Support Evidence Based Midwifery Education in the US

A recently revised Position Statement from the ACNM seeks to limit recognition of midwifery providers to those who have received their training through government accredited programs. This letter seeks implore the ACNM to rescind this statement and unite US Midwifery under the common goal of increasing access for women to the provider and setting of their choice.
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We, the undersigned, are writing to express our concern that one of the final decisions of the outgoing Board of the American College of Nurse-Midwives (ACNM) was to adopt the Position Statement, Midwifery Certification in the US, requiring institution-based education for all professional midwives in the US. This divisive position has no basis in the medical literature and should be abandoned. We call on the Board of the ACNM to support the common goal of increasing women's access to the midwifery providers and birth settings of their choice.

The overwhelming majority of the 5000 births--a full 99%-- in the definitive home birth study published by the British Medical Journal [BMJ 2005;330:1416 (18 June)],  were attended by midwives who earned their CPM credential via the North American Registry of Midwives (NARM) apprenticeship-based Portfolio Evaluation Process (PEP).  The CPM credential, which uses a competency based system to validate multiple routes of midwifery education, is accredited by the National Commission for Certifying Agencies (NCCA), the same agency that accredits the CNM and CM credentials. The majority of CPMs continue to acquire their midwifery education and training via the PEP, and all indications are that the demand for this community-based educational model will only continue.

As referenced in the ACNMs Position Statement, the BMJ study found that low-risk women who planned home births under the care of PEP-prepared midwives credentialed as Certified Professional Midwives (CPMs) experienced outcomes equal to those of low-risk women who planned hospital births, but with far fewer costly and preventable interventions. There are no studies supporting the claim that institution-based education produces superior outcomes for mothers and babies who are cared for by midwives in North America.

Moreover, international standards do not support limiting midwifery education in the US to DOE-approved programs. The International Confederation of Midwives (ICM) defines a midwife as a provider who having been regularly admitted to a midwifery education program duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. All CPMs have met the educational requirements for national certification and we are seeing an increasing trend for legal recognition in many states.

Women need access to professional midwives whose educational and credentialing process provides them with expertise in out-of-hospital birth, just as they need access to professional midwives whose educational and credentialing process prepares them to provide hospital-based and clinical care that extends beyond the childbearing cycle. Neither option should be sacrificed to the interests of dominating both markets. Women deserve better.

We call on the incoming Board of the ACNM to develop evidence-based policies on the licensing and credentialing of midwives in the US and to rescind a Position Statement that will potentially deny women access to PEP-prepared professional midwives with expertise in out-of-hospital birth. We encourage the ACNM, its affiliate chapters, and individual members to recognize that the time has come to stand together as we work to move the profession of midwifery forward.


The North American Registry of Midwives


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Please visit the NARM Forum to read more information about this issue.


Organizational Endorsements (Please contact NARM to add your organization to this letter):

Citizens for Midwifery

International Center for Traditional Childbearing (ICTC)

Midwives Alliance of North America (MANA)

National Association of Certified Professional Midwives (NACPM)

Midwifery Education Accreditation Council (MEAC)

The Big Push for Midwives Campaign

Alabama Midwives Alliance

Friends of Iowa Midwives

Commonwealth Midwives Alliance

South Dakota Safe Childbirth Options, Inc.

Wisconsin Guild of Midwives

New Mexico Midwives Association

Idaho Midwifery Council

California Association of Midwives

North Carolina Friends of Midwifery

Virginia Birth PAC

Alabama Birth Coalition

Ohio Families for Safe Birth

Arkansas Childbirth Institute

Georgia Midwifery Association

Georgia Friends of Midwives



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