Nurse midwife profession
HISTORY OF THE PROFESSION
Nurse-midwifery in the U.S. dates back to 1925. At that time, Mary Breckenridge developed the Frontier Nursing Service in Kentucky. The program utilized public health registered nurses, who had received additional nurse-midwifery education in England, to staff nursing centers in the Appalachian mountains. The centers offered family health care services in addition to childbearing and delivery care to residents within the region.
The first nurse-midwifery education program in the United States was founded in 1932 at the Maternity Center Association of New York City. The program enrolled public health nurses and awarded a certificate in nurse-midwifery to its graduates.
Today, all nurse-midwifery programs are within institutions of higher education. Approximately 70% of 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 be eligible to take the National Certification Examination. There are 47 ACNM accredited nurse-midwifery programs in the United States. Applicants for nurse-midwife programs must be registered nurses and have at least one to two years of nursing experience. As with the nursing profession in general, most CNMs are women. However, in recent years more male nurses have chosen to become nurse-midwives.
Primary health care services for women within underserved populations have been greatly enhanced through the services of nurse-midwives. The National Institute of Medicine has recommended that more reliance be placed upon nurse-midwives for the delivery of women’s health care.
Numerous studies over the past 20 to 30 years have documented the ability of nurse-midwives to independently manage about 80% of all perinatal (including prenatal, delivery, and postpartum) care and up to 85% of the family planning and gynecological needs of women of all ages.
Nurse-midwives work in a collaborative role with OB/GYN physicians and either consult with or refer to other health care providers on cases outside their scope of practice (for example, high-risk pregnancies, women with concurrent chronic disease). See types of health care providers.
SCOPE OF PRACTICE
The nurse-midwife is prepared both academically and clinically to provide a broad range of health care services for women and newborns. CNM functions include diagnostic services (history taking, physical assessment, ordering appropriate laboratory tests and procedures), therapeutic management (outlining care, providing prescriptions, coordinating consultations and referrals), and health promotion and risk-reduction activities.
Although the majority of CNM practice may focus on childbearing, family planning, and gynecological care for well women, CNMs may also assess and manage common acute, episodic illnesses in adults. All services are performed in collaboration with the client. As with the nurse practitioner profession (NP), current prescriptive practice privileges for CNMs varies from state to state. Health care management by CNMs includes independent management, consultation or co-management, and referral services.
Certified nurse-midwives may be found in a variety of settings including private outpatient practices (either by themselves or in collaboration with a physician), health maintenance organizations, hospitals, health departments, and freestanding birthing centers. Traditionally, CNMs have provided 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 two different levels. Licensure is a process that takes place at the state level in accordance with specific state laws. In contrast, certification is established through a national organization and requirements for minimal professional practice standards are consistent across all states.
Licensure: Much like other advanced practice nurses (such as nurse practitioners), licensure requirements for CNMs may vary somewhat from state to state. The current trend is to require master’s degree preparation and national certification.
Certification: National certification is required in some states for CNMs to be licensed to practice. Only graduates of nurse-midwifery programs accredited by the American College of Nurse-Midwives (ACNM) are eligible to take the certification exam administered by the ACNM Certification Council, Inc.
by Arthur A. Poghosian, M.D.
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