The Midwives Model of Care has been proven to provide high quality safe care, low cesarean rates, less unnecessary interventions, reduced costs, expanded access and higher patient satisfaction. In the US, the majority of midwives are either CNMs (nursing school trained with masters degrees) or CPM (direct-entry or apprenticeship model trained).
The scope, legal status, reputation and availability of these two kinds of midwives varies greatly across the US. 24 US states license both kinds midwives for out-of-hospital birth. Other states restrict the practice of midwifery to only hospital-based nursing school trained midwives. In some states like Alabama, CPMs are illegal and they will prosecute or revoke the license of a CNM attending a home birth. Even stand-alone birth centers are illegal. Drive across the state line to Florida and both CPMs and CNMs birth center and home births are not only legal but the government pays them as providers in their state medicaid programs. Quite the contrast!
Alaska has a unique and functional system that allows families to choose freely from a number of licensed professionals for their maternity care in and out of the hospital, including both kinds of midwives, CNMs and CPMs*. Depending on which state you come from, you may have a very different opinion and impression of the different kinds of midwives and what they do. This system saves a lot of money and gives more families access to attentive maternity care. Here are some of the common misconceptions about CNMs and CPMs.
Myth: Certified Nurse Midwives (CNMs) are the only legitimate kind of midwife in the US. All the others are "lay midwives"- untrained and uneducated.
Fact: Certified Professional Midwives (CPM) are professionals having completed educational and clinical training requirements. In Alaska, a CPMs training history is certified by the state and subject to additional rigorous licensing requirements.
A common accusation is that non-nurse midwives are untrained, unqualified to attend births. They say that the only legitimate path to midwifery is to first become a nurse (4 years of university), then work experience (1-2 years usually) followed by graduate school (2 years). That's 7+ years!
The International Conference of Midwives sets standards for midwifery education worldwide including the best systems like New Zealand and the United Kingdom. Their training lasts 3 years and is a totally separate educational path from nursing. So clearly, by the highest international standards you do not need to be a nurse or train for 7+ years to become a proficient midwife.
Alaskan CPMs are required to complete a State approved academic program or a MEAC accredited midwifery school on top of a clinical apprenticeship program that lasts 3-5 years. Upon completion of coursework and clinical requirements they must pass a rigorous national board exam. CDMs are trained to order and interpret labs, carry drugs, suture, and do everything to operate an accredited birth center independently.
Myth: Certified nurse midwives work under a doctor's supervision. Other midwives work on their own out of the "back alley".
Fact: In Alaska, both CNMs and CPMs can practice independently without physician oversight. They often work side by side.
7 out of 9 birth centers in Alaska employ both CPMs and CNMs. They work side by side in the birth center setting. During clinic visits, CNMs offer a wider scope of service, due to their expanded medical training such as prescribing birth control. Some birth center CNMs also attend home births with CPMs.
Here is one such example. These 5 talented midwives are part of a successful practice, and have trained via 3 different routes to earn their credentials: 1 nursing school trained, one foreign trained and two apprenticeship trained.
Myth: CNMs are safe, all other midwives are dangerous.
Fact: CPM birth statistics have been collected by the State of Alaska since 1993. Outcomes show high levels of patient safety.
In Alaska, with regulatory oversight, a long history of midwifery, and collaborative practices, we have excellent outcomes. CPMs have access to necessary training, life saving drugs and equipment to keep birth safe. CPMs have mandatory reporting for all birth outcomes have been and tracked by the State of Alaska since 1993.
Since midwives work independently in the State of Alaska, as opposed to under physician supervision, they are able to practice the Midwifery Model of Care, which has been proven to reduce the incidence of birth trauma, injury and cesarean section while increasing patient satisfaction.
6% of the births in our state are attended out of hospital, the majority by Non-nurse midwives. CPMs are well trained, educated and licensed. It's a birth model that works-family centered, Low intervention, accessible care that saves money.
In states where only Certified Nurse Midwives are recognized and Certified Professional Midwives are not recognized, access to out of hospital birth is severely limited. Since most CNMs work in the hospital setting, it creates an environment where women either birth unassisted (without professional attendant) or hire anyone who calls themselves a "midwife". More and more families are demanding birth options. Out-of-hospital birth has increased 50% over the last decade. Alaska is a great example of providing access and options for safe, supportive care with both CNM and CPM midwifes.
*CPMs are awarded an additional credential in Alaska upon licensure, as a CDM, or Certified Direct-Entry Midwife. This title is a remnant from decades old licensure-before the CPM credential was created and standardized across North America.
What kind of midwife did you have? How is access to midwifery where you live?