Does a CNM do post-partum repairs?

[justme1972]

I know that it sounds like a silly question...but I was just sitting here thinking about it, and was wondering if it fell under the category of surgery, therefore, would a CNM not be permitted to repair lacerations?

[Smark35]

Hopefull2009,

I don't know if it's the same in every hospital, but in the one I work at, CNM's repair 1st and 2nd degree lacs, and call the docs for 3rd and 4th. That said, I've seen 1 3rd degree lac in 10 years from our three CNM's, and never a fourth. (When you don't go hacking at the perineum to make the delivery go faster, it's amazing how many severe lacs are avoided.) :)

[CEG]

Hopefull2009,

I don't know if it's the same in every hospital, but in the one I work at, CNM's repair 1st and 2nd degree lacs, and call the docs for 3rd and 4th. That said, I've seen 1 3rd degree lac in 10 years from our three CNM's, and never a fourth. (When you don't go hacking at the perineum to make the delivery go faster, it's amazing how many severe lacs are avoided.) :)

:yeahthat:

[justme1972]

Very, very interesting :)

I did my externship in L&D this year, and I only got to see, out of all of them this summer, oh...about 2 or 3 that were natural.

Thanks :)

[beckinben, CNM]

I know that it sounds like a silly question...but I was just sitting here thinking about it, and was wondering if it fell under the category of surgery, therefore, would a CNM not be permitted to repair lacerations?

I repair 1st and 2nd degree lacerations. If I have a 3rd, one of my backup docs comes in. I do know CNMs that have privileges to repair 3rd degree lacerations. I haven't seen or had enough 3rd degrees to feel anywhere near comfortable doing them myself. :)

The basics of what CNMs are trained to do are in the ACNM Core Competencies, which you can find here - http://www.acnm.org/siteFiles/descriptive/Core_Competencies_6_07_3.pdf

This is what is covered in your midwifery training. Repair of lacerations is specifically mentioned in the core competencies.

However, skills beyond these can become part of CNM practice, if you have some training and can prove competency. For example, I first assist on c-sections (which could be considered surgery, LOL). My docs trained me to do it, the hospital granted me privileges for it. The ACNM has a specific position statement supporting CNMs who want to first assist. Other CNMs do vacuum assisted deliveries.

The biggest limits on what you can do as a CNM are going to be from state law, hospital policies, what your back up docs (if any) are comfortable with you doing, and what you

yourself feel comfortable with.

[peytonsmom]

I know that my midwife helped stich me up and I had 4th degree tears with my OB in the room (emergency vaccum delivery).