Childbirth, especially of a firstborn, can be an exciting yet overwhelming process for a woman to navigate. More than being at a mother’s side through the entire labor, midwives also can offer clinical prenatal care, support before and after birth, and care for healthy women across their lives.
Midwives focus on building a partnership with women to enable health promotion and disease prevention. They practice in a variety of settings, including communities, hospitals and universities. With an impending shortage of maternity care providers in the United States, midwives present an excellent option for families. However, there’s a good deal of uncertainty regarding midwives, their certification and how they integrate into existing medical practice.
Jefferson (Philadelphia University + Thomas Jefferson University) midwifery doctoral student Karen Jefferson, LM, CM, FACNM, recently co-authored an article for the journal Midwifery to help clear up confusion surrounding the three credentials.
What was the purpose of this paper?
The U.S. is different from other countries, such as Canada, Australia and the United Kingdom, in that there are multiple educational pathways to becoming a nationally certified midwife. Also, our certifications are regulated at the state level, not at the national level. This means that midwives may have 50 different titles, different regulatory boards and different recognition for practice between states. This paper explains the pathways.
What does each national accreditation mean?
Midwives attend the majority of births in most other countries and are the norm. However, in the United States, midwives attend about 10 percent of the births, and many consumers and healthcare practitioners are just becoming familiar with the profession. In 2016, the US Midwifery Education, Regulation, and Association (US-MERA) taskforce created resources to clarify midwifery in our country. The US-MERA taskforce means that by 2020 newly certified midwives—regardless of credential—will have graduated from accredited midwifery education programs, demonstrated competency in midwifery and passed a national certification exam prior to seeking state licensure.
In the United States, two organizations certify midwives: the American Midwifery Certification Board (AMCB) and the North American Registry of Midwives (NARM). Certified Nurse-Midwives (CNM) and Certified Midwives (CM) are certified by AMCB; Certified Professional Midwives (CPM) by NARM. The oldest credential is the CNM, and these midwives can be licensed in all 50 states; the CM is a newer credential and can be licensed in only a few states, but it’s growing. CPMs can now be licensed in 31 states.
Our paper attempted to help explain and contrast those pathways both for students interested in pursuing a midwifery career and for those within the field.
How does Jefferson help provide multiple tracks for people interested in midwifery careers?
The Midwifery Institute at Jefferson prepares midwives for the 21st-century demands for value in healthcare. Consistent with the groundbreaking study released in February that calls for integration of midwifery into the fabric of healthcare, the Midwifery Institute doctoral program integrates education of midwives from multiple backgrounds. I have found it engaging to be in a doctoral cohort with students that include nationally certified midwives with public health, nursing and advocacy backgrounds.
What are the next steps for your work in this area?
As a midwife, doctoral student and chair of the American College of Nurse-Midwives’ Committee for Advancement of Midwifery Practice, I will continue to advocate for a greater role for midwifery in the United States. Through my doctoral project, I plan to work with state affiliates of the largest midwifery organization in the U.S. to assess and strengthen capacity for state-level advocacy. Strong midwifery organizations can work at the state level to ensure the legislative environment allows for full integration of midwifery and midwives into our health systems, which will increase access to maternity and women’s healthcare and improve health disparities.