ACNM Issue Brief on Midwifery Certification FAQs

These FAQs have been compiled to accompany the publication of the 2008 ACNM Issue Brief on Midwifery Certification and will be updated periodically as needed. Please send additional questions or comments on the Issue Brief to issuebrief@acnm.org. We ask that you please indicate your ACNM membership status on all correspondence.

1. Why did ACNM publish this Issue Brief?
2. What has been changed in the 2008 version of the Issue Brief?
3. Is ACNM moving toward or away from acceptance of direct-entry midwifery?
4. What is ACNM’s position on midwifery licensure?
5. Is it new for ACNM to take the position that professional midwives must complete a formal education program?
6. The new Issue Brief on Midwifery Certification doesn’t mention other midwifery certifications beyond those offered by ACNM. Why?
7. Do other certifications besides the CNM and CM meet ACNM’s criteria for professional midwifery specified in the Issue Brief?
8. What accrediting agencies are recognized by the U.S. DOE?
9. What does ACNM hope to accomplish with this revision?
10. Why did ACNM relate its position on professional midwifery to the internationally recognized definitions of skilled attendant and traditional birth attendant?
11. Are there other differences between CNMs and CMs, and other professional midwives?
12. How will this Issue Brief impact ACNM’s state legislative efforts?
13. Is this Issue Brief in some way a position against home birth?
14. Does the Issue Brief assert that those who don’t meet ACNM’s criteria for “professional midwives” cannot call themselves midwives?
15. If demand for midwifery increases, won’t we need more midwives?
    

1.  Why did ACNM publish this Issue Brief?

ACNM is the national organization representing more than 6,000 Certified Nurse-Midwives® (CNMs) and Certified Midwives® (CMs) from all 50 states, the District of Columbia and most U.S. territories. ACNM originally published an Issue Brief on Midwifery Certification in 1997 to explain ACNM’s decision to create its CM program and embrace this pathway to enter the midwifery profession without a nursing credential.

The 1997 Issue Brief explained that CMs are educated to meet the same high standards that CNMs must meet—the standards that every state in the U.S. has recognized as the legal basis for nurse-midwifery practice. Like CNM education programs, all education programs for CMs award a post-baccalaureate certificate or higher degree. CMs take the same AMCB certification exam as CNMs and study side by side with nurse-midwifery students in some education programs. As an organization, ACNM supports efforts to legally recognize CMs as qualified midwifery practitioners granted the same rights and responsibilities as CNMs.

In the wake of the 1997 Issue Brief, ACNM adopted a stance of neutrality regarding midwifery certification; ACNM acknowledged that other certification mechanisms exist, but did not take a position nationally. Ten years later, ACNM members, consumers and legislators/regulators have increasingly expressed dismay and confusion over the variety of certifications, credentials, and acronyms used by midwives, particularly as legislation related to the licensure of direct-entry (non-nurse) midwives is debated at the state level. ACNM’s neutrality has been misinterpreted to mean both approval and disapproval of state legislative initiatives. The document is outdated and does not help ACNM members address current policy issues.

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2. What has been changed in the 2008 version of the Issue Brief?
The position defined in the new Issue Brief is a logical application of ACNM’s long-established principles upon which we have based requirements for midwifery preparation. We also believe that it reflects the majority opinion of the ACNM membership.

ACNM now has joined with the international community (including the World Health Organization, the International Confederation of Midwives, and the International Federation of Gynaecologists and Obstetricians) in expressing the strong belief that completion of an accredited formal education program is essential to preparation for professional midwifery practice.

In putting forth this Issue Brief, ACNM now has a stronger statement on minimum requirements for entry into the professional practice of midwifery. This clarity will be used to inform our state legislative, regulatory and professional practice advocacy.

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3. Is ACNM moving toward or away from acceptance of direct-entry midwifery?
ACNM is proud of its roots in nursing and midwifery, but recognizes that many qualified individuals wish to become midwives and do not wish to become nurses. Over the past 15 years, ACNM’s position on this issue has evolved considerably. The first major step was the development of a certified midwife (CM) credential, which offers a comparable accredited route to midwifery for non-nurses, often taught alongside nurse-midwifery students. CMs and CNMs take the same national certification examination.

Through the revised Issue Brief on Midwifery Certification, ACNM has broadened its recognition of professional midwives to include those who have graduated from an accredited educational program recognized by the U.S. Department of Education (i.e., in 2008, this would include the ACNM Division of Accreditation or the Midwifery Education Accreditation Commission); successfully completed a national certification examination (i.e., in 2008, this would include the American Midwifery Certification Board and the National Alliance of Registered Midwives examinations); and who adhere to the standards for practice and recertification and continuing education requirements developed by the profession.

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4. What is ACNM’s position on midwifery licensure?
It is the responsibility of each state to protect its citizens by establishing regulations for licensure of qualified health care providers. ACNM believes that all professional midwives practicing in a state should be licensed. Currently, CNMs are licensed in all 50 states; CMs are licensed in three states.

All states should provide for licensure and prescriptive authority for midwives who are CMs.

States should consider the licensure of other professional midwives who have successfully completed an academic education program and passed a national certification exam and who adhere to recognized standards of professional practice. States should license midwives in accordance with their defined scope of practice.

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5. Is it new for ACNM to take the position that professional midwives must complete a formal education program?
Since ACNM’s earliest beginnings, formal academic education, along with hands-on clinical experience, has been the cornerstone of our organization. We have devoted significant resources to ensuring the availability of high-quality formal educational programs for U.S. midwives. ACNM developed both accreditation and certification programs which have achieved national recognition over time.

In 2004, ACNM adopted a position statement describing principles for state legislators and regulators in licensing and regulating midwives. The first tenet is the mandate of “successful completion of a formal education program accredited by a nationally recognized agency.”

ACNM recognizes that this 2004 position mandating formal education was not consistent with the neutrality of our most recent Issue Brief on Midwifery Certification. This contributed to ACNM’s decision to update the Issue Brief.

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6. The new Issue Brief on Midwifery Certification doesn’t mention other midwifery certifications beyond those offered by ACNM. Why?
We anticipate that this document will have a long lifespan, and that the midwifery community and state laws and regulations will continue to evolve. We concluded that it was best to focus the Issue Brief on the qualifications that our organization recognizes as the essential components of professional midwifery practice and not define the specific organizations and procedures. The statement describes components of professional practice, not the scope of particular organizations.

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7. Do other certifications besides the CNM and CM meet ACNM’s criteria for professional midwifery specified in the Issue Brief?
At the time of this writing (January 2008), according to the North American Registry of Midwives, it is our understanding that some certified professional midwives (CPMs) also meet ACNM’s criteria.

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8. What accrediting agencies are recognized by the U.S. Department of Education (DOE)?
At this writing (January 2008), in addition to the ACNM Division on Accreditation, the Midwifery Education Accreditation Council is also accredited by the U.S. DOE. MEAC accredits programs for direct-entry midwives who wish to pursue the NARM exam to become a CPM.

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9. What does ACNM hope to accomplish with this revision?
ACNM seeks to bring greater clarity to our policymaking efforts and to advocate for expansion of high-quality midwifery care and reflect recent changes in international nomenclature.

States have an obligation to their citizens to regulate health professions to protect the health and welfare of the public. ACNM believes it is important that these quality control mechanisms constitute neither under- nor over-regulation.

ACNM members and chapters are often asked by legislators, regulators, insurers, members of allied health professions and the public at large to provide input on midwifery-related issues in general and, at times, are asked to weigh in on proposed legislation.

ACNM will continue efforts to break down barriers to midwifery practice that have limited access to midwifery care in the U.S., such as requirements for physician supervision or written collaborative agreements, and the costs of professional liability coverage. These barriers to practice have made it difficult for CNMs and CMs to practice independently in some states, and attend births at home and in freestanding birth centers.

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10. Why did ACNM relate its position on professional midwifery to the internationally recognized definitions of skilled attendant and traditional birth attendant?
The World Health Organization, the International Confederation of Midwives, and the International Federation of Gynecology and Obstetrics use similar criteria to define midwifery. In revising our definition and criteria, it makes sense for ACNM to reflect the consensus of the international community.

As we look around the world, the U.S. is lagging far behind in its use of the midwifery model of care. Maternity care in the U.S. is increasingly characterized by sky-rocketing costs, record high rates of cesarean section and other medical interventions, and higher rates of infant mortality and maternal complications than most of the developed world. Latest estimates for 2004 place the U.S. behind 35 other countries in infant mortality rates; the U.S. rate is over 6 deaths per 1,000 live births, far worse than countries where academically educated midwives are the predominant providers of maternity care. (http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w457)

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11. Are there other differences between CNMs and CMs, and other professional midwives?
One significant difference among midwives is scope of practice. In addition to services provided related to childbearing year, CNMs and CMs are skilled in the independent management of women’s health care and uniquely offer a broad scope of care. Their focus includes common primary care issues, family planning, and gynecologic needs of women, pregnancy, childbirth, the post-partum period, and newborn care. CNMs and CMs provide services to women of all ages.

CNMs have the authority to prescribe, dispense, and administer medications in all 50 states; CMs also have prescriptive authority in New York and Rhode Island. Other midwives do not have prescriptive authority.

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12. How will this Issue Brief impact ACNM’s state legislative efforts?
The Issue Brief will enhance the ability of ACNM and its membership to make recommendations on proposed licensing and regulatory initiatives.

When asked to comment on proposed legislation, the ACNM national office and local chapters can now clarify our definition of a professional midwife to guide legislators and other policymakers.

Several states have already adopted a position on licensure of professional midwives that parallels ACNM’s recommended approach by specifying certain criteria for licensure including formal academic education and certification.

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13. Is this Issue Brief in some way a position against home birth?
Absolutely not. ACNM respects the desire of women to give birth safely in the setting of their choice. Studies of birth center and home births attended by midwives have confirmed the safety of planned out of hospital birth for healthy women experiencing normal pregnancy and birth with midwives who have seamless access to consultation and collaboration with qualified health care professionals and institutions, as needed, within the healthcare system.

ACNM supports education and practice by CNMs and CMs in a variety of settings, including hospitals, birth centers, and at home. State laws often pose insurmountable challenges to CNMs and CMs wishing to attend home births. ACNM supports legislation that will promote the legitimization of home birth as a choice for women and relax the barriers to practice for CNMs and CMs wishing to attend home births.

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14. Does the Issue Brief assert that those who don’t meet ACNM’s criteria for “professional midwives” cannot call themselves midwives?

No. ACNM has not suggested who may or may not use the term midwife.

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15. If demand for midwifery increases, won’t we need more midwives?
Absolutely. There are not currently enough qualified midwives or a system of care to safely accommodate a rapid rise in demand for home birth or midwifery care in the U.S. The system would have to change to ensure an adequate supply of educated midwives.

ACNM believes that significant efforts are needed to increase the number of professional midwives in the U.S. in order to meet an increase in demand for midwifery care, improve access to high quality, evidence-based women’s health and maternal and newborn health care. ACNM is working to expand access to formal education programs to increase the supply of qualified midwives in the U.S. ready to meet these needs and provide safe, high-quality care in the U.S.

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