References to the practice of midwifery have been found as far back in history as notations on an Egyptian medical papyrus dated 1900 BC. Throughout human history midwives have attended to the healthcare needs of women, focusing primarily on labor and delivery, but over time the role of the midwife has expanded to include routine gynecological and primary care for women.
Certified Nurse Midwives (CNM) are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Nurse-midwives have been practicing in the United States since the 1920s.
While most women are familiar with the role of today’s CNM in providing pre-natal and obstetrical care, they might not have considered choosing a CNM for their routine primary and gynecological care, whether they plan on having children or not. A CNM is trained and licensed to provide a far broader spectrum of services than you might be aware, and many women are now choosing to use CNMs as their primary healthcare provider throughout their childbearing years and well past menopause. According to the American College of Nurse-Midwives (ACNM), 53.3% of CNMs identify reproductive care and 33.1% identify primary care as main responsibilities in their full-time positions.
How are CNMs trained? The Accreditation Commission for Midwifery Education (ACME) is the official accrediting body for CNM education programs. There are 39 ACME-accredited midwifery education programs in the United States. Most midwifery programs require applicants to have a bachelor’s degree, although some will admit Registered Nurse without bachelor’s degree and direct them through a BSN (Bachelors of Science in Nursing) degree program before they begin their midwifery education. CNMs must possess a master’s degree from an accredited institution.
What services can CNMs provide? Not only are midwives central to providing obstetric and newborn care, they are also qualified to provide routine primary care and gynecological services. By choosing a CNM as their primary care provider, women’s gynecological and obstetrical needs can be seamlessly integrated into their total healthcare plan. Many CNMs work within practices that include physicians and other providers with whom they collaborate, and cross-disciplinary consultation is common. CNMs can perform pelvic exams, pap smears, STD testing and education, diagnose and treat illness, and refer to specialists when appropriate. They can also perform annual physicals, prescribe medications, order tests, help manage chronic diseases, and follow women all the way through conception, pregnancy, delivery, and post-partum care.
Why choose a midwife over a PCP? The choice of a medical provider is a highly personal one, and women should be encouraged to choose a provider with whom they feel they can have a trusting, and confident relationship. Many women who choose a CNM as a primary care provider appreciate the continuity of care throughout their reproductive years and beyond, while some prefer a provider with a particular specialty.
The future of midwifery. CNMs and other Advanced Practice Registered Nurses (APRNs) are a critical component of addressing the nationwide shortage of primary care providers (PCPs). With record numbers of primary care physicians retiring, and fewer medical school graduates choosing primary care as a specialty, patients are experiencing more difficulty than ever finding a primary care provider. This problem is acutely felt in rural communities like ours, but by integrating the services of CNMs and APRNs into primary care practices, we can address the issues of access and affordability while maintaining the highest standards of care.
A recent report by the Institute of Medicine (IOM) highlights the role of CNMs and other types of APRNs in re-shaping the face of our healthcare system in the coming years. The field of nursing has expanded tremendously and now includes specialized practitioners with advanced education, training, and experience in providing services previously only provided by physicians.
The American College of Nurses reports that as of February 2015 there were 11,018 CNMs practicing across the country. As enrollment in midwifery education programs continues to grow and the number of Americans with access to health insurance continues to expand, more women are being offered the services of a CNM for their routine primary and gynecological care. These specialized providers offer women the benefit of extensive education, training, and experience in their field and can provide excellent care throughout a woman’s reproductive years and beyond.