Gynecological scope of practice

[DreamerMW]

I have a newfound interest in gyn in general and infertility in particular. I'm just wondering how much of it I'll see as a CNM. Do you refer patients to a RE or do you start clomid, etc.? Also, what gyn procedures do you perform and what do you refer out? Any info would be greatly appreciated!

[LibraSunCNM, BSN, MSN, CNM]

I would say in terms of fertility, you're referring out to a GYN or REI. You could always do initial labs before you send her, but I don't know any midwives starting women on Clomid.

In my practice, the GYN patients I see are regular annual GYN exams, family planning visits, or minor complaints, but I work for a large hospital with about a dozen OB/GYNs. So I'm doing a quick physical exam including thyroid, breast, pelvic, and then any Paps/cultures that are needed, and contraceptive counseling/management. Women over 40 aren't sent to my clinic, they're sent to the GYNs. However some midwives working in private practice do colposcopies, endometrial biopsies, pessary fittings, menopause management, etc. Complex patients should be referred out, but different midwives have different levels and qualities of experience and so might be more comfortable managing conditions that others are not.

[klone, MSN, RN]

The most I see our midwives doing is sometimes starting a woman on Metformin if they have underlying PCOS.

[cayenne06, MSN, CNM]

I work exclusively in GYN as a CNM and we can, with the right training, have a very wide scope. I am brand spanking new so my excitement still comes from ultrasounds and IUDs, but my colleagues do everything from endometrial biopsies, initial infertility management, menopausal care (including HRT), colposcopies, vacuum aspirations for miscarriage management (but not for abortion because of medically irrelevant legislation), LEEPs, cryo... and lots more that I cannot think of right now. It all depends on your training and practice environment.

eta- we also do a ton of primary care, again based on experience and training.

[DreamerMW]

Thank you so much everyone! I'm so grateful for this forum and all you sweet CNM's who care to answer all my questions.

[klone, MSN, RN]

Wow, Cayenne! You guys do colpos, LEEP and cryo? Is that state specific, do you know? The most ours do is EMBx.

[cayenne06, MSN, CNM]

Wow, Cayenne! You guys do colpos, LEEP and cryo? Is that state specific, do you know? The most ours do is EMBx.

I don't think it is state specific, but I've only ever practiced in Massachusetts and Connecticut so I'm not positive. But these are all very reasonable skills for a midwife with the necessary training. If we can manage a birth, stop a hemorrhage, resuscitate a baby, and suture a second degree laceration, then we can surely do a LEEP!