Monday, August 20, 2012

ACNM on Minimum Educational Standards

ACNM Series, Part 2

With new legislation introduced in Michigan (Senate Bill 1208) that attempts to hold MI midwives to standards for both practice and education, many questions have surfaced. Our post today will focus specifically on educational standards for various midwives.  Here is what a professional midwife organization, the American College of Nurse Midwives, has to say on the subject of minimum educational standards.  I think you will find it to be largely in line with "What We're Seeking" here on the Safer Midwifery for MI blog.  

"This document...clarifies the position of the American College of Nurse-Midwives (ACNM) with regard to midwifery credentials and appropriate qualification for midwifery practice.  ACNM looks forward to the day when there is one unified profession of midwifery, with unified standards for education and credentialing, working toward common goals."

ACNM states that they, "look forward to the day when midwives have unified standards for education."  This is certainly not the case for midwives in Michigan.  Some have graduate degrees, some are advance practice nurses, some have trained through a rudimentary apprenticeship, and some are learning how to be a midwife on You Tube.  Anyone can call herself a "midwife" regardless of educational background in our state, and now CPMs want a license to practice.   

According to ACNM, not just anyone should be calling herself a "midwife." They have established benchmarks for what constitutes appropriate qualifications in order to call oneself a midwife.  What are those qualifications specifically?  What constitutes a "professional" midwife?  

"ACNM supports the following definition of a professional midwife:
“A professional midwife in the United States is a person who has graduated from a formal education program in midwifery that is accredited by an agency recognized by the US Department of Education.
(Please note: a CPM who trained through a MEAC-accredited midwifery school would meet this standard. The problem is that NARM does not require any formal education and therefore CPM credential does not assure that a midwife has been trained through any formal, accredited midwifery program.)
"The professional midwife has evidence of meeting established midwifery competencies that accord with a defined scope of practice corresponding to the components and extent of coursework and supervised clinical education completed. In addition, this person has successfully completed a national certification examination in midwifery and is legally authorized to practice nurse-midwifery in one of the 50 states, District of Columbia, or US jurisdictions.”

Sounds like a formal education by an accredited program isn't asking too much after all.  Neither is a defined scope of practice

ACNM supports laws and regulations that include:
(This is a shortened list as it pertains to this topic.  Full list of criteria in the linked document above.)
1. Successful completion of a formal education program accredited by an agency recognized by the US Department of Education.

2. Successful completion of a national certification examination in midwifery.

4. A scope of autonomous practice, recognized by law or regulation, that is consistent with the content of the education process and certification exam.

In an effort to support their "unified" vision for educational standards ACNM's statement specifically addresses an alternative to nursing school.  Senate Bill 1208 proposed an RN requirement as a minimum standard.  Some didn't support requiring midwives to go to nursing school.  ACNM themselves didn't think an RN degree (2 years) was sufficient.  If you continue reading, you'll see that ACNM already has an alternative to nursing school in place, a credential called a CM, Certified Midwife.  This credential includes a bachelor's degree in something other than nursing, then two years of graduate school in and accredited midwifery program.  Perhaps this should be the minimum standard for Michigan midwives. 

The Accreditation and Credentialing Process for CNMs and CMs
"Nurse-midwifery and certified midwifery education programs in the US are currently accredited by an autonomous agency recognized by the US Department of Education, the Accreditation Commission for Midwifery Education (ACME)

"Because ACNM believes that a nursing credential is not the only avenue of preparation for midwives to deliver safe and competent care, we moved to accredit education programs for midwives who do not wish to earn a nursing credential. The American Midwifery Certification Board, Inc. [AMCB, formerly the ACNM Certification Council, Inc. (ACC)] opened its national certification exam to nonnurse graduates of midwifery education programs and issued the first certified midwife (CM) credential in 1997.

"Certified midwives are educated to meet the same high standards that certified nurse-midwives must meet. These are the standards that every state in the U.S. has recognized as the legal basis for nursemidwifery practice. All education programs for CMs, like CNMs, are at the post-baccalaureate level.  Beginning in 2010, a graduate degree will be required for entry into clinical practice for both CMs and CNMs. CMs take the same AMCB certification exam as CNMs and study side-by-side with nurse midwifery students in some education programs. As an organization, ACNM supports efforts to legally recognize CMs as qualified midwifery practitioners granted the same rights and responsibilities as CNMs."

Having minimum standards for education should be a given when defining any "profession".  I have to imagine it becomes even more important for a profession in which lives are directly at stake.  How is it that Michigan has not yet established this for midwives practicing in our state?  How is it that CPMs are actively lobbying for a license, but the focus clearly circumvents any discussion of minimum standards for education?  When a CPM has so many routes to earning her "Certified Professional Midwife" credential, none of which require formal education of any kind, how can that be considered adequate in terms of educational preparation?  Not to mention that it's very clever of NARM to title this certification "Professional" when it doesn't even meet "professional" standards according to ACNM. 

I'd like to leave you with these thoughts...What obligation does ACNM have as a professional organization to speak up on this issue?  Perhaps they should lobby for legislation that would actually make birth safer, no matter where a baby is being born.  Perhaps it's time for them to back up this "position statement" with actions.  We need your help ACNM to protect the integrity of midwifery, and to protect the families "midwives" jointly serve. 

Link to part 1 ~ What ACNM has to say about Senate Bill 1208

For more on this topic, including ACNM's stance at the federal level, visit: 
Confutata: CNMs Don't Want to Play


  1. I agree that the ACNM needs to be clearer and more forceful in articulating their position. The ACNM created a stir in CPM circles in 2009 by opposing federal recognition of CPMs for precisely this reason (I blogged it at the time: "CNMs don't want to play at providing health care."

    It might come as a surprise to members of the legislature, as NARM doesn't advertise the fact, but fewer than half of CPMs have graduated from a MEAC-approved midwifery course; the majority are credentialled under NARM's PEP provision.

    1. Thank you for this post and reference to your blog. I didn't know about the federal stance that ACNM has taken on this. I'll share this and the other points you made with our legislators next month when we meet. Thank you!