Certified Nurse Midwives - An APRN Specialty

by sirI Admin

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The Certified Nurse-Midwife (CNM) is an Advanced Practice Registered Nurse (APRN) who is a graduate of a nurse-midwifery program and is nationally certified. Many states recognize this specialty and some do not. There are 4 APRN specialty areas: The Certified Registered Nurse Anesthetist (CRNA) The Nurse Practitioner (NP) The Clinical Nurse Specialist (CNS) The Certified Nurse Mid-Wife (CNM) This Article will cover the CNS and touch on the lay Mid-wife as well.

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    Certified Nurse Midwives - An APRN Specialty

    Certified nurse-midwives (CNMs) are educated in the two disciplines of nursing and midwifery. They provide primary healthcare to women of childbearing age including: prenatal care, labor and delivery care, care after birth, gynecological exams, newborn care, assistance with family planning decisions, preconception care, menopausal management and counseling in health maintenance and disease prevention. CNMs attend a very small percentage of the births in the United States.

    The CNM dates back to the early 1920’s when Mary Breckinridge started a program in Kentucky using nurses from other countries. As the need for licensed professional nurses grew programs started growing and now all CNM must be educated as RN’s, complete a Nurse Midwifery program, and become certified as nurse midwives. These programs must be accredited by the American College of Nurse Mid-wives (ACNM).

    The CNM works closely with Obstetricians and Gynecologists (OB-GYN physicians). They take on what is considered “low-risk” pregnancies. Should the midwife recognize the gravida is high-risk, he/she will consult and refer immediately to the OB-GYN. The majority of CNM work in hospitals and in poor, rural townships/cities. They also are employed in birthing centers and Health Departments. The role of the CNM has greatly enhanced the quality of healthcare for women in the past 40 years in areas where OB-GYNs are not available.

    Scope of Practice

    • Physical Assessment
    • Prescription privileges
    • Education
    • Referrals and consultations
    • General health of women and the newborn
    • General non-complicated vaginal birth of the gravida and immediate care of the newborn

    Regulation of the CNM

    The state Board of Nursing (BON) licenses the RN
    Only graduates of an accredited midwifery program are eligible to sit for certification as CNM

    The Future of the CNM

    For the past several years, there has been much discussion about the education process for the APRN. Right now there is a vision that by 2015, all Nurse Practitioners will be educated as Doctorate of Nursing Practice (DNP). The CNS seems to follow along the same line of thinking. The DNP is recommended not required by 2015, and only the APRNs that have adopted the clinical doctorate requirement are CRNAs. New CRNAs graduating in 2025 or later will have to have their clinical doctorate for certification.

    I have spoken to several Educators in Nurse midwifery and most do not embrace the idea of accepting the DNP. This is still in the 1st phase of consideration, but I’ve yet to meet any CNM or Educator who considers going to DNP as advantageous. This remains to be seen as the years go by.

    Differences between CNM and Lay Mid-wife

    There are basically only two kinds of midwives: lay midwives and certified nurse midwives. The difference between the two is their training.

    Lay midwives are not nurses, rather, they're women who have had direct training in midwifery through self-study and majority, apprenticeship. Some lay midwives later decide to enter into a Masters Nursing Program and combine Nurse- Midwifery with the program.

    A licensed midwife is sanctioned by her state after she passes a test administered by the state’s medical board licensing division. Licensing requirements differ among states; some, like Oregon, do not require licensing at all. Lay midwives in eight states – Indiana, Iowa, Kentucky , Maryland, Missouri, North Carolina, Virginia, and Wyoming – and in the District of Columbia legally are not able to become licensed midwives. So while you may be able to have a legal homebirth in those states, a lay midwife could risk arrest by attending.

    In my opinion, the Woman’s Health Care Giver should be a Certified Nurse Midwife for a variety of reasons including, but no limited to, liability.

    I think the book, Midwives, about a midwife in rural Vermont, is an excellent read. It makes one stop and think just how important this specialty is, risks involved, the heartache, and exhilaration - all felt by one person who chose to provide healthcare for two important individuals in her life … the pregnant woman who gave complete trust to her health care provider (the midwife) and the newborn baby who was vulnerable to everything that occurred.
    Last edit by Joe V on Dec 3, '13
    Joe V and hecallsmeDuchess like this.
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    20 Comments so far...

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    While I appreciate your article very much, you have incorrectly used "lay midwife" and "licensed midwife" interchangeably (probably just a copy and paste error).

    For clarification, there are 5 types of midwives:

    Certified Nurse Midwife (CNM)- an RN with a Master's level specialty that has passed national board certification (AMCB)

    Certified Midwife (CM)- not a nurse, but has college education specializing in midwifery and also has passed the same exam as the CNM. This designation is only accepted in a few north-eastern states in the US

    Certified Practicing Midwife (CPM)- not a nurse, but rather a graduate of a MEAC approved program or submission of portfolio directly to NARM, the certifying board for home birth midwives

    Licensed Midwife (LM)- not a nurse, a midwife that is licensed individually in their particular state, may or may not be nationally certified by NARM, depending on the licensing regulations of each particular state

    Lay Midwife- not licensed, not formally educated midwife, AKA traditional midwife

    http://www.midwife.org/Become-a-Midwife
    http://narm.org/certification/
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    Quote from mamagui
    While I appreciate your article very much, you have incorrectly used "lay midwife" and "licensed midwife" interchangeably (probably just a copy and paste error).

    For clarification, there are 5 types of midwives:

    Certified Nurse Midwife (CNM)- an RN with a Master's level specialty that has passed national board certification (AMCB)

    Certified Midwife (CM)- not a nurse, but has college education specializing in midwifery and also has passed the same exam as the CNM. This designation is only accepted in a few north-eastern states in the US

    Certified Practicing Midwife (CPM)- not a nurse, but rather a graduate of a MEAC approved program or submission of portfolio directly to NARM, the certifying board for home birth midwives

    Licensed Midwife (LM)- not a nurse, a midwife that is licensed individually in their particular state, may or may not be nationally certified by NARM, depending on the licensing regulations of each particular state

    Lay Midwife- not licensed, not formally educated midwife, AKA traditional midwife

    Become a MidwifeCertification | NARM

    Hello and thank you for the additional information. You are correct as well. But this Article only covered the CNM and the Lay Midwife. The Lay Midwife is not educated (formally as you pointed out), but receives learning through apprenticeship and self-study. You are also correct in that the Licensed Midwife, not a nurse, is licensed state by state (as stated above).

    Thank you for pointing out that my header did not include comparison of the other two (CPM and (CM) and that I did indeed, leave out the header about the Licensed Midwife.. I will be adding another Article later that will discuss all disciplines of midwifery.

    (I will be re-formatting this Article to include your additional information). Thank you for clarification.
    Joe V likes this.
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    Quote from sirI
    The role of the CNM has greatly enhanced the quality of healthcare for women in the past 40 years in areas where OB-GYNs are not available.
    As a CNM, I would venture to say that CNMs have greatly enhanced the quality of healthcare for women even in areas where OB/GYNs ARE available. We're not just physician-extenders, although many midwives work in settings where they are treated as such.
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    Quote from LilyRoseCNM
    As a CNM, I would venture to say that CNMs have greatly enhanced the quality of healthcare for women even in areas where OB/GYNs ARE available. We're not just physician-extenders, although many midwives work in settings where they are treated as such.
    I totally agree with you (CNM), LilyROseCNM
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    I just wanted to include the extra information about other types of midwives so that people were aware of what they are
    sirI likes this.
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    I think defining CNMs as APRNs - advanced practice registered nurses - gets complicated when the AMCB has a pathway for becoming a midwife - equivocal to the CNM - without first becoming a nurse.

    The Credential CNM and CM

    There are many articles and opinions out there on this one. Is midwifery an APRN specialty, or is it a distinct profession with a nursing entry to practice? Hmmmm.
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    Quote from queenanneslace
    There are many articles and opinions out there on this one. Is midwifery an APRN specialty, or is it a distinct profession with a nursing entry to practice? Hmmmm.
    If I am understanding correctly, those that are NOT nurses do not receive the credential CNM, rather receive the CM after passing the same boards. The CM can only practice in a few north east states. Therefore, a CNM is still considered an advanced practice registered nurse, while a CM is a Certified Midwife. I think
  11. 0
    ...so, I guess midwifery is both, depending on the type midwife. Also, the scope of practice is distinct for a CNM as they provide well woman care across the lifespan, have prescriptive authority, etc., whereas the CM focuses mostly on perinatal care.
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    A 2010 issue of the Journal of Midwifery and Women's Health devoted quite a few articles to the discussion of regulation of midwifery practice.

    If you have access to this journal, or can get to a library that does -there are quite a few articles discussing the relationship between nursing and midwifery.
    http://onlinelibrary.wiley.com/doi/1...sue-5/issuetoc

    The article I really appreciated was by Helen Varney Burst: Nurse-Midwifery Self-Identification and Autonomy

    Another good resource on the development of the CM credential - which by certification is an equivalent credential to the CNM - and includes the same scope of practice and training (independent practitioners providing well-woman care, gynecology, primary care as well as antepartum, intrapartum and postpartum care) - is a book that's a few years old now titled "Midwifery & Childbirth in America" by Judith Rooks.

    [May I link to a google book? Is that allowed?]
    Midwifery and Childbirth in America - Judith Rooks - Google Books
    Go to page 247, there's a good overview of the development of both the CPM and the CM credentials by MANA and ACNM respectively.

    CMs do not have recognition by most states - perhaps, because state BONs license CNMs dually as nurses and CNMs, or advance practice nurses. There is some concern that if CNMs are licensed as APRNs - as many states are currently pushing for uniform APRN licensure across multiple advance practice nurse specialties, that barriers to recognition of the CM credential will be increased.
    Joe V likes this.


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