CNM opposition to CPM licensure

To become a Certified Nurse-Midwife (CNM) first one must train as an RN, then pursue an additional two years of training related to nurse-midwifery. CNMs in South Dakota then must obtain a signed collaborative agreement with a physician and have it approved by the Boards of Medicine and Nursing. “We worked too hard and put up with too much to see someone else try to get it without even going to school,” one CNM explained to me recently when asked why she was against licensing of Certified Professional Midwives (CPMs)

The differences between CNM and CPM practice are explained below. They are distinct and quite separate in their scope.

CPM training is entirely in preparation for out-of-hospital birth. CNM training does not require homebirth experience.

CPMs seek to practice in solely out-of-hospital settings. CNMs provide services primarily in hospitals and clinics, with some practicing in birth centers. Only 2% of CNMs provide home birth services (nationwide average).

CPM practice extends from the first prenatal visit to a six-week postpartum exam. CNM practice addresses the reproductive concerns of women from the onset of menses through senescence, it includes pregnancy and birth services, but not limited to, pregnancy and birth services.

CPMs train to provide care for normal healthy women having normal healthy pregnancies and refer complications to other providers. CNM training includes the management of all routine obstetrical interventions including imaging, fetal monitoring, intra-vaginal and intravenous medications for induction and augmentation, intravenous medication for pain management and the prevention and treatment of infection, intra-vaginal and parenteral medication for the control of hemorrhage, use of vacuum extractor, and assisting at surgical deliveries. CNM training also includes other reproductive health services related to screening and lifelong wellness, contraception, sexually transmitted disease care, management of menses and menopause and other elements of comprehensive lifelong woman care.

CPMs have typically provided care that extends into remote rural areas typical of much of the state and particularly typical of the population that chooses home birth in SD for cultural or religious reasons. CNMs are limited by American College of Nurse Midwives (ACNM) practice standards to provide home birth services only within thirty minutes of a hospital with obstetrical services. In South Dakota CNMs’ potential service area is very limited.

CPM practice is quite limited when compared to the scope of practice afforded to nurse-midwives who have undergone extended academic and clinical training. CPM practice overlaps very little with CNM practice, due to the scarcity of CNMs who are trained and willing to provide home birth services and the ACNM’s limitation of practice based on hospital proximity. However necessary CPM skills have been defined by a job analysis accepted by the National Commission for Certifying Agencies (the same agency that accredits the CNM credential for ACNM credentialing) and are fully met by the CPM credentialing process. After recognizing the rigor and validity of the North American Registry of Midwives (NARM) administered CPM credential, 23 states (with several additional states pending) currently accept the CPM credential as the standard for licensing of non-nurse-midwives.