Midwifery in North Carolina

One may be tempted to assume that all midwives share the same philosophy on birth, have a similar style to their work and are legally equal. However, the approach to midwifery from one midwife to the next is as diverse as the clients who hire them and the legal status between midwives is also different.

The most common midwives in North Carolina are Direct-Entry Midwives (including Certified Professional Midwives) and Certified Nurse Midwives. At this time CNM are legal in NC; Direct-Entry Midwives are not.

Most Direct-Entry Midwives have a naturopathic philosophy to pregnancy and birth. And although they do not discredit the medical community, they take pride in the fact that they offer an alternative to the medical model of care. Most incorporate limited medical testing, alternative remedies, spirituality and the use of herbs in their practice. In 2003 there were 12 Certified Professional Midwives and several Direct-Entry Midwives practicing in North Carolina.

Because Certified Nurse Midwives are trained and licensed in the medical community, they may be more inclined to incorporate medical aspects into their practice. But, you may also find them to be open to the naturopathic way as well. As of 2003 there were 189 CNMs practicing in North Carolina.

From the Citizens for Midwifery Web site (www.cfmidwifery.org), here is a brief overview of each type of midwife:

Direct-Entry Midwives (including Licensed Midwives)

1. Not required to be nurses.

2. Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).

3. May or may not have a college degree.

4. May or may not be certified by a state or national organization.

5. Legal status varies according to state. At this time, not legal in NC.

6. Licensed or regulated in 17 states.

7. In most states licensed midwives are not required to have any practice agreement with a doctor.

8. Educational background requirements and licensing requirements vary by state.

9. By and large maintain autonomous practices outside of institutions.

10. Train and practice most often in home or out-of-hospital birth center settings.

For more information contact your state's midwifery organization or CFM (1-888-CfM-4880)

The Certified Professional Midwife (CPM) credential & the North American Registry of Midwives (NARM)

1. Not required to be nurses.

2. Multiple routes of education recognized; direct entry midwives and certified nurse midwives can qualify for this credential.

3. Education programs accredited by the Midwifery Education Accreditation Council prepare students to meet the requirements for the CPM.

4. Out-of-hospital birth experience is required.

5. Have met rigorous requirements and passed written exam and hands-on skills evaluation.

6. Administered by the North American Registry of Midwives.

7. Legal status varies according to state. At this time, not legal in NC.

8. Practice most often in homes and birth centers.

For more information contact the North American Registry of Midwives at 1-888-84-BIRTH (eastern time) or by writing to:

NARM

PO Box 6449

Bend, OR 97708-6449.


The North American Registry of Midwives (NARM)

PO Box 6449
Bend, OR 97708-6449

About five years ago educators, program directors and experienced midwives in the field of direct entry midwifery decided it was time to begin developing a national credential, the Certified Professional Midwife (CPM) credential, which is administered through the North American Registry of Midwives and has rigorous standards for knowledge, skills and experience.

As of June 1998 there were nearly 400 CPMs in the US. Almost all of the states that license direct entry midwives are now using the written exam of the CPM process as their state licensing exam, and work is underway in many states for the CPM to be the basis of licensing these midwives. In Washington and Oregon having a CPM is a route to licensure.

Certified Nurse Midwives (CNMs)

1. Educated in both nursing and midwifery, primarily in the hospital setting; are "advanced practice nurses".

2. Must have at least a Bachelors Degree when training is complete. In North Carolina 75% hold a Masters Degree or higher in nursing education.

3. Have successfully completed a university-affiliated nurse-midwifery program accredited by the American College of Nurse-Midwives, and passed the exam.

4. Out-of-hospital clinical experience is not required.

5. Are legal and can be licensed in all states.

6. Most practice in hospitals and birth centers.

7. In NC must have some kind of agreement with a doctor for consultation and referral; practicing without such an agreement can lead to loss of license.

In North Carolina CNM must complete a formal educational course leading to a master's degree or certification of completion is required. The educational program must be approved by the American College of Certified Nurse Midwives (ACCNM) and the nurse midwife must be a registered nurse and certified by the ACCNM. Applicants are required to submit an application for approval to practice by the Midwifery Joint Committee. Applicants must successfully pass a national certification examination administered by the ACCNM in addition to having successfully passed the National Council Licensure Examination (NCLEX) for registered nurses. Validation of continued competency for certification is required every 5 years for all certified nurse midwives in clinical practice.

For more information contact the American College of Nurse-Midwives at 202-728-9860, or write to 818 Connecticut Ave. NW, Suite 900, Washington, DC 20006.