Certified Nurse Midwives in Delivery: What benefits they bring! Presented by: Deborah Johnson, CNM Jodee Gutierrez CNM

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1 Certified Nurse Midwives in Delivery: What benefits they bring! Presented by: Deborah Johnson, CNM Jodee Gutierrez CNM

2 History of Midwifery Midwife means with woman French Sage femme Spanish La Partera German Hebamme

3 Midwives have been assisting with delivery of women since the beginning of recorded time Ancient Egypt Ancient Egypt The Bible Genesis 35:17- Rachel giving birth Exodus 1:20 Hebrew midwives refused to kill baby boys

4 History of Midwifery in the USA Many midwives were accused of being witches and were executed in the 1600 s % of births attended by a Midwife Mostly rural women or urban immigrant women Midwives only attended 15% of births

5 The Frontier Nursing Service was started in Kentucky in 1925 with British midwives to provide health care to isolated areas in the Appalachian mountains

6 Educational programs Certified Nurse Midwives educated in both Nursing and Midwifery. Frontier School of Midwifery started in 1939 as British Midwives returned home during WWII. Today there are 45 Midwifery programs in the USA, most are Masters Degree programs.

7 Types of Midwives Certified Nurse Midwives (certified through American Midwifery Certification Board) Certified Midwives (certified through American Midwifery Certification Board) Certified Professional Midwives (certified through North America Registry of Midwives) Lay Midwives

8 Midwifery Scope of Practice Primary health care services for women from adolescence beyond menopause Gyn and family planning, preconception care Care during pregnancy, childbirth and postpartum period. Health promotion, disease prevention, and individualized wellness education Prescriptive authority in most states

9 Certified Nurse Midwives in Washington 9.1% of all births in 2009 CNM s have been practicing in Washington state since 1976 CNM s are licensed as Advanced Registered Nurse Practitioners A Master s degree is required for new licensure All third-party payers, including Medicaid, are required to reimburse for midwifery services

10 Total US Births Attended by Midwives Source: Centers for Disease Control and Prevention

11 Percentage of Live Births Attended by Certified Nurse-Midwives, Source: Centers for Disease Control and Prevention

12 Proportion of Vaginal Births Attended by Certified Nurse-Midwives, 2009 Source: Centers for Disease Control and Prevention

13 Absolute Change in the Proportion of Vaginal Births Attended by Certified Nurse-Midwives (CNMs), Source: Centers for Disease Control and Prevention

14 National Data 2009 CNMs attended 313,516 births in the United States, or 1 out of every 9 vaginal births 11.3% of all vaginal births or 7.6% of all US births Proportion of CNM/CM attended births has risen every year since 1989.

15 Medical Model of Care Obstetricians diagnose and treat pregnancy complications and manage those complications that can affect pregnant women and their unborn babies Recognizing these problems when they occur is an essential component of caring for pregnant women Medical model focus is on the potential of pathologic events during pregnancy and birth

16 The Midwifery Model of Care Health promotion Psycho-social adjustment to pregnancy and changes Education Culturally sensitive Family centered care

17 Joint Statement ACOG and ACNM 2011 OB-GYN s and CNMs are experts in their respective fields of practice and are educated, trained, and licensed independent providers who may collaborate with each other based on the needs of their patients To provide highest quality and seamless care, OB- GYN s and CNM s should have access to a system of care that fosters collaboration

18 Collaborative Practice Collaboration is derived from the Latin verb collaborate which means to labor together Midwives and physicians working together collaboratively allows for care that suits the unique and individual needs of each woman and her family

19 Examples of Collaborative Care CNM only management Term pregnancy No major risk factors CNM with Physician comanagement GDM diet controlled Need for cesarean section Assisted vaginal delivery (forceps and vacuum) PPROM Maternal fever Category II FHR tracing Transfer of care to Physician GDM insulin requiring, or pre-existing diabetes Multiple gestation pregnancy VBAC Magnesium Sulfate administration Category III FHR tracing Preterm labor

20 Evidenced Based Care Lower rates of cesarean birth Lower rates of elective inductions and augmentation Reduction in 3 rd and 4 th degree lacerations Lower use of epidural anesthesia Higher rates of breastfeeding Increased patient satisfaction and sense of control during labor

21 The Cochrane Collaboration: Gold Standard for Evidence-Based Practice Midwifery care is appropriate for the majority of women during pregnancy, labor, and birth Hatem 2008

22 Cochrane Review: What the Evidence Shows Decreased use of regional anesthesia Fewer episiotomies Fewer instrumental deliveries Increased comfort in being cared for by a midwife she knew Increased feeling of control in labor Increased breastfeeding initiation Shorter hospital stay

23 Midwives are Experts in Normal Pregnancy

24 The Midwifery Model of Care Midwifery focuses on pregnancy being a normal and healthy life event Midwives are experts in supporting the normal physiology of labor, delivery, and breast feeding.

25 Midwives in Delivery Labor support and encouragement Not only natural childbirth Regional anesthesia if woman desires Less episiotomies Less Instrumental deliveries

26 Labor Support and Encouragement

27 Laboring in Various positions

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31 Circle of Light Sandra Bierman

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