Certified Professional Midwives
Certified Professional Midwives (CPMs) are knowledgeable, skilled and trained professional primary maternity care providers. CPMs are credentialed to offer expert care, education, counseling and support to women through pregnancy, birth and the postpartum period. CPMs practice as autonomous health professionals working within a network of relationships with other maternity care providers who can provide consultation and collaboration when needed. Among their qualities, CPMs are:
- Trained to provide health-promoting and preventive care that is evidence-based, incorporates best practices and avoids overuse of drugs and interventions
- The only maternity care providers specifically trained to attend births outside the hospital
- Independent practitioners who have met the standards for certification
- Licensed to practice in 25 states
Midwives attended the majority of births in the US until the early 20th century, when the associations of physicians began to assert authority over all health-related activities. Concerns over infant mortality and the well being of women in childbirth moved the experience into the realm of a health problem requiring medical expertise to manage. Nurse-midwifery originated in the 1920’s through the efforts of public health nurses and others who saw the need for midwives in growing populations that were underserved by physicians.
The number of nurse midwives grew to about 1,000 in the 1970’s, when several factors began to influence the practice, whether by nurses or by independent practitioners:
- Standard, formal education and certifications were established for nurse-midwives and Federal funds provided training.
- The number of independent midwife-attended births fell to its lowest point, at less than 1% in 1975.
- But the growing preference for natural home births began to grow, reinvigorating the use of trained non-nurse midwives, which led to expansion, professionalization and credentialing through the 1990s.
- In 2000, The National Association of Certified Professional Midwives was incorporated to develop and refine the standards, philosophy and scope of practice that led to a period of state licensure that continues today.
Professionals working in the US: Approximately 2,800
|Examples of Use||Education & Certification||Midwifery in US|
Examples of Use:
CPMs provide thorough care throughout the prenatal, delivery and postnatal stages of childbearing to women who are healthy and experiencing a normal pregnancy who will experience “normal physiological labor and birth.”* Among these services CPMs:
- Monitor the physical, psychological and social well being of the mother throughout the pregnancy and after delivery;
- Provide the mother with individualized education and counseling that emphasizes health promotion and the prevention of pregnancy problems;
- Provide hands-on assistance during labor and delivery and postpartum support;
- Identify and refer women who need obstetrical attention
These methods of trained maternity care result in healthy outcomes for mothers, babies and families, with high rates of full term, full weight babies. Research has shown that CPM care can lead to fewer interventions (including Cesarean section), fewer premature and low-birth-weight babies, and to significantly higher rates of breastfeeding.
From the Scope of Practice statement for members of NACPM:
“CPMs work with women and families to identify their unique physical, social and emotional needs. They are trained to recognize abnormal or dangerous conditions needing expert help outside their scope, and they maintain a plan for consultation and referral when these conditions arise. When needed, they provide temporary emergency care and support. NACPM members may practice and serve women in all settings and have particular expertise in out-of-hospital settings.”
* The following definition of “normal physiological labor and birth” was published in 2012 by three primary professional midwife organizations: the American College of Nurse-Midwives, the Midwives Alliance of North America, and the NACPM.
“A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus. This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts normal physiologic processes. Some women and/or fetuses will develop complications that warrant medical attention to assure safe and healthy outcomes. However, supporting the normal physiologic processes of labor and birth, even in the presence of such complications, has the potential to enhance best outcomes for the mother and infant.”
(See the link to the consensus document, with extensive footnotes, in the Reference Section at the end of this page.)
Education, Training and Certification
CPMs are trained in a variety of settings under the supervision of qualified instructors. Using a competency-based system to validate multiple routes of midwifery education, their training and education may occur in a classroom, private practice, or clinical setting, but it must include a minimum number of types of clinical experiences, including out-of-hospital births.
The education and training in the Basic and Clinical Sciences generally takes three to five years to complete.
CREDENTIALS AND CERTIFICATION
The Certified Professional Midwife credential was established in 1994. It is administered by the North American Registry of Midwives (NARM) which is accredited by the National Commission for Certifying Agencies (NCCA), the same agency that accredits the Certified Nurse-Midwife. The NCCA is the accrediting body of the National Organization for Competency Assurance (NOCA).
Certified Professional Midwives in US Healthcare
CPMs practice in most of the 50 states, even in states where there currently is no licensing for the profession. As of mid-2014 a number of active legislative initiatives were under way for licensing in the 25 states where none is yet available. There are a few states where CPMs are actively being prosecuted for practicing without a license, often in states where active legislative initiatives for licensing have been underway for many years.
CPMs and Nurse-Midwives
CPM’s are nationally credentialed and specifically trained for out-of-hospital birth, offering services at home and in birth centers. Certified Nurse Midwives are also nationally credentialed, but enter the profession through nursing, with additional training in midwifery. Their training includes advanced practice in gynecology and well-woman care, but they are not required to have training out-of-hospital birth, and very few choose to practice in out-of-hospital settings, in homes or in community birthing centers.
Medicaid: 12 states mandate Medicaid reimbursement for services by state plan amendment (Alaska, Arizona, California, Florida, Idaho, New Hampshire, New Mexico, Oregon, South Carolina, Vermont, Virginia, Washington)
Private Payer: Statutory mandate for private payer reimbursement in four states (WA, FL, VT, NH); reimbursement in other states varies widely
Affordable Care Act: Mandate for Medicaid reimbursement for provider fees at birth center facilities and in state-licensed providers and birth centers
References for Certified Professional Midwives
Professional Organizations and Certification for Certified Midwives
National Association of Certified Professional Midwives
Midwives Alliance of North America
Credentialing: North American Registry of Midwives
Education: Midwifery Education Accreditation Council
Coalitions: Collaborative Initiatives
Licensing: NACPM Licensing Details