WHAT IS A CERTIFIED NURSE-MIDWIFE (CNM)?
Midwives provide initial and ongoing comprehensive assessment, diagnosis and treatment. They conduct physical examinations; prescribe medications including controlled substances and contraceptive methods; admit, manage and discharge patients; order and interpret laboratory and diagnostic tests and order the use of medical devices. Midwifery care also includes health promotion, disease prevention, and individualized wellness education and counseling. These services are provided in partnership with women and families in diverse settings such as ambulatory care clinics, private offices, community and public health systems, homes, hospitals and birth centers.
Midwifery as practiced by CNMs encompasses a full range of primary health care services for women from adolescence beyond menopause. These services include primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth and the postpartum period, care of the normal newborn during the first 28 days of life, and treatment of male partners for sexually transmitted infections.
Education and Training
CNMs are educated in two disciplines: midwifery and nursing. They earn graduate degrees in Nurse-Midwifery (Master of Science in Nurse-Midwifery, or MSN), complete a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass a national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM. Then they must meet their individual state requirements for licensing.
CNMs must demonstrate that they meet the Core Competencies for Basic Midwifery Practice of the American College of Nurse-Midwives (ACNM) upon completion of their midwifery education programs and must practice in accordance with ACNM Standards for the Practice of Midwifery. ACNM competencies and standards are consistent with or exceed the global competencies and standards for the practice of midwifery as defined by the International Confederation of Midwives To maintain the designation of CNM or CM, midwives must be recertified every 5 years through AMCB and must meet specific extensive continuing education requirements.
What are the “Midwifery model of care” and the “Medical model of care”?
Views of the childbearing process and of appropriate care for childbearing women vary. Two contrasting perspectives are often called the “midwifery Model of Care” and the “Medical Model of Care.” There are striking differences in the two models. These differences can have a great impact on your experience and outcomes.The classic midwifery model is based on the assumption that most pregnancies, labors, and births are normal biological processes that result in healthy outcomes for both mothers and babies. It focuses on maximizing the health and wellness of a woman and her baby, identifying and managing medical problems early on, and attending to the emotional, social, and spiritual aspects of pregnancy and birth.
Midwifery care seeks to protect, support, and avoid interfering with the unique rhythm, character, and timing of each woman’s labor. Midwives are trained to be vigilant in identifying women with serious complications. Medical expertise and interventions are sought when necessary but are not used routinely.A strict medical model of care focuses on preventing, diagnosing, and treating the complications that can occur during pregnancy, labor, and birth. Prevention strategies tend to emphasize the use of testing, coupled with the use of medical or surgical interventions to avert a poor outcome. Medical expertise and interventions are vital for women and babies with complications. However, routine interventions on women at low risk of problems can actually lead to problems. Training in the medical model does not typically focus on developing skills to support the natural progression of an uncomplicated birth.
Find out more about the different kinds of physicians and midwives who provide care: Choosing a Maternity Care Provider
Here are some contrasts between the two models:
Midwifery Model of Care
- Birth is a social event, a normal part of a woman’s life.
- Birth is the work of the woman and her family.
- The woman is a person experiencing a life-transforming event.
- Hospital, home, or other out of hospital setting.
- Informal system of care
- See birth as a holistic process
- Shared decision-making between caregivers and birthing woman
- No class distinction between birthing women
Medical Model of Care
- Childbirth is a potentially pathological process.
- Birth is the work of doctors, nurses, midwives and other experts.
- The woman is a patient.
- Hospital, unfamiliar territory to the woman
- Bureaucratic, hierarchical system of care
- Trained to focus on the medical aspects of birth
- “Professional” care that is authoritarian
- Often a class distinction between obstetrician and patients
Midwives Model of Care includes:
- monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
- providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
- minimizing technological interventions and
- identifying and referring women who require obstetrical attention.
Naturally, the midwifery model describes the practice of many midwives, and the medical model describes the practice of many doctors. But many caregivers combine elements of both. It is possible, but less common, to find doctors whose practice most closely resembles the midwifery model of care and midwives whose practice most closely resembles the medical model.Thinking about these different views can help you to understand your own values and ideas about pregnancy and birth, and can help you select a caregiver who is compatible with your needs and values. Many women have a clear preference for one or the other of these models. Take this quiz to see if a midwife might be right for you! Click on the link below.
Is a Midwife Right for You? QUIZ