Scope of Practice
This information is adapted from the Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives from the American College of Nurse-Midwives.
Overview of Midwifery Scope of Practice
The Vanderbilt Nurse-Midwifery Program prepares students to become a Certified Nurse-Midwives (CNMs®). CNMs provide health care in all US states. Midwifery as practiced by CNMs includes range of health care services for women/individuals from adolescence through the life course. These services include the independent provision of:
- Primary care
- Gynecologic, sexual and reproductive services for women, transgender, and gender non-conforming individuals
- Pregnancy-related care including prenatal care, birth, and postpartum
- Assessment of the newborn and care of the well, term newborn during the first 28 days of life
- Treatment of male partners for sexually transmitted infections
- Health promotion, disease prevention, and individualized wellness education and counseling
Midwives provide comprehensive assessment, diagnosis and treatment. They conduct physical examinations; prescribe medications including contraceptive methods and controlled substances; admit, manage and discharge patients; order and interpret laboratory and diagnostic tests. In providing care they consult, collaborate, and refer to and with other health care professionals to ensure individuals receive team-based medical care consistent with medical needs and personal preferences.
Locations for Practice
Nurse-midwives are licensed in all US states and work in a variety of settings. Services are provided in partnership with women/individuals and families in settings including:
- Ambulatory care clinics (private, non-profit, and federal health centers across the US),
- Health systems (academic, community-based, public, Indian Health Service)
- Intrapartum care facilities (hospitals, birth centers, and homes)
These settings are located in urban, suburban, and rural areas – anywhere were gynecologic, reproductive, and sexual health services are needed. Practice models vary across sites and include midwife-owned practice, private group practices, academic medical centers, corporate health systems, and federal of Indian health services.
Hallmarks of Midwifery
According to the American College of Nurse-Midwives, the art and science of midwifery are characterized by the following hallmarks:
- Recognition, promotion, and advocacy of menarche, pregnancy, birth, and menopause as normal physiologic and developmental processes
- Advocacy of non-intervention in physiologic processes in the absence of complications
- Incorporation of evidence-based care into clinical practice
- Promotion of person-centered care for all, which respects and is inclusive of diverse histories, backgrounds, and identities
- Empowerment of women and persons seeking midwifery care as partners in health care
- Facilitation of healthy family and interpersonal relationships
- Promotion of continuity of care as partners in health care
- Utilization of health promotion, disease prevention, and health education
- Application of a public health perspective
- Utilizing an understanding of social determinants of health to provide high-quality care to all persons including those from underserved communities
- Advocating for informed choice, shared decision making, and the right to self-determination
- Integration of cultural safety into all care encounters
- Incorporation of evidence-based integrative therapies
- Skillful communication, guidance, and counseling
- Acknowledgment of the therapeutic value of human presence
- Ability to collaborate with and refer to other members of the interprofessional health care team
- Ability to provide safe and effective care across settings including home, birth center, hospital, or any other maternity care service
Credentials and Certification
Vanderbilt nurse-midwifery students graduate with a Masters of Science in Nursing or a Post-masters Certificate depending on their selected pathway. (A seamless transition to the DNP is available.) On completion of the midwifery program, students are eligible to take the American Midwifery Certification Board (AMCB) exam. The cumulative pass rate of our students taking their first AMBC certification exam is 95%. On completion of the AMCB exam, graduates will be Certified Nurse-Midwives and can obtain licensure to practice in all US states. To maintain the designation of CNM, midwives must be recertified every 5 years and must meet continuing education requirements.
Curriculum Congruence with National and International Standards
The Vanderbilt nurse-midwifery curriculum is based on the 2020 Core Competencies for Basic Midwifery Practice developed by the American College of Nurse-Midwives. The ACNM 2020 Competencies provide clear information on what is included within our curriculum as preparation for nurse-midwifery practice. Prior to graduation all students must demonstrate they meet or exceed all of the Core Competencies and can practice in accordance with ACNM Standards for the Practice of Midwifery. The Core Competencies are consistent with or exceed global Essential Competencies as defined by the International Confederation of Midwives.