What IS A NURSE-MIDWIFE?
DON'T WORRY! We get this question ALL THE TIME.
There is a lot of confusion in the community about what a midwife is exactly, let alone what a nurse-midwife is. We are used to being asked if we are the same as a doula (a doula is an invaluable member of a birth team who provides non-medical support to women and their partner during labor, but we are not the same). We get shocked looks when people hear that we work in a variety of settings, including hospitals. In fact, many nurse-midwives in California work for well-known healthcare organizations like Kaiser or the UC Healthcare Systems, where they hold faculty positions and train incoming medical students and resident physicians during their first few years of obstetrics and gynecology programs. We're kind of a big deal! We are experts at normal birth.
Midwives can function in many different roles, which vary based on their training, certifications, and licensure. There are several types of midwives, and you can learn more about some of the other types of midwives HERE.
In California, there are approximately 1,200 Nurse-Midwives. Nurse-midwives attend approximately 11% of all the vaginal births in California, of which 95% occur in the hospital.
Nurse-midwives, or "certified nurse-midwives" (CNMs) are masters-prepared or doctorally-prepared nurses who have first completed training in nursing and have taken the registered nursing license exam. In addition to training as a nurse, the nurse-midwife has completed a higher education program (either a master's or doctoral degree with a focus in midwifery) and performed hundreds to thousands of additional clinical hours both managing primary care patients and attending births during their training. After the completion of a higher education program, Certified Nurse-Midwives sit for an additional national certification exam. Nurse-midwives are entitled to apply for a furnishing license and a DEA license from the state of California after the completion of their education and licensing, allowing us to independently prescribe medications to the patients we are treating.
Another common question we hear is: what is the difference between a nurse and a nurse-midwife? The difference between a registered nurse and a Certified Nurse-Midwife is that a registered nurse supports the care of a patient by carrying out orders from a provider (a physician or a Certified Nurse-Midwife, for example), while the Certified Nurse-Midwife has an increased scope of practice that allows them to diagnose and treat patients within their area of expertise, including independently managing the birth of a baby. The area of expertise for a nurse-midwife includes both primary care and maternity care for healthy women and their families. For example, nurse-midwives may independently delivery a baby in an uncomplicated vaginal delivery or, in consultation with a physician, may treat a patient with uncomplicated primary hypertension. Nurse-midwives can even assist physicians in the operating room with routine or emergency cesarean births. Like all healthcare providers, the Nurse-midwife performs patient care within their designated scope of practice. Nurse-midwives are an integral part of team-based care. In the team-based approach, nurse-midwives can also co-manage moderate-risk clients in consultation with a physician. In this model of care, the physician attends to the medical needs of the client, while the nurse-midwife attends to the birth. It is through this approach that every patient, especially those with diverse needs, gets the right care at the right time by a diverse group of providers.
California's Nurse-Midwifery Scope of Practice
The CA nurse-midwife provides the necessary supervision, care and advice in a variety of settings to women during pregnancy, labor and postpartum periods, conducts deliveries on his or her own responsibility and cares for the newborn and the infant. This includes preventive measures and the detection of abnormal conditions in mother and child and procurement of physician assistance and consultation when indicated, and execution of emergency care until physician assistance can be obtained. The nurse-midwife also provides well-woman care including interconceptional periods, and family planning needs. For any activities provided outside of this scope, the CNM utilizes standardized procedures as described in Section 2725 of the Code. (CCR § 1463)
Whether the nurse-midwife is practicing as a home birth provider or working in the hospital setting, the nurse-midwife provides independent patient care while practicing collaboratively with provider counterparts, like physicians, anesthesiologists, social workers, registered nurses, and case managers to deliver safe, cost-effective care to healthy women and their families. Like all medical professionals, nurse-midwives are bound by a code of ethics and adhere to a well-defined scope of practice.
In recent years, California has been in the spotlight for a growing healthcare crisis. Organizations like the CDC and the WHO have reported higher cesarean birth rates and worsening maternal child health outcomes across the country. There is a growing lack of access to healthcare for patients in rural and urban areas due to the high cost of healthcare or loss of insurance coverage. The goals set fourth by the Healthy People 2020 Initiative for maternal-child care will not be met by the year 2020. There is an increasing gap in quality and access to care for women and families of color, resulting in higher maternal mortality rates for those women. Additionally, California is facing a growing healthcare provider shortage as less and less primary care physicians and obstetricians are entering the workforce.
Fortunately, nurse-midwives can be part of the solution to this epidemic in California. Nurse-midwives are well known to have better outcomes for women during pregnancy care than the popularized medical model of care. Nurse-midwives follow the nursing-model of care that practices a physiologic approach to pregnancy and heath management. The physiologic approach to birth means that nurse-midwives treat pregnancy like a natural process, rather than an illness or disease. The nursing model looks at the whole patient, addressing the individuals needs from physical, emotional, and psychological considerations. In birth, the nurse-midwife is trained to care for healthy patients with less interventions than the medical model, resulting in increased use of non-pharmaceutical methods of pain and labor management. The nurse-midwife can boast a plethora of advantages for their patients using this approach, including lower cesarean birth rates, higher successful vaginal birth after a past cesarean delivery, fewer episiotomies, less narcotic use, fewer medical interventions during labor, less perineal trauma, higher rates of breastfeeding, better outcomes for patients facing racial disparities, and better maternal and neonatal health outcomes both during and after pregnancy.
Additionally, nurse-midwives are staunch advocates for patients, including getting involved at the state level to improve maternal-child health outcomes through changing legislation. Nurse-midwives have historically fought for better access to safe, cost-effective healthcare for all patients, and continue to fight for anti-racism and reproductive justice for all Californians today. The California Nurse-Midwives Association (CNMA) is the professional organization that represents the professional nurse-midwives in California. CNMA works with its members to organize advocacy efforts at local and state levels of government in California. CNMA believes that Californians deserve equal access to maternity care, and that every family deserves a midwife.
You can learn more about Nurse-midwives HERE, learn more about the California Nurse Midwives Association HERE, our exciting advocacy efforts HERE, and you can even meet some of the midwives of California on our Meet the Midwives page HERE to see the faces of real midwives who provide excellent patient care every day to families across the state. If you are a family considering pregnancy, we encourage you to consider midwifery care with your next baby, and to always keep midwives on your mind when you visit the ballot box!
Elizabeth Kicko, MS-RN, CNM, PHN, WHNP-BC
Edited by Holly Smith, CNM
Health Policy Committee Chair