Sensitivity and Regulations in Midwifery
The practice of midwifery seems timeless with a sturdy scenario of development, improved understanding, and professional practice. Midwifery encompasses care of women during pregnancy, labor, and the postpartum period, as well as care of the newborn, but doesn’t end in that phase; midwives also work in health promotion, disease prevention, and individualized wellness education and counseling.
This type of profession is quite sensitive because as midwives, we must strictly follow the different regulations intended for us. The International Confederation of Midwives defines midwifery regulation as a set of criteria and processes arising from the legislation that identifies who is a midwife and who is not and describes the scope of midwifery practice. The scope of practice is those activities which midwives are educated in, competent, and authorized to perform.
Defining Midwifery: Criteria and Processes
Every state has a designated practice environment for midwifery. In the United States, 51 state governments play a vital role in defining the degree to which midwives can provide care. State laws and regulations establish midwives’ scope of practice, set licensure requirements, and regularly determine their ability to get paid and obtain access to healthcare facilities.
Midwives may have different levels of training:
Certified nurse-midwives (CNMs) are registered nurses who have graduated from an accredited nurse-midwifery education program and have passed a national exam. They can practice in all 50 states and the District of Columbia. The majority of CNMs practice in the hospital setting and this is reflected in their education. Certified midwives (CMs) are non-nurse midwives who have a bachelor’s degree or higher in a health field, have completed an accredited midwifery program overseen by the same agency that regulates CNM education, and have passed a national exam. Only a few states permit CMs to practice.
Certified professional midwives (CPMs)
Certified professional midwives (CPMs) are independent practitioners educated through a pathway distinct from the discipline of nursing who have passed a national exam. The international term for them is direct-entry midwives. CPM education emphasizes community (out-of-hospital) birth and continuity of care. CPMs may qualify for certification either by graduating from a midwifery education program or by completing a competency-based portfolio evaluation process, a formalized apprenticeship-based educational pathway. Thirty-five states and Washington DC have specific legal requirements for education and licensing of direct-entry midwives, and they may have a variety of names, although the most common is Licensed Midwife (LM).
Unlicensed Midwives
Unlicensed Midwives. In addition, there are midwives who—for religious, personal, and philosophical reasons—choose not to become certified or licensed. Typically they call themselves traditional midwives, although some reserve this term for those who come from indigenous communities. Unlicensed midwives believe that they are ultimately accountable to the communities they serve, that midwifery is a social contract between the midwife and client/patient and should not be legislated at all, or that women have a right to choose qualified care providers regardless of their legal status.
It is very important that you know your state laws before starting your midwifery practice.
Some states don’t allow certain licensure types to practice or have no midwifery regulations at this time. Oklahoma, Washington DC, and Michigan recently created midwifery licensure for CPMs. Iowa, Georgia, Massachusetts, New York, and Illinois currently have active CPM licensing bills in their legislatures, while six more states are in the planning stage of working on midwifery regulations in their state. CPMs are currently legal or illegal in 14 states and may run the risk of practicing medicine without a license if caring for families there.
Scope of Practice: Competency and Authorization
In addition, each state sets the scope of practice and, in some, the practice location for each type of midwife. In general Certified Professional Midwives (CPMs) work in birth center and home settings. Certified Midwives and Certified Nurse Midwives can practice in all settings in most states, but more than 94% work in hospitals. There are only a few states where Certified Midwives can practice with their certification. Certified Nurse Midwives have national recognition but have state variations in authority and practice scope, as well as the need for a supervising relationship with a physician. Some states, such as Colorado, don’t allow CNMs to attend home births.
When looking at becoming a midwife, it is just as important to understand the different types of midwives as what services can be offered within that defined scope. Some states don’t allow a midwife to own their own business. Michigan doesn’t allow any nurse, including nurse-midwives (CNMs who are regulated under the nursing board) to own an independent midwifery practice. Some states have separate midwifery boards for CNMs while others mix regulatory authority of CNMs, CMs, and/or CPMs under one board. However, the majority are licensed as advanced practice nurses, which can influence their practice scope and responsibility. Know where you want to practice and what service you want to offer at your practice.
After you figure out the educational path that makes the most sense for you, there needs to be some thought about what setting and state you want to be in the long term. We have put together an EXTENSIVE list of midwifery pathway regulations for each state including birth center regulations. Please watch our great training that goes into more detail on birth center and midwifery state regulations attached below.
