CNM scope of practice

beckinben, CNM · Jan 31, 2008

Does anyone know how to find a scope of practice for CNM's? In my state (according to the health department website), Licensed Midwives can provide complete prenatal care including pap smears, ordering appropriate tests, carrying pitocin, erythromycin, and vit. K to births, etc.
However, LM's cannot do breech births, VBAC's, diabetics, or twins. Does anyone know if CNM's are allowed to, or is the scope of practice pretty much the same? If the scope of practice is the same, what is the real difference between CNM's and LM's, other than that one works in a birth center or hospital and one does home births?

The scope of practice for CNMs is defined by each state. For most, the scope of practice is found somewhere in state statutes or state regulations. Usually, it is in the same practice act that defines the scope for a registered nurse, since many states see CNMs as a type of advanced practice nurse, but every state is a little different. A good source of information is either the Board of Nursing for your state or whatever board licenses CNMs.

Some states reference the American College of Nurse Midwives' statements on standards of practice for midwifery and core competencies for midwifery as a way of defining scope of practice. These can be found here - http://www.midwife.org/code_of_ethics.cfm

As far as LM's - a CNM will always have a larger scope of practice than a LM. For one, a CNM also has the scope of practice of an RN. CNMs in all 50 states can get prescriptive authority. CNMs have a greater scope as far as gynecological care. I routinely see women who are not pregnant as part of my practice for pap smears, menstrual problems, infections and the like. Most LM's do not. CNMs also have the ability to do home births (most do not attend home births, but some do). LMs would not have much success trying to get privileges to do births in the hospital.

The ablility of CNMs to attend breech births, VBACs, twins, and diabetics will vary widely - and much of what we can and cannot do is influenced by factors other than state regulations, like hospital regulations and insurance concerns. I myself do not do breech births (I first assist on their cesarean) and I usually don't attend VBACs (but occasionally do). However, I have had two sets of twins this year, and don't usually mind managing diabetes, unless they have other complications.

Hope that helps. If you have a specific state you are wondering about, I can probably find more specific information.

AmericanChai · Jul 15, 2010

I was just researching for a paper and found this for AZ! Maybe it would give you an idea on what to look for in your state. Scroll down a bit and find the exact scope of practice as well as prohibited actions.

http://www.azsos.gov/public_services/Title_09/9-16.htm