Midwifery Practice and Education: Current Challenges and Opportunities

By Walker, Deborah; Lannen, Barbara et al. | Online Journal of Issues in Nursing, May 2014 | Go to article overview

Midwifery Practice and Education: Current Challenges and Opportunities


Walker, Deborah, Lannen, Barbara, Rossie, Debra, Online Journal of Issues in Nursing


Midwifery is an ancient profession still actively practiced throughout the world. In the United States, the first modern day nurse-midwives were British- educated women brought to this country by Mary Breckinridge in 1925. Their focus was to provide healthcare in the remote mountains of rural Kentucky (Kina et. al. 20131 for an organization that became known as the Frontier Nursing Service (FNS). The same year, the first school specifically established to educate nurse-midwives was established in New York City, the Manhattan Midwifery School.

From these early beginnings, the profession has grown to include 13,607 Certified Nurse-Midwives (CNMs), 87 Certified Midwives (CMs) (AMCB.2014b! and 39 CNM/CM education programs (ACNM.2012bJ. The current maternal-infant healthcare climate in the US is widely acknowledged to be in great need of modification with midwives being seen as key in returning birth care to a more normal, physiologic state that is woman-centered. Consequently, more needs to be done to realize the goal of every woman and family having access to midwifery care. Yet legislative, business, and education challenges to midwifery practice remain. Reviewing all the clinical practice and educational challenges is not within the scope or space limitations of this paper; thus, select current clinical practice and educational challenges as well as

possible solutions are discussed.

Background of CNM Practice

CNMs are registered nurses educated In the two disciplines of midwifery and nursing who attend graduate education programs (usually in schools/colleges of nursing) approved by the Accreditation Commission for Midwifery Education (ACME). Graduates must pass a national certification exam administered by the American Midwifery Certification Board (AMCB); they are licensed and have prescriptive authority in every state (ACNM. 2012c). The American College of Nurse-Mldwlves (ACNM) values graduate education but does not support only the Doctor of Nursing Practice (DNP) as a requirement for entry Into practice (ACNM. 2012d). CMs are educated in the discipline of midwifery and earn graduate degrees from ACME accredited midwifery education programs after completing health and science education requirements (ACNM. 2012c). CM education programs base their curricula on the same ACNM documents as CNM programs and their graduates sit for the same certification exam (ACNM. 2012c). CMs are currently licensed in five states: Delaware, Missouri, New York, New Jersey, and Rhode Island.

Successful completion of the ACME accredited education programs demonstrates that CNM/CMs have met the ACNM Core Competencies for Basic Midwifery Practice (ACNM. 2012e). Midwives practice in accordance with the ACNM Standards for the Practice of Midwifery (ACNM. 2011a) which are consistent with or exceed the global competencies and standards for midwifery practice as defined by the International Confederation of Midwives (ACNM. 2012c). To maintain the designation of CNM or CM, midwives must recertify every five years through AMCB and meet designated continuing education requirements (ACNM. 2012c). CNM/CMs represent the majority of US midwives and, in 2011, attended 92.2% of midwife-attended births (ACNM. 2013a). Other midwife providers Include Certified Professional Midwives (CPM), Direct Entry Midwives (DEM) and lay midwives. In this paper, the terms "midwives" and "midwifery" are used to signify CNM/CMs and their clinical practice.

Midwives are designated primary care providers, and their care Includes primary; gynecologic and family planning; preconception; pregnancy, childbirth and the postpartum period; normal newborn during the first 28 days of life; and treatment of male partners for sexually transmitted infections (ACNM. 2012c). Care settings include outpatient clinics, private offices, community and public health centers, birth centers, homes, hospitals, and more. Midwifery care also includes health promotion, disease prevision, and individualized wellness education and counseling (ACNM. …

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