Wednesday, August 15, 2012

What ACNM has to say about Senate Bill 1208

Part 1 of 2 series on ACNM:
As the most nationally respected midwifery organization, we had hoped that ACNM would support Senate Bill 1208.  Read more to learn about their concerns with this bill, and what they are hoping for the future of midwifery in our state.

In a recent letter to Safer Midwifery for MI, ACNM's MI Affiliate, President Ruth Zielinski writes:  "We strongly support licensing and regulating midwives as a measure of accountability and safety for the public, if appropriate minimum standards for education have been met."

She continues by writing: 
"The ACNM MI Affiliate does not support Senate Bill 1208 for many reasons: 

  • SB 1208 does not meet the International Confederation of Midwives (lCM) minimum standard educationally for professional midwives.  According to the ICM Global Standards for Midwiferv Education "Minimum length of a direct entry midwifery education program is three (3) years Minimum length of a post-nursing/ health care provider program is eighteen (18) months.  SB 1208 does not require any additional midwifery training beyond a nursing education. 

  • The bill deletes the definition of certified nurse midwife and adds a definition of licensed midwife, essentially negating over 30 years history in the state which has established a consistent level of education and mechanisms for licensure for the professionals who are Certified Nurse Midwives.

  • The bill dilutes even further, the educational standards currently in place for Certified Nurse Midwives by not providing for any differentiation between CNMs and CPMs in regard to education or scope of practice. The minimum requirement for Certified Nurse Midwifery education is a graduate degree post baccalaureate nursing education: Comparison of Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives (ACNM document) 

  • SB 1208 limits a midwife's scope of practice to birth, whereas the scope of practice for a Certified Nurse Midwife includes primary and well woman care. The services provided by CNMs includes "primary care, gynecologic and family planning services, preconception care" ACNM Definition of Midwifery and Scope of Practice,of Certified Nurse-Midwives and Certified Midwives"

In a nutshell, it appears that ACNM doesn't think this bill requires enough educational training in the area of midwifery, citing International Standards as being more appropriate. ACNM also notes the "redefining" of nurse midwives as licensed midwives, and limiting their scope of practice for Certified Nurse Midwives is concerning.  It also appears that they don't much like being limited to the same scope of practice as CPMs, and I can see why.  Their concerns are valid considering they have earned licenses in every state, are overseen by the board of nursing, have graduate degrees as advanced practice nurses, and have worked hard to earn respectable professional recognition.  

So, now what?  ACNM has met with Senator Whitmer's team about their suggested revisions.  Senator Whitmer's team has acknowledged the concerns regarding
nurse midwives.  They have expressed their willingness to amend the language to represent a bill that would not limit the scope of practice or dilute the respected credentials of CNMs.  They have also explained that while International Standards may be more desirable and appropriate, schools that offer such training are not available in MI.  Establishing the RN degree as a minimum for formal education is something that is readily available to people who want an alternative route to becoming a midwife.  Senator Whitmer's team is steadfast in their commitment to work in appropriately regulating and establishing minimum educational standards for anyone who is not a CNM or CM, but wants to call herself a "midwife".  

In the closing of her letter to Safer Midwifery about ACNM's position on SB 1208, Ruth writes: 

The Michigan Affiliate supports the position that, 
"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.  In the meantime we continue to maintain our standards for academic preparation and clinical practice." 

We, at Safer Midwifery for Michigan, will look forward to that day too.  A "
unified profession of midwifery, with unified standards for education and credentialing."  Sounds like a dream, and I often wonder why that is not already the case in today's world.  The truth is it's a deeply divided, broken profession, with some practicing well and others who are slipping through the cracks at the expense of precious lives.  I hope ACNM can back up their goals and statements by actively seeking the change women need and deserve. 

The language of Senate Bill 1208 may need to change slightly in areas, but the larger issues Senator Whitmer is attempting to address are spot on.  Thank you Senator for stepping forward to improve the safety & professional practices of midwifery, and thank you ACNM for your valid concerns and constructive feedback.  

More about what ACNM says about educational standards, and the definition of "professional midwife" next week on the blog!

For more information on International Standards, see the following links: 


  1. So in this bill, are Certified Midwives (without nursing degrees) permitted to gain license to practice in the state of Michigan? All I have seen and read tells me that only nurses trained in midwifery will be licensed.

  2. Dear Future Midwife,
    My understanding is that this bill is aimed at setting the minimum criteria for education at that of an RN. I know CNMs were unhappy with the language as they felt it limited their scope of practice, and blurred the lines too far between CPMs and CNMs. CMs have not been part of the discussion, but SHOULD be!! I think CMs and CNMs should be the two licensed options in our state, period. That gives non-nursing midwives an alternative, but still holds them to high educational standards and a clearly defined scope of practice. There are now (as of Nov 1, 2012) 4 different bills in our legislature that discuss midwifery in some form or another. None of them mentions CMs. This is a problem that needs to be addressed. Thank you for your comment.