HISTORY OF THE PROFESSION

Nurse-midwifery dates back to 1925 in the United States. At that time, Mary Breckenridge developed the Frontier Nursing Service in Kentucky. The program used public health registered nurses, who had been educated in England, to staff nursing centers in the Appalachian mountains. The centers offered family health care services, as well as childbearing and delivery care, to residents in the area.

The first nurse-midwifery education program in the U.S. began in 1932 at the Maternity Center Association of New York City. The program enrolled public health nurses, and awarded its graduates a certificate in nurse-midwifery.

Today, all nurse-midwifery programs are in colleges and universities. Most nurse-midwives graduate at the Master's degree level. These programs must be accredited by the American College of Nurse-Midwives (ACNM) in order for graduates to take the National Certification Examination.

There are 40 ACNM accredited nurse-midwifery programs in the U.S. Applicants for nurse-midwife programs usually must be registered nurses and have at least 1-2 years of nursing experience. As with the nursing profession in general, most certified nurse-midwives (CNMs) are women. However, in recent years more male nurses have chosen to become nurse-midwives.

Nurse-midwives have improved primary health care services for women in rural and inner-city areas. The National Institute of Medicine has recommended that nurse-midwives be given more responsibility for delivering women's health care.

Many studies over the past 20 - 30 years have shown that nurse-midwives can manage most perinatal (including prenatal, delivery, and postpartum) care, and most of the family planning and gynecological needs of women of all ages.

Nurse-midwives work together with OB/GYN doctors. They either consult with or refer to other health care providers in cases that are outside of their experience (for example, high-risk pregnancies and pregnant women who also have a chronic disease).

See also: Types of health care providers

SCOPE OF PRACTICE

The nurse-midwife is educated and trained to provide a broad range of health care services for women and newborns. CNM functions include diagnosis (taking a medical hystory, doing a physical assessment, ordering laboratory tests and procedures), managing therapy (outlining care, providing prescriptions, coordinating consultations and referrals), and activities that promote women's health and reduce health risks.

Although most of the CNM practice focuses on childbearing, family planning, and gynecological care for well women, CNMs may also check and manage common illnesses in adults. All services are done together with the patient.

As with the nurse practitioner profession (NP), CNMs are legally allowed to write prescriptions in some states but not in others. CNMs provide independent health care management, consultation or co-management, and referral services.

PRACTICE SETTINGS

Certified nurse-midwives work in a variety of settings, including private practices (either by themselves or together with a physician), health maintenance organizations (HMOs), hospitals, health departments, and birthing centers. CNMs often provide care to underserved populations in rural areas or inner-city settings.

REGULATION OF THE PROFESSION

As with many other professions, certified nurse-midwives are regulated at 2 different levels. Licensing occurs at the state level and falls under specific state laws. As with other advanced practice nurses (such as nurse practitioners), license requirements for CNMs can vary from state to state. The current trend is to require a master's degree and national certification.

Certification is done through a national organization and all states have the same requirements for professional practice standards. Only graduates of nurse-midwifery programs accredited by the American College of Nurse-Midwives (ACNM) are eligible to take the certification exam given by the ACNM Certification Council, Inc.