Certified Nurse-Midwives Fill Widening Access Gap

By Kristine Hartvigsen on May 23rd, 2016

The woman who delivers her baby in a car pulled to the side of the road might provide an exciting headline on the local evening news. And while these stories usually have happy endings, they nonetheless represent significant risk for each and every woman who endures such an episode. Fortunately, emergent roadside births are relatively rare.

OBHG believes every patient is best served by a team working in tandem to deliver the best care possible, and we occasionally have hospital-based opportunities for experienced, passionate Certified Nurse Midwives. OBHG representatives will be exhibiting in Albuquerque, NM, for the American College of Nurse-Midwives Annual Meeting from May 22-26. We invite any CNMs to stop by our table and say hello.

Research suggests that the farther a woman must travel to receive OB/GYN care increases her risk for pregnancy complication and an adverse outcome. In many areas, especially across rural America, women must travel up to six hours to see an obstetrician or reach a healthcare facility that still offers labor-and-delivery services.

Nearly half of all counties in the United States now have no obstetric care providers, according to the American Congress of Obstetricians and Gynecologists (ACOG). In addition, ACOG projects that there will be a 25% shortage of OB/GYNs within the next 14 years. The reasons for this vary. One is the retirement of dedicated rural OB/GYNs. Another is low interest among medical school graduates in practicing OB/GYN because of liability risk and upward-spiraling malpractice insurance costs.

Before the post WWII baby boom, nurse-midwives almost exclusively devoted their services to lower-income women delivering at home. Around 1950, a shortage of obstetricians led to the acceptance and employment of more nurse-midwives in hospital obstetric wards.

Today, as access to OB care continues to present challenges in many areas, Certified Nurse-Midwives (CNMs) are in greater demand than ever before. Their training is rigorous; all programs accredited by the American College of Nurse-Midwives (ACNM) Accreditation Commission for Midwifery Education (ACME) require a bachelor's degree for admission, and many require that the applicant’s bachelor’s degree be in nursing. Upon graduation from an ACME-accredited program, individuals take the American Midwifery Certification Board (AMCB) national certifying exam. If successful, they receive a Certificate in Nurse-Midwifery. Interestingly, about 2% of CNMs are men. The Bureau of Labor Statistics predicts that employment rates for nurse-midwives will increase by 31% between 2012 and 2022.

There is growing respect between physicians and CNMs who work collaboratively in hospital labor-and-delivery units. CNMs now attend an estimated 12% of hospital vaginal births. Though data are sparse, there is mounting evidence that collaborative midwife-hospitalist OB/GYN care models tend to produce fewer medical interventions, lower C-section rates, and increased rates of vaginal birth after cesarean (VBAC). CNMs can write prescriptions in all states. Ten states require physician supervision of CNMs, and CNMs cannot perform C-sections.

In 2011, the American Congress of Obstetricians and Gynecologists and the American College of Nurse-Midwives issued a joint statement of practice relations with the “shared goal of safe women’s healthcare in the United States through the promotion of evidence-based models” provided by OB/GYNs and CNMs. Both organizations have come out in support of the federal “Improving Access to Maternity Care Act of 2015” (HR 1209), which would establish a health professional shortage area designation for maternity care services. Such designations already exist for primary care, dental, and mental health services.

Obtaining this health professional shortage designation for maternity care would make possible scholarships and loan repayment to professionals who agree to work in those shortage areas for a minimum amount of time. The bill was introduced in the U.S. House last year and remains in the House Subcommittee on Health.

OBHG practitioners are on the front lines in hospitals 24 hours a day. Their life-changing, life-saving work is the foundation of our success and our most valued resource.

This blog provides general information and discussion about healthcare-related subjects. The content and linked materials provided are not intended and should not be construed as medical advice. If the reader is an expectant mother or has a medical concern, she should consult with an appropriately licensed physician or healthcare provider.

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