The American College of Nurse-Midwives, With women, for a lifetime®
A Career in Nurse-Midwifery
Presented to the 61st Annual Convention of the National Student Nurses Association
April 5 & 6, 2013By
Elaine Germano, CNM, DrPH, FACNMSenior Education Policy Advisor
American College of Nurse-Midwives
The American College of Nurse-Midwives, With women, for a lifetime®
What is a Certified Nurse-Midwife?
• An advanced practice nurse educated in the two professions of nursing and midwifery
• Licensed to practice and prescribe in all 50 states, DC and most US Territories
• Provides primary care to women across the lifespan, including care during pregnancy and childbirth
The American College of Nurse-Midwives, With women, for a lifetime®
Midwifery: An Ancient Profession
The American College of Nurse-Midwives, With women, for a lifetime®
Mary Breckinridge
Founded the Frontier Nursing Service (FNS)
in1925
Sent British nurse-midwives on
horseback to isolated families in Appalachia
The American College of Nurse-Midwives, With women, for a lifetime®
FNS midwives cared for women and families in their homes in Appalachia
• In order to improve the health of families, we must first care for the mothers
The American College of Nurse-Midwives, With women, for a lifetime®
The Growth of Midwiferyis supported by publishedresearch that shows CNMs:
• Provide high-quality care• Have comparable or better
outcomes• Have high levels of patient
satisfaction• Lower costs due to fewer
interventions
The American College of Nurse-Midwives, With women, for a lifetime®
Nurse-midwives provide primary care to women across the lifespan
The American College of Nurse-Midwives, With women, for a lifetime®
So, What Exactly Do Nurse-Midwives Do?
• Well-Woman Annual Exams– Menstrual and sexual
history, along with family, medical and social history
– Physical exam, including breast and pelvic exams
– Pap test, STI screening– Lab, diagnostic tests– Prescriptions
The American College of Nurse-Midwives, With women, for a lifetime®
Midwives also provide: • Primary Care Visits
– Minor complaints, e.g. colds, flu, urinary tract infections
– Headache, depression, diabetes, thyroid conditions, etc
– Counseling (including preconception counseling)
The American College of Nurse-Midwives, With women, for a lifetime®
Prenatal Care
• Regular individual or group visits• Partners encouraged to attend!• Vital signs, lab and diagnostic tests • Fetal Assessment (heart tones, fundal height)• Nutritional/exercise assessment
The American College of Nurse-Midwives, With women, for a lifetime®
Post-partum care and Breastfeeding support
The American College of Nurse-Midwives, With women, for a lifetime®
A Typical Day in the Office• First patient:
– First visit of 26 year old woman, 1st pregnancy, LMP 2/22/12, EGA 6w1d
– c/o urinary frequency and intermitant R-sided pain, 7 on scale of 10; decreased appetite
– Denies vag bldg, nausea, vomiting or other sx• Gather additional data:
– PMH, PSH, Gyn hx, Ob hx, Soc hx– Allergies, Meds, Pre-pregnancy wt
The American College of Nurse-Midwives, With women, for a lifetime®
First Patient (cont.)• Gather objective data:
– VS, ht, wt, BMI – Labs – PE– transvaginal u/s
• What are your concerns?– Ectopic pregnancy– Medications– UTI
The American College of Nurse-Midwives, With women, for a lifetime®
First Patient (cont)• Assessment
– 26yo GIP0, EDD 12/1/13– IUP GA 6w1d– UTI
• Management Plan– Tx UTI– Counsel re: exercise, diet, expected wt gain,
medications; stage of pregnancy expectations
The American College of Nurse-Midwives, With women, for a lifetime®
Second Patient• Returning client
– 19yo female, taking ocps x2 mos, c/o bloating, breast tenderness, thinking of stopping pills; also c/o vag discharge x5 d
– Denies vag itching or d/c, admits to some dysparuina and dysuria, unsure about partner sx
• Gather additional data:– Review hx, any changes incl. change in partner?– Use of condoms, correct use of ocps?
The American College of Nurse-Midwives, With women, for a lifetime®
Second Patient (cont.)• Gather objective data:
– VS, wt– Labs, incl. wet prep + GC/CT, UA– Pelvic exam
• What are your concerns?– UTI– STIs– Correct use of ocps
The American College of Nurse-Midwives, With women, for a lifetime®
Second Patient (cont.)• Assessment
– BV, Trichomoniasis– At risk for pregnancy
• Management Plan– Tx STI and vag. infection– Counsel re: use of condoms, continuing current
ocps, consider change in 1 month
The American College of Nurse-Midwives, With women, for a lifetime®
Additional Patients• 52yo woman c/o perimenopausal sx, smoker,
wants HRT• 33yo G3P2, 20 wks GA, no concerns, 28 lb wt
gain• 28yo G2P2, IUD Paragard x3 yrs c/o excessive
bleeding and lower abd pain• 27yo G2P1, 37 wks GA, normal pregnancy,
tired of being pregnant, wants induction
The American College of Nurse-Midwives, With women, for a lifetime®
Healthy Mothers, Healthy Babies, Healthy Families
The American College of Nurse-Midwives, With women, for a lifetime®
Philosophy of Care• Listening to women – the hallmark of
midwifery care• Focus on prevention and education• View pregnancy as a normal process• Provide compassionate and family-centered
care• Encourage women’s participation in
decision-making• Use technology and intervention appropriately• Consultation, collaboration and referral with
members of the health care team
The American College of Nurse-Midwives, With women, for a lifetime®
Midwives promote the health and well-being of women and infants within their families and
communities
The American College of Nurse-Midwives, With women, for a lifetime®
Emphasis on Primary Care
Reproductive Care(53.3%)
Primary Care(33.1%)
Labor and Birth(13.6%)
The American College of Nurse-Midwives, With women, for a lifetime®
Antepartum
Intrapart
um
Postpart
um
Newborn
Gyneco
logy
Primary
Care0%
10%20%30%40%50%60%70%80%90%
100%
Scope of Practice of Full-Time Midwives
The American College of Nurse-Midwives, With women, for a lifetime®
CNMs Have Excellent Outcomes
00.5
11.5
22.5
33.5
4
Infant Mortality
NeonatalMortality
LowBirthweight
CNMs
MDs
The American College of Nurse-Midwives, With women, for a lifetime®
Midwives Provide Effective Labor
Support• Twice as much ambulation in labor• Twice as much intermittent
monitoring• Twice as many non-medicated births• Half as many episiotomies• Supportive care during labor
The American College of Nurse-Midwives, With women, for a lifetime®
Midwifery Prenatal Care Contributes to Excellent
Outcomes
Midwifery Prenatal Care
Listen to Women
Provide Emotional
Support
Pregnancy and Birth
Education
Collaborate with Physicians
The American College of Nurse-Midwives, With women, for a lifetime®
Patients Prefer Practices with CNM Providers
0
20
40
60
80
100
%
Satisfied Use Again
CNMs
NoCNMs
The American College of Nurse-Midwives, With women, for a lifetime®
Where do midwives attend births?
Hospital Birth Center Home0
102030405060708090
10096.1
2.1 1.7
%
The American College of Nurse-Midwives, With women, for a lifetime®
Planned Home Birth: A Safe Option
with ACNM Midwives
• Low Infant Mortality - 2.5 per 1000• Transfer to hospital during labor- 8.3%• Postpartum/Neonatal Transfers - 1.9%
The American College of Nurse-Midwives, With women, for a lifetime®
Reimbursement for CNMs
• Medicaid: mandatory coverage of CNMs in all states
• Medicare: sets standard for all private insurance, CNMs at 100% of physician fee schedule
• Private insurance: mandated coverage of CNM services in 33 states
The American College of Nurse-Midwives, With women, for a lifetime®
Primary Employers
• Hospitals and medical centers: 35%• MD practices: 30%• Community health centers: 8.4%• Midwife Practice: 7%• Academic Institution: 7%• Other: 12.6%
The American College of Nurse-Midwives, With women, for a lifetime®
Salary
• Full-time (35 hrs per wk or greater) average $114,152 per year
• Productivity bonus: 25 % receive, 75% do not
The American College of Nurse-Midwives, With women, for a lifetime®
The American College of Nurse-Midwives
• The professional association representing CNMs and Certified Midwives (CMs)
• Since 1929 - oldest women's health care organization in the US
• Ensures foundation of midwifery education through the Core Competencies for Basic Midwifery Practice
• Sets Standards for the Practice of Midwifery• Provides Clinical Bulletins
The American College of Nurse-Midwives, With women, for a lifetime®
ACNM’s Department of Global Outreach
• Since 1982 – projects and technical assistance in 30 developing countries
• Devised Life Saving Skills Training Program used in Asia and Africa
• Assists and strengthens midwifery associations
The American College of Nurse-Midwives, With women, for a lifetime®
Midwifery Education• 39 midwifery education
programs nationwide• Most onsite; 5 fully
distance-based• Bridge programs (ADN
to MSN)• Master’s programs• DNP programs
The American College of Nurse-Midwives, With women, for a lifetime®
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te, Nursi
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Associa
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Bachelor's
, Nursi
ng
Bachelor's
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ursing
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er's, N
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ype
0
10
20
30
40
50
60
Earned Degrees of CNMs and CMs (%)
The American College of Nurse-Midwives, With women, for a lifetime®
2008 2009 2010 2011 20120
50
100
150
200
250
300
350
400
450
500
320 325344
398
474
The Number of New CNM/CMs Has Risen 48% Since 2008Source: American Midwifery Certification Board
The American College of Nurse-Midwives, With women, for a lifetime®
Midwifery Certification• National certification exam administered by
American Midwifery Certification Board• Graduate Degree required in order to take
certification exam• Number of ever-certified CNMs/CMs more
than 12,000• Recertification every five years
The American College of Nurse-Midwives, With women, for a lifetime®
Learn More…
• Learn more about midwifery at www.midwife.org
• See http://midwife.org/become_midwife.cfm for midwifery education information
• Visit http://midwife.org/find.cfm to find a midwife in your area
• See www.gotmom.org for ACNM’s online breastfeeding resource