Download Certified Nurse Midwives in Delivery

Certified Nurse Midwives in
Delivery: What benefits they bring!
Presented by:
Deborah Johnson, CNM
Jodee Gutierrez CNM
History of Midwifery
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Midwife means “with woman”
French “Sage femme”
Spanish “La Partera”
German “Hebamme”
Midwives have been assisting with delivery of
women since the beginning of recorded time
Ancient Egypt
Ancient Egypt
The Bible
– Genesis 35:17- Rachel giving birth
– Exodus 1:20 – Hebrew midwives
refused to kill baby boys
History of Midwifery in the USA
• Many midwives were
accused of being
witches and were
executed in the 1600’s
• 1900 - 50% of births
attended by a Midwife
Mostly rural women
or urban immigrant
women
• 1930 - Midwives only
attended 15% of births
The Frontier Nursing Service was started in Kentucky in
1925 with British midwives to provide health care to
isolated areas in the Appalachian mountains
Educational programs
• Certified Nurse Midwives educated in both
Nursing and Midwifery.
• Frontier School of Midwifery started in 1939
as British Midwives returned home during
WWII.
• Today there are 45 Midwifery programs in the
USA, most are Masters Degree programs.
Types of Midwives
• Certified Nurse Midwives (certified through
American Midwifery Certification Board)
• Certified Midwives (certified through
American Midwifery Certification Board)
• Certified Professional Midwives (certified
through North America Registry of Midwives)
• Lay Midwives
Midwifery Scope of Practice
• Primary health care services for women from
adolescence beyond menopause
• Gyn and family planning, preconception care
• Care during pregnancy, childbirth and
postpartum period.
• Health promotion, disease prevention, and
individualized wellness education
• Prescriptive authority in most states
Certified Nurse Midwives in
Washington
• 9.1% of all births in 2009
• CNM’s have been practicing in Washington state
since 1976
• CNM’s are licensed as Advanced Registered Nurse
Practitioners
• A Master’s degree is required for new licensure
• All third-party payers, including Medicaid, are
required to reimburse for midwifery services
Total US Births Attended by Midwives
1989-2009
Source: Centers for Disease Control and Prevention
Percentage of Live Births Attended by Certified
Nurse-Midwives, 1989-2009
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Source: Centers for Disease Control and Prevention
Proportion of Vaginal Births Attended
by Certified Nurse-Midwives, 2009
Source: Centers for Disease Control and Prevention
Absolute Change in the Proportion of Vaginal Births
Attended by Certified Nurse-Midwives (CNMs), 1990-2009
Source: Centers for Disease Control and Prevention
National Data
• 2009 CNMs attended 313,516 births in the
United States, or 1 out of every 9 vaginal
births
• 11.3% of all vaginal births or 7.6% of all US
births
• Proportion of CNM/CM attended births has
risen every year since 1989.
Medical Model of Care
• Obstetricians diagnose and treat pregnancy
complications and manage those
complications that can affect pregnant women
and their unborn babies
• Recognizing these problems when they occur
is an essential component of caring for
pregnant women
• Medical model focus is on the potential of
pathologic events during pregnancy and birth
The Midwifery Model of Care
• Health promotion
• Psycho-social adjustment to pregnancy and
changes
• Education
• Culturally sensitive
• Family centered care
Joint Statement ACOG and ACNM
2011
• “ OB-GYN’s and CNMs are experts in their respective
fields of practice and are educated, trained, and
licensed independent providers who may collaborate
with each other based on the needs of their patients”
• “To provide highest quality and seamless care, OBGYN’s and CNM’s should have access to a system of
care that fosters collaboration”
Collaborative Practice
• Collaboration is derived from the Latin verb
collaborate which means “to labor together”
• Midwives and physicians working together
collaboratively allows for care that suits the
unique and individual needs of each woman
and her family
Examples of Collaborative Care
• CNM only management
• Term pregnancy
• No major risk factors
• CNM with Physician comanagement
• GDM diet controlled
• Need for cesarean section
• Assisted vaginal delivery
(forceps and vacuum)
• PPROM
• Maternal fever
• Category II FHR tracing
• Transfer of care to
Physician
• GDM insulin requiring, or
pre-existing diabetes
• Multiple gestation
pregnancy
• VBAC
• Magnesium Sulfate
administration
• Category III FHR tracing
• Preterm labor
Evidenced Based Care
• Lower rates of cesarean birth
• Lower rates of elective inductions and
augmentation
• Reduction in 3rd and 4th degree lacerations
• Lower use of epidural anesthesia
• Higher rates of breastfeeding
• Increased patient satisfaction and sense of
control during labor
The Cochrane Collaboration:
Gold Standard for Evidence-Based Practice
• Midwifery care is appropriate for the
majority of women during pregnancy,
labor, and birth
Hatem 2008
Cochrane Review:
What the Evidence Shows
Decreased use of regional anesthesia
Fewer episiotomies
Fewer instrumental deliveries
Increased comfort in being cared for by a midwife
she knew
• Increased feeling of control in labor
• Increased breastfeeding initiation
• Shorter hospital stay
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Midwives are Experts in Normal
Pregnancy
The Midwifery Model of Care
• Midwifery focuses on pregnancy being a normal and
healthy life event
• Midwives are experts in supporting the normal
physiology of labor, delivery, and breast feeding.
Midwives in Delivery
• Labor support and encouragement
• Not only “natural childbirth”
Regional anesthesia if woman desires
• Less episiotomies
• Less Instrumental
deliveries
Labor Support and Encouragement
Laboring in Various positions
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“Circle of Light” Sandra Bierman
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