Nurse Midwifery Health Article

Definition

Nurse midwifery is a profession that independently functions within the health care system. Nurse midwives manage the different stages of women's health from

pregnancy, to childbirth, through the postpartum period, as well as meeting women's gynecological needs during the menopausal and post-menopausal periods. Nurse midwives additionally may provide newborn care and will occasionally provide prenatal education, all as a part of their philosophy of family-centered care. A nurse midwife is a person trained in the two professions of nursing and midwifery as compared to a certified midwife (CM) who is trained in midwifery but not through the profession of nursing.

The certified nurse midwife (CNM) is an individual who has successfully completed an approved course of study in nurse midwifery and practices in compliance with the Standards for the Practice of Nurse Midwifery as defined by the American College of Nurse Midwives (ACNM). Midwives have attended births in America since colonial times, but the actual profession of nurse midwifery was not officially recognized in the United States until the early 1920s.

Description

The nurse midwife provides women during pregnancy with appropriate supervision, care, and advice. During labor and the postpartum period, the nurse midwife performs vaginal deliveries and may care for the newborn while facilitating family involvement, particularly of fathers and siblings. Nurse midwives foster an environment that facilitates minimal intervention while continuously assessing for abnormal conditions in the mother and child that would necessitate medical assistance or emergency procedures.

Nurse midwives promote family-centered maternity care that incorporates counseling and education for the woman and the family. The occupation stresses the importance of antenatal education and preparation for parenthood. The nurse midwife acts as a kind of primary-care provider by providing the woman with family planning and a range of gynecological care.

Many of the clients that a nurse midwife cares for can be classified as "vulnerable" by one or more of the subsequent criteria: less than 16 years of age; level of education less than eight years; race and ethnicity other than white; and source of payment through public programs such as Medicaid, Medicare, and the Indian Health Service or free/self-pay. Women and infants seen by nurse midwives live disproportionately in areas where a higher than average number of people live below the poverty level.

The ACNM is the main professional organization in the Unites States representing CNMs and CMs. The group is the oldest women's health organization in the Unites States with roots back to the 1920s. ACNM conducts

research in midwifery practice; accredits midwifery schools; coordinates and administers continuing education programs; develops clinical practice standards of care; and works with state and federal agencies and members of Congress in promoting midwifery.

Work settings

The practice of nurse midwifery is legal in all 50 states and the District of Columbia. Most nurse midwives function in a hospital or physician practice and attend deliveries in hospital settings. In 1997, 96% of nurse midwives delivered in hospitals, 2.4% delivered in separate birth centers and 1% delivered in a home setting.

Hospitals

Nurse midwives have various roles in the care facility, from providing solely intrapartal care to antepartal care to well-woman care to all of these combined. One of the more recent developments in hospital labor and delivery is the creation of birthing rooms that provide a more comfortable, home-like ambiance. Comfort features include showers or Jacuzzis, and beds that convert to birthing beds in which a woman can labor, deliver, and recover. Nurse midwives have been strong proponents of such advances and find them very useful in their practice.

Health maintenance organizations (HMOs) and managed care

Nurse midwives fit well into the model of managed care, which emphasizes cost-effective care focusing on prevention. They provide OB/GYN care as well as family planning. In 1992, Kaiser Permanente, a California-based HMO, reported that nurse midwives handled 70% of the low-risk obstetrical patients and had contributed to lowering the cesarean section rate to 12%. The national average for cesarean sections is 23.5%.

Private practices

A great number of nurse midwives work in private practices of different sorts. Some practice in private OB/GYN practices with physicians, others in private nurse midwife only practices with physician consultation available, some in freestanding birth centers and a few perform home births. Private practices give nurse midwives greater

Birth centers

Freestanding birth centers offer the patient and her family a place to give birth that is a compromise between the hospital and home. In birthing centers, the nurse midwife tries to foster a home-like atmosphere as much as possible but still has the advantages of specialized equipment and proximity of emergency transportation.