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A Career in Nurse-Midwifery

A Career in Nurse-Midwifery. Presented to the 61 st Annual Convention of the National Student Nurses Association April 5 & 6, 2013 By Elaine Germano , CNM, DrPH, FACNM Senior Education Policy Advisor American College of Nurse-Midwives. What is a Certified Nurse-Midwife?.

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A Career in Nurse-Midwifery

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  1. A Career in Nurse-Midwifery Presented to the 61stAnnual Convention of the National Student Nurses Association April 5 & 6, 2013 By Elaine Germano, CNM, DrPH, FACNM Senior Education Policy Advisor American College of Nurse-Midwives

  2. 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

  3. Midwifery: An Ancient Profession

  4. Mary Breckinridge Founded the Frontier Nursing Service (FNS) in1925 Sent British nurse-midwives on horseback to isolated families in Appalachia

  5. 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

  6. The Growth of Midwifery • is supported by published • research that shows CNMs: • Provide high-quality care • Have comparable or better outcomes • Have high levels of patient satisfaction • Lower costs due to fewer interventions

  7. Nurse-midwives provide primary care to women across the lifespan

  8. 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

  9. 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)

  10. 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

  11. Labor and Birth Attendance

  12. Post-partum care and Breastfeeding support

  13. 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 vagbldg, nausea, vomiting or other sx • Gather additional data: • PMH, PSH, Gynhx, Ob hx, Sochx • Allergies, Meds, Pre-pregnancy wt

  14. First Patient (cont.) • Gather objective data: • VS, ht, wt, BMI • Labs • PE • transvaginal u/s • What are your concerns? • Ectopic pregnancy • Medications • UTI

  15. 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

  16. 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?

  17. 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

  18. 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

  19. Additional Patients • 52yo woman c/o perimenopausalsx, smoker, wants HRT • 33yo G3P2, 20 wks GA, no concerns, 28 lbwt 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

  20. Healthy Mothers, Healthy Babies, Healthy Families

  21. 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

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

  23. Primary Care (33.1%) Emphasis on Primary Care Reproductive Care (53.3%)

  24. CNMs Have Excellent Outcomes

  25. 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

  26. Midwifery Prenatal Care Contributes to Excellent Outcomes

  27. Patients Prefer Practices with CNM Providers

  28. Where do midwives attend births? %

  29. 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%

  30. Number of CNM-Attended Births

  31. 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

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

  33. Salary • Full-time (35 hrs per wk or greater) average $114,152 per year • Productivity bonus: 25 % receive, 75% do not

  34. 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

  35. 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

  36. Midwifery Education • 39 midwifery education programs nationwide • Most onsite; 5 fully distance-based • Bridge programs (ADN to MSN) • Master’s programs • DNP programs

  37. Midwifery Education Trends

  38. 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

  39. 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

  40. With Women… …For a Lifetime

  41. www.midwife.org The American College of Nurse-Midwives

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