Direct-entry midwife

Last updated
A pregnant woman receives a visit from a midwife in her home. Midwife home appointment.jpg
A pregnant woman receives a visit from a midwife in her home.

A direct-entry midwife is a midwife who has become credentialed without first becoming a nurse. There are direct-entry midwifery programs that prepare students to become Certified Nurse Midwives (CNMs) or Certified Professional Midwives (CPMs). [1] [2] Certified Professional Midwives are known for being "more natural and less intervention oriented." [3] In other words, these midwives typically work outside of the hospital setting in homes and birth centers and do not employ methods for childbirth that physicians in hospitals commonly use such as caesarean section, forceps and other types of equipment and drugs.

Contents

Legality of direct-entry midwifery in the United States

While direct-entry midwifery is popular and legal in many cultures around the world, it struggles to gain legality in several states in the U.S. Nurse-midwives can practice legally in all 50 states. [4] However, Certified Professional Midwives are regulated and licensed in 23 states. [5]

17 states do not regulate Certified Professional Midwives or provide an avenue for licensure. [5] Penalties for practicing as a midwife without a CNM credential range from a misdemeanor to a Class C Felony. [6] These states include Connecticut, the District of Columbia, Georgia, Illinois, Iowa, Kansas, Massachusetts, Mississippi, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, and West Virginia. [7]

North Dakota, for instance, is one of many states that have no official laws regulating or prohibiting the practice of midwives without a CNM credential. States can unintentionally encourage issues with midwifery by not providing standards or licensure opportunities to ensure the competency of midwives. [8]

Also, practicing midwifery without having a CNM credential in these states is basically equivalent to practicing medicine without a license and has severe penalties. [3]

Some states, while they regulate the profession, make it very difficult for midwives to obtain licenses to perform. Hawaii is one of these states. While Certified Professional Midwifery is legal in Hawaii, licensure has been deemed too expensive and is unavailable to most, according to the Midwives Alliance of North America. Delaware is another state that, while it regulates the profession, sets up obstacles that make it difficult for CPMs to practice in the state. Theoretically, Delaware CPMs are able to obtain a permit to practice, but one has not been issued since 2007.

The decline of midwifery in the United States

The decline of midwifery in the United States can be contributed to a number of complex factors: the rise of the American Medical Association and the growth of hospitals in the country in the late 1800s and early 1900s shifted births from the home to the hospital. [9] The fall can also be attributed to the movement toward universities teaching gynecology and surgery as well as advancements in technology such as anesthesia and forceps. All of this led physicians to see midwives as competition instead of partners. They were also worried about what people would think about doctors if it appeared that anyone so uneducated could perform the work of a medical professional. [3]

During this time period, organized medicine launched a campaign to convince the public that hospital births were the best option, while painting midwives as unintelligent, untrustworthy and criminal. [9] However, it was not just physicians who joined in the campaign against midwifery – by the late nineteenth century, wealthy, pregnant women joined in because they thought childbirth was less painful and safer if performed by physicians. [10]

The case for legalizing certified professional midwifery

Statistics show that American women want alternatives to hospital births. 20 percent of women indicated in a study in 2006 that if they have the option to have a non-hospital delivery with readily available medical backup, they would take it. [10] The State of the World's Midwifery report supports the profession, urging governments to recognize it as vital to maternal and newborn health services. It also urges governments to consider establishing a scope of practice, specified credentials for entering the profession and educational standards. [11] Those who argue for the legalization of direct-entry midwifery also cite its health benefits, both to the mother and the fetus. [11] Women who give birth in hospitals experience higher risks and adverse effects than women who give birth with a midwife. [12] Studies also show that the use of midwives in childbirth can decrease maternal and newborn mortality as well as stillbirths, perineal trauma, instrumental births, intrapartum analgesia and anesthesia, severe blood loss, preterm births, newborn infants with low birth weigh, hypothermia and neonatal intensive care units. [13]

There are also indications that midwife-assisted childbirth is safer than birth in a hospital because there's a lower chance of intervention. [10]

[ dubious ]

The case against legalizing certified professional midwifery

Those debating against the legalization of certified professional midwives usually question the competence, regulation and scope of midwives. [10] Questions regarding whether CPMs should be legally recognized as birth attendants, what their job should allow them to do, and who is responsible for their regulation surface. [10] Health care professional also cite recent studies [14] that have shown that hospital births have lower rates of perinatal death, neonatal death, 5-minute Apgar scores < 4, and neonatal seizures when compared to planned out-of-hospital births, including those with a midwife. Also of note, while hospital births are associated with higher rates of intervention such as forceps, labor induction, labor augmentation, and cesarean delivery, the data is skewed, as midwives do not have the necessary training to use the aforementioned techniques when deemed medically necessary.

Common routes for licensure

Many CPMs also support regulation and licensure because they believe limitations on a legalized profession would outweigh having to operate under the threat of prosecution in states where the profession is illegal. [3] For instance, to qualify for licensure in California, a midwife must complete a three-year postsecondary midwifery education program and pass a licensing examination. [3] In Minnesota, licensed midwives are required to screen potential clients, and only accept those who are expected to have a “normal” delivery. In 1994, the North American Registry of Midwives (NARM) formed, as it recognized a need for direct-entry midwives to obtain national certification. State regulation of direct-entry midwifery was varied, and the professional associated realized the professional needed certification standards. As of 1994, direct-entry midwives can receive certification through NARM and be designed as certified professional midwives (CPMs). Now, for states that regulate the profession, most of them require midwifery candidates to take the NARM exam and complete NARM certification before receiving a license from the state, [15] however certification and licensure is only recognized in states that legalize and recognize midwifery.” In order to be recognized as a CPM by NARM, a midwife must meet three criteria: meet all education requirements and pass a certification exam; meet minimum experience requirements; document proficiency in all midwifery skills (Stover, 2011, p. 325). This can take anywhere between three and five years. This certification also must be renewed every three years.

Related Research Articles

<span class="mw-page-title-main">Midwifery</span> Pregnancy and childbirth-related profession

Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period, in addition to the sexual and reproductive health of women throughout their lives. In many countries, midwifery is a medical profession. A professional in midwifery is known as a midwife.

<span class="mw-page-title-main">Home birth</span> An attended or an unattended childbirth in a non-clinical setting

A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. They may be attended by a midwife, or lay attendant with experience in managing home births. Home birth was, until the advent of modern medicine, the de facto method of delivery. The term was coined in the middle of the 19th century as births began to take place in hospitals.

An advanced practice nurse (APN) is a nurse with post-graduate education and training in nursing. Nurses practicing at this level may work in either a specialist or generalist capacity. APNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing.

<span class="mw-page-title-main">Certified nurse-midwife</span> Advanced practice nurse who provides mid-level nursing and midwifery care

In the United States, a Certified Nurse-Midwife (CNM) is a nurse midwife who exceeds the International Confederation of Midwives' essential competencies for a midwife and is also an advanced practice registered nurse, having completed registered nursing and midwifery education leading to practice as a nurse midwife and credentialing as a Certified Nurse-Midwife. CNMs provide care of women across their lifespan, including pregnancy and the postpartum period, and well woman care and birth control. Certified Nurse-Midwives are recognized by the International Confederation of Midwives as a type of midwife in the U.S.

Yvonne Cryns is an American midwife and political activist. From 1991 to 2001, she served as a traditional midwife in Illinois and Wisconsin. Cryns has a Certified Professional Midwife (CPM) designation.

The Midwives College of Utah, formerly the Utah School of Midwifery, is an institution of direct-entry midwifery training that is headquartered in Salt Lake City, Utah but offers all programs completely online. Founded in 1980, it is one of the largest and longest-standing direct-entry (out-of-hospital) midwifery programs in the nation. It has been accredited through the Midwifery Education Accreditation Council (MEAC) since 1996, which is approved by the U.S. Secretary of Education as a nationally recognized accrediting agency. The school is also accepted by the California Medical Board for state licensure.

The Midwives Alliance of North America (MANA) was founded in April 1982 to build cooperation among midwives and to promote midwifery as a means of improving health care for North American women and their families. Its stated goal is to unify and strengthen the profession of midwifery, thereby improving the quality of health care for women, babies, and communities.

A birth attendant, also known as skilled birth attendant, is a health professional who provides basic and emergency care to women and their newborns during pregnancy, childbirth and the postpartum period. A birth attendant, who may be a midwife, physician, obstetrician, or nurse, is trained to be present at ("attend") childbirth, whether the delivery takes place in a health care institution or at home, to recognize and respond appropriately to medical complications, and to implement interventions to help prevent them in the first place, including through prenatal care. Different birth attendants are able to provide different levels of care.

<span class="mw-page-title-main">Nursing in Canada</span> Overview of nursing in Canada

Nurses in Canada practise in a wide variety of settings, with various levels of training and experience. They provide evidence-based care and educate their patients about health and disease.

<span class="mw-page-title-main">Monthly nurse</span> Occupation

A monthly nurse is a woman who looks after a mother and her baby during the postpartum or postnatal period. The phrase is now largely obsolete, but the role is still performed under other names and conditions worldwide.

<span class="mw-page-title-main">Health professional requisites</span> Regulations used by countries

Health professional requisites refer to the regulations used by countries to control the quality of health workers practicing in their jurisdictions and to control the size of the health labour market. They include licensure, certification and proof of minimum training for regulated health professions.

Ruth Watson Lubic, CNM, EdD, FAAN, FACNM, is an American nurse-midwife and applied anthropologist who pioneered the role of nurse-midwives as primary care providers for women, particularly in maternity care. Lubic is considered to be one of the leaders of the nurse-midwifery movement in the United States.

In the United States, certified nurse midwives (CNMs) are advanced practice registered nurses in nurse midwifery, the nursing care of women during pregnancy and the postpartum period. CNMs are considered as midwives.

Midwives in the United States assist childbearing women during pregnancy, labor and birth, and the postpartum period. Some midwives also provide primary care for women including well-woman exams, health promotion, and disease prevention, family planning options, and care for common gynecological concerns. Before the turn of the 20th century, traditional midwives were informally trained and helped deliver almost all births. Today, midwives are professionals who must undergo formal training. Midwives in the United States formed the Midwifery Education, Regulation, and Association task force to establish a framework for midwifery.

Mary Francis Hill Coley was an American lay midwife who ran a successful business providing a range of birth services and who starred in a critically acclaimed documentary film used to train midwives and doctors. Her competence projected an image of black midwives as the face of an internationally esteemed medical profession, while working within the context of deep social and economic inequality in health care provided to African Americans. Her life story and work exist in the context of Southern granny midwives who served birthing women outside of hospitals.

<span class="mw-page-title-main">Midwife</span> Medical professional who practices obstetrics as a health science

A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.

<span class="mw-page-title-main">Ronnie Lichtman</span> American midwife, educator and womens health advocate

Ronnie Sue Lichtman, is a midwife, educator, writer and advocate for women's health. She has published widely for both lay and professional audiences. The Chair of the Midwifery Education Program at The State University of New York (SUNY) Downstate Medical Center in New York City, she earned a Ph.D. in sociomedical sciences from Columbia University Graduate School of Arts and Sciences, and her MS in Maternity Nursing with a specialization in midwifery from Columbia University School of Nursing. She previously directed the midwifery programs at Columbia University and Stony Brook University.

<span class="mw-page-title-main">Nurse midwife</span>

A nurse midwife is both a nurse and a midwife, having completed nursing and midwifery education leading to practice as a nurse midwife and sometimes credentialed in the specialty. Nurse midwives provide care of women across the lifespan, including during pregnancy and the postpartum period, and well woman care and birth control.

Elizabeth Davis is an author, women's health care specialist, educator, consultant, and Certified Professional Midwife (CPM). She is a resident of Sebastopol, California and a mother of three children. Since 1977, Davis has pioneered a professional path for midwives in the United States while educating women around the world. Davis is globally active as an expert on midwifery and reproductive health issues. She has been involved with midwifery education, legalization, and the battle for professional autonomy. She lectures on reproductive rights, sexuality, and healing birth trauma.

<span class="mw-page-title-main">American College of Nurse-Midwives</span>

The American College of Nurse-Midwives (ACNM) is a professional association in the United States, formed in 1955, that represents certified nurse-midwives (CNMs) and certified midwives (CMs). Dating back to 1929, ACNM strives to be a leading example for excellence in midwifery education and practice in the United States and has a special interest in promoting global health in developing countries. "Members are primary care providers for women throughout the lifespan, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. ACNM reviews research, administers and promotes continuing education programs, and works with organizations, state and federal agencies, and members of Congress to advance the well-being of women and infants through the practice of midwifery."

References

  1. "pathways to midwifery education". ACNM. Retrieved 2017-03-22.
  2. "History of the Development of the CPM | NARM". narm.org. Retrieved 2017-03-22.
  3. 1 2 3 4 5 Rausch, Christopher (2008). "The Midwife and the Forceps;The Wild Terrain of Midwifery Law in the United States and Where North Dakota is Heading in the Birthing Debate". North Dakota Law Review. 84 (I): 219–255.
  4. "Legal Status of U.S. Midwives". mana.org. 2013-08-08. Retrieved 5 November 2014.
  5. 1 2 Elton, Catherine (2010-09-04). "American Women: Birthing Babies at Home". Time. Retrieved 5 November 2014.
  6. Cheyney, Melissa; Everson, Courtney; Burcher, Paul (March 2014). "Homebirth Transfers in the United States: Narratives of Risk, Fear, and Mutual Accommodation". Qualitative Health Research. 443 (24).
  7. "State By State". mana.org. 2023-05-01. Retrieved 1 May 2023.
  8. Rausch, Christopher (2008). "The Midwife and The Forceps: The Wild Terrain of Midwifery Law in the United States and Where North Dakota is Heading in the Birthing Debate". North Dakota Law Review. 84 (1): 219–255.
  9. 1 2 Crilley, Claire (July 2014). ""The midwife must be abolished!": The Fall of Midwifery in Mid-Twentieth Century New Orleans". Newcomb College Institute Research on Women, Gender, & Feminism. 1 (2): 14–20.
  10. 1 2 3 4 5 Stover, Sarah Anne (2011). "Born by the Woman, Caught by the Midwife: The Case for Legalizing Direct-entry Midwifery in all 50 States". Health Matrix: Journal of Law-Medicine. 21 (1): 307–351.
  11. 1 2 Sandall, Jane (December 2012). "Every Woman Needs a Midwife, and Some Women Need a Doctor Too". Birth. 39 (4): 323–326. doi:10.1111/birt.12010. PMID   23281954.
  12. Sakala, Carol; Corry, Maureen (October 2008). "Evidence-Based Maternity Care: What It Is and What It Can Achieve". Childbirth Connection.
  13. ten Hoope-Bender, Petra (2014). "Improvement of maternal and newborn health through midwifery". Lancet. 384 (9949): 1226–1235. doi:10.1016/s0140-6736(14)60930-2. PMID   24965818. S2CID   205973325.
  14. Snowden, Jonathan M.; Tilden, Ellen L.; Snyder, Janice; Quigley, Brian; Caughey, Aaron B.; Cheng, Yvonne W. (2015). "Planned Out-of-Hospital Birth and Birth Outcomes". New England Journal of Medicine. 373 (27): 2642–2653. doi:10.1056/NEJMsa1501738. PMC   4791097 . PMID   26716916.
  15. Stover, Sarah (2011). "Born by the Woman, Caught by the Midwife: The Case for Legalizing Direct-Entry Midwifery in All Fifty States". Health Matrix: Journal of Law-Medicine. 21 (1): 307–351. PMID   21847904.