The American College of Nurse-Midwives, With women, for a lifetime ® A Career in Nurse-Midwifery Presented to the 61 st Annual Convention of the National.

The American College of Nurse-Midwives, With women, for a lifetime®

A Career in Nurse-Midwifery

Presented to the 61st Annual Convention of the National Student Nurses Association

April 5 & 6, 2013By

Elaine Germano, CNM, DrPH, FACNMSenior Education Policy Advisor

American College of Nurse-Midwives

The American College of Nurse-Midwives, With women, for a lifetime®

What is a Certified Nurse-Midwife?

• An advanced practice nurse educated in the two professions of nursing and midwifery

• Licensed to practice and prescribe in all 50 states, DC and most US Territories

• Provides primary care to women across the lifespan, including care during pregnancy and childbirth

The American College of Nurse-Midwives, With women, for a lifetime®

Midwifery: An Ancient Profession

The American College of Nurse-Midwives, With women, for a lifetime®

Mary Breckinridge

Founded the Frontier Nursing Service (FNS)

in1925

Sent British nurse-midwives on

horseback to isolated families in Appalachia

The American College of Nurse-Midwives, With women, for a lifetime®

FNS midwives cared for women and families in their homes in Appalachia

• In order to improve the health of families, we must first care for the mothers

The American College of Nurse-Midwives, With women, for a lifetime®

The Growth of Midwiferyis supported by publishedresearch that shows CNMs:

• Provide high-quality care• Have comparable or better

outcomes• Have high levels of patient

satisfaction• Lower costs due to fewer

interventions

The American College of Nurse-Midwives, With women, for a lifetime®

Nurse-midwives provide primary care to women across the lifespan

The American College of Nurse-Midwives, With women, for a lifetime®

So, What Exactly Do Nurse-Midwives Do?

• Well-Woman Annual Exams– Menstrual and sexual

history, along with family, medical and social history

– Physical exam, including breast and pelvic exams

– Pap test, STI screening– Lab, diagnostic tests– Prescriptions

The American College of Nurse-Midwives, With women, for a lifetime®

Midwives also provide: • Primary Care Visits

– Minor complaints, e.g. colds, flu, urinary tract infections

– Headache, depression, diabetes, thyroid conditions, etc

– Counseling (including preconception counseling)

The American College of Nurse-Midwives, With women, for a lifetime®

Prenatal Care

• Regular individual or group visits• Partners encouraged to attend!• Vital signs, lab and diagnostic tests • Fetal Assessment (heart tones, fundal height)• Nutritional/exercise assessment

The American College of Nurse-Midwives, With women, for a lifetime®

Labor and Birth Attendance

The American College of Nurse-Midwives, With women, for a lifetime®

Post-partum care and Breastfeeding support

The American College of Nurse-Midwives, With women, for a lifetime®

A Typical Day in the Office• First patient:

– First visit of 26 year old woman, 1st pregnancy, LMP 2/22/12, EGA 6w1d

– c/o urinary frequency and intermitant R-sided pain, 7 on scale of 10; decreased appetite

– Denies vag bldg, nausea, vomiting or other sx• Gather additional data:

– PMH, PSH, Gyn hx, Ob hx, Soc hx– Allergies, Meds, Pre-pregnancy wt

The American College of Nurse-Midwives, With women, for a lifetime®

First Patient (cont.)• Gather objective data:

– VS, ht, wt, BMI – Labs – PE– transvaginal u/s

• What are your concerns?– Ectopic pregnancy– Medications– UTI

The American College of Nurse-Midwives, With women, for a lifetime®

First Patient (cont)• Assessment

– 26yo GIP0, EDD 12/1/13– IUP GA 6w1d– UTI

• Management Plan– Tx UTI– Counsel re: exercise, diet, expected wt gain,

medications; stage of pregnancy expectations

The American College of Nurse-Midwives, With women, for a lifetime®

Second Patient• Returning client

– 19yo female, taking ocps x2 mos, c/o bloating, breast tenderness, thinking of stopping pills; also c/o vag discharge x5 d

– Denies vag itching or d/c, admits to some dysparuina and dysuria, unsure about partner sx

• Gather additional data:– Review hx, any changes incl. change in partner?– Use of condoms, correct use of ocps?

The American College of Nurse-Midwives, With women, for a lifetime®

Second Patient (cont.)• Gather objective data:

– VS, wt– Labs, incl. wet prep + GC/CT, UA– Pelvic exam

• What are your concerns?– UTI– STIs– Correct use of ocps

The American College of Nurse-Midwives, With women, for a lifetime®

Second Patient (cont.)• Assessment

– BV, Trichomoniasis– At risk for pregnancy

• Management Plan– Tx STI and vag. infection– Counsel re: use of condoms, continuing current

ocps, consider change in 1 month

The American College of Nurse-Midwives, With women, for a lifetime®

Additional Patients• 52yo woman c/o perimenopausal sx, smoker,

wants HRT• 33yo G3P2, 20 wks GA, no concerns, 28 lb wt

gain• 28yo G2P2, IUD Paragard x3 yrs c/o excessive

bleeding and lower abd pain• 27yo G2P1, 37 wks GA, normal pregnancy,

tired of being pregnant, wants induction

The American College of Nurse-Midwives, With women, for a lifetime®

Healthy Mothers, Healthy Babies, Healthy Families

The American College of Nurse-Midwives, With women, for a lifetime®

Philosophy of Care• Listening to women – the hallmark of

midwifery care• Focus on prevention and education• View pregnancy as a normal process• Provide compassionate and family-centered

care• Encourage women’s participation in

decision-making• Use technology and intervention appropriately• Consultation, collaboration and referral with

members of the health care team

The American College of Nurse-Midwives, With women, for a lifetime®

Midwives promote the health and well-being of women and infants within their families and

communities

The American College of Nurse-Midwives, With women, for a lifetime®

Emphasis on Primary Care

Reproductive Care(53.3%)

Primary Care(33.1%)

Labor and Birth(13.6%)

The American College of Nurse-Midwives, With women, for a lifetime®

Antepartum

Intrapart

um

Postpart

um

Newborn

Gyneco

logy

Primary

Care0%

10%20%30%40%50%60%70%80%90%

100%

Scope of Practice of Full-Time Midwives

The American College of Nurse-Midwives, With women, for a lifetime®

CNMs Have Excellent Outcomes

00.5

11.5

22.5

33.5

4

Infant Mortality

NeonatalMortality

LowBirthweight

CNMs

MDs

The American College of Nurse-Midwives, With women, for a lifetime®

Midwives Provide Effective Labor

Support• Twice as much ambulation in labor• Twice as much intermittent

monitoring• Twice as many non-medicated births• Half as many episiotomies• Supportive care during labor

The American College of Nurse-Midwives, With women, for a lifetime®

Midwifery Prenatal Care Contributes to Excellent

Outcomes

Midwifery Prenatal Care

Listen to Women

Provide Emotional

Support

Pregnancy and Birth

Education

Collaborate with Physicians

The American College of Nurse-Midwives, With women, for a lifetime®

Patients Prefer Practices with CNM Providers

0

20

40

60

80

100

%

Satisfied Use Again

CNMs

NoCNMs

The American College of Nurse-Midwives, With women, for a lifetime®

Where do midwives attend births?

Hospital Birth Center Home0

102030405060708090

10096.1

2.1 1.7

%

The American College of Nurse-Midwives, With women, for a lifetime®

Planned Home Birth: A Safe Option

with ACNM Midwives

• Low Infant Mortality - 2.5 per 1000• Transfer to hospital during labor- 8.3%• Postpartum/Neonatal Transfers - 1.9%

The American College of Nurse-Midwives, With women, for a lifetime®

Number of CNM-Attended Births

The American College of Nurse-Midwives, With women, for a lifetime®

Reimbursement for CNMs

• Medicaid: mandatory coverage of CNMs in all states

• Medicare: sets standard for all private insurance, CNMs at 100% of physician fee schedule

• Private insurance: mandated coverage of CNM services in 33 states

The American College of Nurse-Midwives, With women, for a lifetime®

Primary Employers

• Hospitals and medical centers: 35%• MD practices: 30%• Community health centers: 8.4%• Midwife Practice: 7%• Academic Institution: 7%• Other: 12.6%

The American College of Nurse-Midwives, With women, for a lifetime®

Salary

• Full-time (35 hrs per wk or greater) average $114,152 per year

• Productivity bonus: 25 % receive, 75% do not

The American College of Nurse-Midwives, With women, for a lifetime®

The American College of Nurse-Midwives

• The professional association representing CNMs and Certified Midwives (CMs)

• Since 1929 - oldest women's health care organization in the US

• Ensures foundation of midwifery education through the Core Competencies for Basic Midwifery Practice

• Sets Standards for the Practice of Midwifery• Provides Clinical Bulletins

The American College of Nurse-Midwives, With women, for a lifetime®

ACNM’s Department of Global Outreach

• Since 1982 – projects and technical assistance in 30 developing countries

• Devised Life Saving Skills Training Program used in Asia and Africa

• Assists and strengthens midwifery associations

The American College of Nurse-Midwives, With women, for a lifetime®

Midwifery Education• 39 midwifery education

programs nationwide• Most onsite; 5 fully

distance-based• Bridge programs (ADN

to MSN)• Master’s programs• DNP programs

The American College of Nurse-Midwives, With women, for a lifetime®

Associa

te, Nursi

ng

Associa

te, Not N

ursing

Bachelor's

, Nursi

ng

Bachelor's

, Not N

ursing

Mast

er's, N

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er's, P

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Doctorat

e, Any T

ype

0

10

20

30

40

50

60

Earned Degrees of CNMs and CMs (%)

The American College of Nurse-Midwives, With women, for a lifetime®

Midwifery Education Trends

The American College of Nurse-Midwives, With women, for a lifetime®

2008 2009 2010 2011 20120

50

100

150

200

250

300

350

400

450

500

320 325344

398

474

The Number of New CNM/CMs Has Risen 48% Since 2008Source: American Midwifery Certification Board

The American College of Nurse-Midwives, With women, for a lifetime®

Midwifery Certification• National certification exam administered by

American Midwifery Certification Board• Graduate Degree required in order to take

certification exam• Number of ever-certified CNMs/CMs more

than 12,000• Recertification every five years

The American College of Nurse-Midwives, With women, for a lifetime®

Learn More…

• Learn more about midwifery at www.midwife.org

• See http://midwife.org/become_midwife.cfm for midwifery education information

• Visit http://midwife.org/find.cfm to find a midwife in your area

• See www.gotmom.org for ACNM’s online breastfeeding resource

The American College of Nurse-Midwives, With women, for a lifetime®

With Women…

…For a Lifetime

The American College of Nurse-Midwives, With women, for a lifetime®

The American College of Nurse-Midwives

www.midwife.org