Thursday, May 3, 2012

Licensure, Education, Accreditation, and Certification of Midwives


·         How are midwives licensed?

o   Certified nurse-midwives (CNMs) are licensed through their state’s board of nursing, midwifery board, or medical oversight board. *(This is where you will place information specific to your state). Nurse-midwives in Indiana are regulated as independent practitioners under the Indiana State Board of Nursing. Indiana regulations require a nurse-midwife to obtain a written collaborative agreement with a physician or obtain hospital privileges. ACNM: Our Credentials
                 
                *(Below you will place information specific to your state).

o   Nurse-midwives obtain an Indiana license through submission of an application and a small fee to the Indiana Professional Licensing Agency. Proof of an active, unrestricted registered nursing license, graduation from an accredited nurse-midwifery program, and successful passing of the national certification exam is required. Once obtained, licensure must be renewed every two years.

o   Licensure varies for direct entry midwives (DEMs). Currently, twenty-one states offer licensure or regulation to DEMs. Generally, these states have a midwifery board that oversees and licenses DEMs. Requirements for licensure vary state to state and may include certification through the North American Registry of Midwives, graduation from an accredited midwifery program, and continuing education. Midwives Alliance of North America Legality of DEMs



·         How are midwives educated?

o   CNMs are first registered nurses. They must complete a graduate level, accredited midwifery program with supervised clinical experience in at least one birth setting: hospital, birth center, or home. The nurse-midwifery program at Frontier Nursing University, for example, requires nine terms of didactic and clinical education with a minimum of 675 clinical hours in practice. Frontier Nursing University

o   DEMs may come from many educational backgrounds such as apprenticeship, accredited non-nurse-midwifery programs, correspondence programs, or self study. In states where DEMs are licensed, education requirements are decided by each state’s licensing body.



·         Are midwifery programs accredited?

o   Accreditation for midwifery programs is granted and maintained through the Accreditation Commission for Midwifery Education (ACME). ACME accredits both CNM and direct entry midwifery programs and is recognized by the U.S. Department of Education. Currently, the University of Indianapolis is the only accredited nurse-midwifery program in the state of Indiana. There are several online, accredited programs available to Indiana residents, including Frontier Nursing University, the oldest and most prestigious nurse-midwifery school. ACNM: Accreditation

o   Accreditation is offered for direct entry midwifery programs through the Midwifery Education Accreditation Counsel. These programs prepare DEMs to pass the exam and skills testing required for certification through the North American Registry of Midwives. MEAC

·         How are midwives certified?

o   The American Midwifery Certification Board (AMCB) awards and maintains certification for nurse midwives in the United States. Initial certification is obtained by passing the national certification exam that tests candidates on antepartum, intrapartum, postpartum, newborn, well-woman gynecology, primary care, and professional issues. ACMB

o   In order to sit for the exam, candidates must provide  proof of a registered nursing license active within the United States, have fulfilled the requirements of a graduate level nurse-midwifery education program accredited by ACME, and have a letter of verification from their program’s director. Nurse-midwifery candidates must pass the national certification test within 24 months of graduation with a maximum of four attempts.

o   Once initially certified, nurse-midwives must recertify every five years through AMCB. Nurse-midwives must complete three continuing education modules covering three practice areas: antepartum/intrapartum, postpartum/newborn, and gynecology/primary care. In addition to the practice modules, nurse-midwives must complete two continuing education units equal to 20 hours of study.

o   Certification is available for DEMs. Some states in the U.S. recognize the Certified Professional Midwife certification offered through the North American Registry of Midwives. Certification requires documentation of clinical experience in an out of hospital birth setting and passing of a written exam and skills demonstration. NARM: Certification



·         What is the scope of practice for midwives?

o   The scope of practice for CNMs includes primary care of women from adolescence through menopause. Gynecological care is provided, including family planning, preconception care, treatment of sexually transmitted infections for women and their partners. Comprehensive maternity care is provided including prenatal, antenatal, postpartum, and newborn care up to 28 days. CNMs order and interpret diagnostic tests, prescribe medications, perform complete physical exams, and manage care. ACNM: Our Scope of Practice

                *(Below you will place information specific to your state).

o   The scope of practice for nurse-midwives is defined within the Indiana Nurse Practice Act as the practice of nursing, well woman gynecology, family planning, antepartum, intrapartum, postpartum care, and the treatment of health problems for “the normal and expanding family”

o   In order to have prescriptive authority in Indiana, nurse-midwives must have a written collaborative agreement and proof of successful completion of two semester hours of a graduate level pharmacology class. Prescriptive authority is maintained by completing 30 CEUs, eight in pharmacology, every two years (Indiana Nurse Practice Act, 2007b). Controlled substances may be prescribed after obtaining an Indiana controlled substances registration and federal registration with the Drug Enforcement Administration (Indiana Nurse Practice Act, 2007b).

o   The scope of practice for direct entry midwives may be defined by the state in which they practice. It is usually limited to maternity services as prenatal, antepartum, postpartum, and limited neonatal care. DEMs cannot prescribe medications or order diagnostic tests.

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