Midwives as Primary Care Providers for Women

Abstract

Midwives certified by the American Midwifery Certification Board (AMCB) are prepared to provide primary care to women from menarche across the lifespan and to well newborns to 28 days using consultation, collaboration, and referral to other providers as needed. The scope of midwifery in the United States did not always include primary care for women, although imprecise definitions of primary care make this difficult to study. The expansion of the scope of practice occurred in response to population needs and research on nurse-midwifery practice patterns. The scope of practice of midwifery is tied to educational standards through the regulation and licensure at the state level. Although the current scope of practice includes primary care for women, many certified nurse-midwives and certified midwives are unable to practice to the full extent of their education due to state-level licensure restrictions. We discuss the addition of primary care to midwifery and the current state of AMCB-certified midwives as primary care providers for women.

Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care

“…They work collaboratively with physicians and other members of the health workforce to optimize patient care and health. For example, NPs provide a range of comprehensive care services to address individuals' physical and mental health needs across the life span, and CNMs provide primary sexual and reproductive health services across the life span as well as postpartum care, childbirth, and care of newborns (Phillippi & Barger, 2015;Pohl et al, 2010b). CNSs and CRNAs increase access to affordable care services for populations in rural areas (Seibert et al, 2004).…”

Midwifing the End of Life: Expanding the Scope of Modern Midwifery Practice to Reclaim Palliative Care

“…Examples of these barriers include: midwifery care confined only to reproductive health care, limited prescriptive authority, regulatory language requiring physician supervision, mandatory written collaborative agreements, and restrictions on third‐party reimbursement . At present, 19 states clearly recognize primary care as an integral part of the midwifery scope of practice, and 13 other states have regulatory language that is somewhat more ambiguous but can be interpreted to support primary care provided by midwives . Although all 50 states have granted some degree of prescriptive authority to CNMs, many states restrict this authority in various ways.…”

Expanded Practice in Midwifery: Designing, Implementing, and Maintaining Programs

“…Further expansion of the CNM role included general gynecology and perimenopausal care in the 1970s and primary care in the 1990s . Today, the scope of CNM and certified midwife (CM) practice includes caring for women throughout the life span …”

“…Recognizing that advancements in health care science and delivery were driving changes in practice, the American College of Nurse‐Midwives (ACNM) developed a position statement on Expansion of Midwifery Practice and Skills Beyond Basic Core Competencies in 1992, with revisions in 1997 and 2015 . This document provides standards and guidelines for expanded practice development for individual CNMs/CMs and their clinical practices while reinforcing that new practice skills must be in accordance with Standard VIII of ACNM's Standards for the Practice of Midwifery …”