Midwifery 101

Certified Nurse-Midwives (CNMs) are licensed, independent healthcare professionals who practice the disciplines of nursing and midwifery. CNMs often earn a bachelor’s degree in a nursing program and practice as Registered Nurses prior to attending a graduate program for midwifery education accredited by the Accreditation Commission for Midwifery Education (ACME). After earning a master’s degree, Nurse Midwives must sit for national certification boards through the American Midwifery Certification Board (AMCB) to practice midwifery.

What is Nurse Midwifery?

Most people associate nurse midwives with their work in pregnancy and birth, specifically for providing “natural” births. And while it’s true that CNMs are experts in physiologic birth, and love this work, they also practice a wide range of women’s, reproductive, and primary healthcare.

What is physiologic birth?

“Physiologic” means the normal, healthy, expected bodily function. So, a physiologic birth happens when a pregnant woman naturally begins labor and progresses at her body’s pace through vaginal birth without medical interventions. Midwives are skilled in encouraging and supporting this process, and able to recognize any signs that would indicate a need to depart from a true physiologic birth in order to protect the health of a laboring woman or her baby.

What other services do CNMs offer?

The exact scope of care can vary from state to state as governed by state Boards of Nursing and Medicine. In some states, including North Carolina, licensure requires physician supervision, but the supervision does not limit the care or relationship between the CNM and the patient. The nurse midwifery scope includes:

  • Primary care
  • Well-woman care
  • Gynecologic care from adolescence through menopause and beyond
  • Family planning services
  • Treatment of STDs (includes male partner treatment)
  • Nutrition counseling
  • Preconception care
  • Pregnancy, childbirth, and postpartum care
  • Newborn care (up to 28 days of life)
  • Health promotion, disease prevention


The Reply certified nurse midwifery team, L to R: Amanda Meisel, MSN, CNM; Aleisa Carlson, CNM, WHNP-BC; Elizabeth Tyson, MPH, CNM; Samantha Ratcliffe, MSN, CNM, WHNP-BC; and Sara Fawson, DNP, CNM, WHNP-BC.

Can my CNM prescribe the medications I need?

Yes, CNMs have prescriptive authority and, like other healthcare professionals, CNMs must obtain registration with the Drug Enforcement Administration (DEA) to prescribe controlled substances.

Can I request a CNM to attend my birth and catch the baby when I am in labor?

Because CNMs are very knowledgeable in physiologic birth, they often are the lead clinician present for a labor that starts on its own and progresses to vaginal birth. This is typical for the majority of vaginal births at Reply. CNMs also may manage induced labors. However, CNMs are not surgeons and do not perform C-Section births or other operative deliveries. Certain high-risk pregnancies also necessitate physician care. Reply’s CNM and physician team collaborates closely to create the best plan for each patient throughout the stages of pregnancy, labor, and birth.

North Carolina is one of the states that requires physician supervision of CNMs. What does that mean?

Though CNMs practice autonomously and have independent licensure, in some states CNMs engage in a collaborative practice agreement with a supervising physician/surgeon (usually an ob/gyn). The supervising physician often is within the same practice as the CNM (as is the case at Reply). This does not mean that the physician is always physically present with the CNM during appointments or births; it means that the physician provides initial and on-going oversight to the CNM’s practice.

Where do Reply CNMs attend births?

Some CNMs attend births in homes, while the majority of births attended by CNMs (about 94-95%) are in hospitals. The Reply CNM team attends births at WakeMed Cary hospital. We are committed to helping you achieve the labor and birth that you hope for, and our aim is to help you prepare for this through our midwifery-led program CenteringPregnancy and through comprehensive education during your visits with us.

Do I qualify for Midwifery care?

It’s important to know that the choices you make about your pregnancy or birth (such as whether or not you choose an epidural) will not determine whether or not you qualify for midwifery care! CNMs are champions of comprehensive education and Reply CNMs want to help you make the best decisions for you. Sometimes in the event of health complications or a pregnancy that becomes high risk, this will mean transferring to physician-only care or a more integrated plan of collaborative care with both physician and CNM. Talk with your CNM or physician if you have questions about midwifery care.

If I see a CNM for an annual well-woman exam, am I supposed to come back for another visit with an OB/GYN too?

CNMs are highly skilled at providing well-woman exams and other services within their scope of care, and are trained to recognize when referrals are needed. Reply CNMs work closely with our ob/gyn colleagues and will make referrals for additional visits or to other healthcare professionals when warranted. For a typical, comprehensive well-woman exam and many common gyn visits, women may choose to see a CNM and will not need to see an ob/gyn for an additional visit.

Can I see a CNM at Reply if I’m having difficulty becoming pregnant?

Difficulty becoming pregnant means you should be seen for a “new subfertility visit.” Only certain clinicians at Reply are trained to provide subfertility visits. If you are interested in a subfertility visit at Reply, you will be scheduled with one of our trained physicians or CNMs; to learn more about our program visit Reply Infertility/Subfertility Services.

Are there different kinds of midwives?

Yes there are! You can learn more about the different kinds of midwives from the American College of Nurse Midwives (ACNM). At Reply, our nurse midwifery team is comprised solely of CNMs.

Nurse Midwife Fast Facts:

  • >12% of all births are attended by a CNM or CM1
  • Medicare and Medicaid reimburse CNMs at the same rate that physicians are reimbursed. This is true for most private insurances as well. This means that almost 100% of insurance payers will cover midwifery services.
  • There are 12,218 CNMs practicing in the US (as of Feb. 2019)
  • 94% of births that CNMs attend are in hospitals
  • CNMs are considered primary care providers
  • CNMs can see patients from adolescence through menopause and beyond

The question everyone is wondering… how do I pronounce “midwifery?” Listen here!

 

How do I establish care with a Reply Nurse Midwife?

Reply CNMs are available for in-office and telehealth visits. You may schedule a visit by calling 919-230-2100, or by clicking here. You may also visit our YouTube Channel to meet each of the Reply midwives, learn more about their passions, and their journeys to midwifery.

We look forward to connecting with you soon!

1CM: Certified Midwives: masters-prepared healthcare professionals who also are skilled in the practice of midwifery. To learn more about CMs, visit this link.

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Resources

https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000266/Definition%20of%20Midwifery%20and%20Scope%20of%20Practice%20of%20CNMs%20and%20CMs%20Feb%202012.pdf

https://www.midwife.org/acnm/files/cclibraryfiles/filename/000000007531/EssentialFactsAboutMidwives-UPDATED.pdf

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