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We should look at how midwives are underutilized

Dear Editor,

Having recently retired from the Military after a 20 plus year career, I am and have been a Certified Nurse Midwife (CNM) practicing independently in the U.S. Army for over 10 years.  There is much focus in our legislation currently regarding Midwives and the right to a Home Birth.  I am concerned that there is a lack of understanding surrounding the definition of Midwifery (CNM vs. CM vs. CPM).  It can be very confusing and misleading.  I am a CNM, an Advanced Practice Nurse, who chose to do obstetric and gynecologic care for women from “womb to tomb,” to include adolescent care; contraceptives; pregnancy (prenatal, antenatal, intrapartum and postpartum care); lactation consultation; care of the infant for the first 29 days; and menopausal issues.  A CNM does NOT typically do in-home births, this requires additional training and a collaborative agreement with a licensed MD.  I have always done in-hospital deliveries affording women an alternative to Obstetrician and/or Family Practice physician medical model.

A Certified Nurse-Midwife (CNM) is an individual Masters level educated in the two disciplines of Nursing and Midwifery, who possesses evidence of certification according to the requirements of the requirements of the American College of Nurse-Midwives (ACNM).  A Certified Midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.  A Certified Professional Midwife (CPM) is a knowledgeable, skilled and independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM).  CPMs are currently working with Alabama State Legislators to have the right to do home births.  As a whole, midwives reduce medical costs; litigation rates are much lower, our patient satisfaction exceeds traditional benchmarks of patient satisfaction.  Our clients/patients are more autonomous, well-informed, often higher levels of education, and more participative in their care.

I feel that if we are going to focus on this issue in the State of Alabama, we should look at how Midwives are underutilized.  I understand UAB used to have CNMs and eliminated them reportedly under the pretense that residents were not getting adequate opportunity for deliveries.  In many military facilities, the CNMs supervise the residents affording them the opportunity to learn the value of labor sitting/coaching, the hallmark of midwifery practice.  Once a Physician understands the value in midwifery there is a much better understanding and mutual respect.  Brookwood Women and Infant Center advertises “have the birth of your choice” but is still an ALL MD staff.  Having been a labor and delivery nurse, I know who manages labor.  I think the group of young women that I met supporting the Alabama Birth Coalition are bright, professional women and should be given the right to choose.  As a group of professionals, we do have to be very careful the floodgates are not opened for all that want to deliver a baby at home.  There has to be STRICT adherence to guidelines much like the ACNM practice guidelines.  Adhering to clearly defined risk factors, the patient would have to be counseled given her risks when she does not meet criteria for a home birth and informed she cannot deliver at home for her and her infant’s well being.

This State needs to look at the value of Midwives as a whole and consider the evidence to give CNMs the right to practice independently in underserved, as well as, populated communities that would prefer to have Obstetric/Gynecologic care done by a CNM (APN).  The CNM can function independently which is not currently considered in Alabama.  Midwives want to care for the underserved communities, these are the resources that need to be looked at and are basically untapped!  While preparing to retire, many of my CNM/Advanced Practice nursing colleagues in the Army would say “DON’T go to Alabama you can’t get a job”.  I admit it is VERY difficult to find one in my specialty.

If the Alabama Board of Nursing isn’t comfortable with new ideas, maybe it is time to get some new board members.  There needs to a support systems for Advanced practice nurses, some programs taught in this States universities, rather than suppress the value of Advanced Practice Nursing. There is a need for fresh ideas and schools of thought.  Change is inevitable in the medical community.  Thinking outside the box, wanting to be a scholarly community and support our women’s request should be valued not oppressed.

Do we want to remain in the minority of states that do not have independent nurse practitioners and/or midwives?  Did you know that in-home birth is considered a felony in Alabama?  Should we not afford that RIGHT and the CHOICE for a healthy mother?   Much like lotto, women cross the state line to have the right to have the birth of their choice.

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LTC (r) EuLynne Harrison, MSN, CNM, CLC

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