A Certified Nurse Midwife (CNM) is a licensed health care practitioner trained as both a nurse and midwife, and certified by the American Midwifery Certification Board. Normally, the CNM has a master’s degree in nursing. However, licensing requirements vary from state to state.
Midwives provide an alternative approach to health care for women, while still working within the established framework of medical science. Midwives can be primary care providers. Typically they provide more personalized care than can be expected from a primary care MD or specialist MD. They approach puberty, birth, and menopause as normal aspects of a woman’s life rather than as medical emergencies that need to be cured or repaired. They often emphasize counseling and education over medical intervention.
CNMs are primary healthcare providers for women of childbearing age. They may perform routine annual gynecological exams. They also perform family planning services and preconception care. Additionally, CNMs may provide counseling in health maintenance and disease prevention, and even menopausal management.
The personalized approach provided by midwives may be preferable in the case of adolescent health care. CNMs, as part of an interdisciplinary healthcare team, help guide teenagers toward healthy behaviors and lifelong positive lifestyle choices, supplementing parental influence, especially where the subject matter may seem too awkward or delicate for the teenager to discuss with parents.
The primary focus of midwifery is expectant women, and CNMs provide a range of clinical services for pregnant women, new mothers and newborns. They manage labor and deliver infants. CNMs are involved in almost 8 percent of births in the United States and 96 percent of these births are in hospitals.
Midwives emphasize natural childbirth as much as possible. Typically, midwives care for patients in a private and comfortable birthing center, or even in the comfort of the patient’s own home. Additionally, they are often part of hospital labor and delivery teams. A patient may choose to utilize the services of a midwife whether they intend to give birth at home, in a birthing center, or a hospital.
In addition to their emphasis on natural childbirth, midwives are often preferred by expectant mothers because of the lower costs, including lower maternity care costs, the availability of payment plans and sliding-scale fees, all while accepting most health insurance plans. While the details of CNM licensing may vary from state to state, they can prescribe medication in all 50 states and the District of Columbia.
Midwifery is an appropriate choice for low-risk pregnancies, which constitute 60 to 80 percent of pregnancies. The other 20 to 40 percent could potentially have complications, and may require the intervention of an MD. Since it is not always clear when a pregnancy may involve complications, midwives routinely consult with obstetricians, perinatologists and other specialist MDs, and will refer patients to the appropriate MDs should complications arise.
With their medical as well as counseling training, CNMs provide for both the routine medical and emotional needs of women patients, and can refer patients to qualified specialists for matters beyond the scope of their expertise.