Nurse-Midwives

Nurse-midwives examine pregnant women and monitor the growth and development of fetuses. Typically a nurse-midwife is responsible for all phases of a normal pregnancy, including prenatal care, assisting during labor, and providing follow-up care. A nurse-midwife always works in consultation with a physician, who can be called upon should complications arise during pregnancy or childbirth. Nurse-midwives can provide emergency assistance to their patients while physicians are called. In most states, nurse-midwives are authorized to prescribe and administer medications. Many nurse-midwives provide the full spectrum of women's health care, including regular gynecological exams and well-woman care.

Not all midwives are certified nurse-midwives. Most states recognize other categories of midwives, including direct-entry (or licensed) midwives, certified professional midwives, and lay (or empirical) midwives.

Direct-entry midwives are not required to be nurses in order to practice as midwives. They typically assist in home births or at birthing centers and are trained through a combination of formal education, apprenticeship, and self-education. Although they generally have professional relationships with physicians, hospitals, and laboratories to provide support and emergency services, few direct-entry midwives actually practice in medical centers. Direct-entry midwives can receive the Certified Midwife (CM) designation from the American College of Nurse-Midwives as a recognition of their professional abilities. CMs are licensed to practice in New York, New Jersey, and Rhode Island.

Certified professional midwives (CPMs) must meet the basic requirements of the North American Registry of Midwives (NARM). Potential CPMs must pass a written examination and an assessment of their skills, and they must have proven training assisting in out-of-hospital births. The NARM accepts various midwifery programs and practical apprenticeship as a basis for certification. For more information, visit http://www.narm.org.

Lay midwives usually train by apprenticing with established midwives, although some may acquire formal education as well. Lay midwives are not certified or licensed, either because they lack the necessary experience and education or because they pursue nontraditional childbirth techniques. Many lay midwives practice only as part of religious communities or specific ethnic groups, and they typically assist only in home birth situations. Some states have made it illegal for lay midwives to charge for their services.

Education and certification standards for direct-entry midwives, certified professional midwives, and lay midwives vary from state to state. Certified nurse-midwives, who must complete a core nursing curriculum—as well as midwifery training—to become midwives. When the terms "nurse-midwife" and "midwife" are used, certified nurse-midwife is implied.

An important part of a nurse-midwife's work is the education of patients. Nurse-midwives teach their patients about proper nutrition and fitness for healthy pregnancies and about different techniques for labor and delivery. Nurse-midwives also counsel their patients in the post-partum period about breast-feeding, parenting, and other areas concerning the health of mother and child. Nurse-midwives provide counseling on several other issues, including sexually transmitted diseases, spousal and child abuse, and social support networks. In some cases, this counseling may extend to family members of the soon-to-be or new mother, or even to older siblings of the family's newest addition.

Nurse-midwives may also record patient information, file documents and patient charts, do research to find out why a woman is having a particular problem, and consult with physicians and other medical personnel. Many midwives build close relationships with their patients and try to be available for their patients at any time of the day or night.



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