborations, and referrals need by the family.

Standard #7: Nurse Midwifery care is documented in legible, complete health records.

The certified nurse midwife facilitates client's access to their record, but treats records as confidential documents. They provide written documentation of risk assessment, course of management, and outcome of care, and use this documentation to facilitate communication of information for consults and the institution in which they practice.

Standard #8: Nurse Midwifery care is evaluated according to a program for quality assessment that includes a plan to identify and resolve problems.

The certified nurse midwife seeks consultation to review problem identified by quality assurance programs, and participates in peer review. They collect data systematically and are involved in analysis of that data for the evaluation process and outcome of care.

For further information: www.acnm.org/prof/standard.htm

Education

There are three ways to become a certified nurse midwife:

• Become a RN through a junior college (associate degree) and then apply to a CNM program.
• Apply to a school that integrates a nursing degree into its CNM program, which would allow non-nurses to become a RN while in the process of gaining the CNM.
• Become a Physician's Assistant and take an enrichment program that will allow you to practice as a certified midwife.

Option 1 Advantages:

• Associate nursing degrees can be gained at a local community college.
• Most CNM programs require at least a year experience before applying this allows you 3-5 years before you turn your focus towards midwifery.
• This program provides you a break between nursing school and midwifery school.

Option 2 Advantages:

• Can enter as a non-nurse
• Obtain a bachelors degree in the process
• If you already have a bachelors degree this program is shorter than option 1.
• This option can be ideal for families on a budget because it decreases time spent in school.

Option 3 Advantages:

• Learn many skills that pertain to general medicine
• Maintain a holistic approach.
• Allows for more flexibility of where you can practice.
• Allows for a natural break in training.
• More autonomy than a RN.
• Training is based on being able to diagnose and treat

For further in formation about education: www.efn.org/~djz/birth/MT/education/cnmprog.html
www.acnm.org/educ

Research Studies
Research studies confirm cost effectiveness and quality of care provided by CNM.
 

A study from the National Center for Health Statistics, Center for Disease Control and Prevention examined all single, vaginal births in the U.S. in 1991 delivered between 35-43 weeks gestation by either a physician or certified nurse midwife.  It found the risk for neonatal mortality (death within the first 28 days) was 33% lower for midwives.  For further information and the article: www.cdc.gov/nchswww/releases/98news/98news/midwife.htm

• A study found in Clinical Excellence for Nurse Practitioners compared the cost between a free-standing birth center, a mixed staff women's clinic, and a traditional obstetrician's practice.  It found that there was significantly less technologically interventive processes of care received in the free-standing clinic and that the free-standing clinic was almost $2,000 cheaper then the mixed staff clinic and the obstetricians office.  It also found that there were no significant differences in the maternal or infant clinical outcomes in the less expensive mode of care. (Stone, Walker, 1997, p.465-465)
• A study done by The World Health Organization identified three trials that compared midwives as general practioners-managed care vs. obstetrician/gynecologist shared care.  The results showed similar clinical efficiency of the two groups, but women favored the midwifery led care.  It also found a cost reduction if antenatal care was provided by the midwife rather than the obstetrician/gynaecologist. (Khan-Neelofur, D., Gulmezolglu, M., Villar, J., 1998, p.7-26)
• The ANA did a meta-analysis on Certified Nurse Midwives and found that CNMs perform fewer fetal monitors, fewer episiotomies, and fewer forcep deliveries.  They also found that CNMS administer less IVs, deliver fewer low birth weight and premature infants, and had shorter patient stays. (ANA, 1993)
• In another meta-analysis it was found that Nurse Midwives used less technology and analgesia than physicians during intrapartum care, and they achieved equivalent neonatal outcomes to those same physicians. (Brown, Grimes, 1995, p. 332-339)

References

    American College of Nurse Midwives. (1997). Midwifery education introduction. [on line], available: http://acnm.org/educ/doaintro.htm

    American College of Nurse Midwives. (1989). ACNM philosophy. [on line], available: http://www.acnm.org/about/philosop.htm

    American College of Nurse Midwives. (1993). Professional information standards for the practice of nurse-midwifery. [on line], available: http://acnm.org/prof/standard.htm

    American Nurses Association. (1993, January).  Executive summary: A meta-analysis of process of care, clinical outcomes, and cost effectiveness of nurses in primary care roles: Nurse Practitioners and Nurse-Midwives.

    Brown, Grimes. (1995). A meta-analysis of nurse practitioners and nurse midwives in primary care.  Nursing Research, Nov-Dec 44(6). p.332-339.

    Center for Disease Control and Prevention. (1998). New Study Shows Lower Mortality Rates for Infants Delivered By Certified Nurse Midwives. [on line], available: http://www.cdc.gov/nchswww/releases/98news/98news/midwife.htm

    Midwifery Today. (1995). Choosing a Certified Nurse-Midwifery Program. [on line], available: http://www.efn.org/~djz/birth/MT/education/cnmprog.html

    Nursing Facts. (1993). Advanced Practice Nursing: A New Age in Health Care. [on line], available: http://www.nursingworld.org/readroom/fsadvprc.htm

    Stone, P.W., Walker, P.H.  (1997).  Clinical and cost outcomes of a free-standing birth center: a comparison study.  Clinical Excellence for Nurse Practitioner, Nov. 1(7).  p.456-465.

Other Good Sites

La Leche League
http://www.lalecheleague.org/

Online Birth Center
http://www.efn.org/~djz/birth/birthindex.html

National Prevention Agency Center for Disease Control and Prevention
http://www.cdc.gov/

Family Web Home page
http://www.familyweb.com

Water Birth Information Center
http://www.well.com/user/karil/

Site that goes through the different options for child birth
http://home.earthlink.net/~shehina/options.html

Site that compare Obstetrician vs. Midwife
http://www.parentsoup.com/library/eppq001a.html
 
 

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