What does the term "midwife" mean to you? What do you think it means to the public where you live?
How are nurse-midwives licensed in your state (as a midwife or APRN)? What is your opinion on this and why? Name one situation it may make sense to introduce yourself as an APRN and a situation where you would introduce yourself as a midwife?
Does the definition of nurse-midwifery practice in the state regulations match the definition from the ACNM?
Be familiar with the standing documents of ACNM and key position statements such as the joint statement, collaborative management, and the culture of safety.
Is the scope of practice for nurse-midwives in your state to the full extent of their education and training, or does it require a formal written supervisory or collaborative agreement with physicians? What is your opinion about state requirements for written agreements with physicians?
What is the difference between certification and licensure? What are the benefits of certification to you and your clients?
Does your state have birth center regulations? If so, is accreditation required? What are the pros and cons of accreditation?
Do CNMs in the hospitals collaborate with community birth midwives in your area? What can CNMs do to strengthen and improve the safety of transfers from home or birth center to the hospital when transfer is needed?
What legislative issues is your state’s Affiliate of ACNM working on?
Is your state nurses’ association working on any legislative issues that might impact nurse-midwives (or patients served) in your state?
Have you identified any ways you might be able to support the legislative agenda of your state’s ACNM Affiliate or the Nurse’s Association?
Sample Answer
To me, a midwife is a healthcare professional who provides comprehensive care to women throughout their lifespan, with a specialized focus on pregnancy, childbirth, and the postpartum period. The term "midwife" literally means "with woman," reflecting the core philosophy of providing continuous, supportive care. In the public eye where I live in Arizona, the term "midwife" often conjures images of home births and a more "natural" approach to childbirth, distinct from the hospital-based care provided by obstetricians. However, the public's understanding is evolving to recognize that many midwives, particularly certified nurse-midwives (CNMs), practice in hospitals and work collaboratively with physicians.To me, a midwife is a healthcare professional who provides comprehensive care to women throughout their lifespan, with a specialized focus on pregnancy, childbirth, and the postpartum period. The term "midwife" literally means "with woman," reflecting the core philosophy of providing continuous, supportive care. In the public eye where I live in Arizona, the term "midwife" often conjures images of home births and a more "natural" approach to childbirth, distinct from the hospital-based care provided by obstetricians. However, the public's understanding is evolving to recognize that many midwives, particularly certified nurse-midwives (CNMs), practice in hospitals and work collaboratively with physicians.
Licensure and Scope of Practice
In Arizona, nurse-midwives are licensed as Advanced Practice Registered Nurses (APRNs). My opinion is that this is appropriate because it accurately reflects the professional's dual training and credentials—both as a registered nurse and as a master's-level advanced practitioner. This dual licensure provides a clear professional identity and aligns with the structure for other advanced practice specialties like nurse practitioners. It makes sense to introduce myself as an APRN in a general professional setting, such as a large interdisciplinary meeting, to immediately establish my level of education and training. However, I would introduce myself as a midwife to a pregnant patient and her family to convey the specific, personalized, and holistic nature of my care.
The definition of nurse-midwifery practice in Arizona's state regulations aligns with the definition from the ACNM (American College of Nurse-Midwives), as both recognize CNMs as independent practitioners who provide a full range of primary and reproductive healthcare services to women, including care during labor and birth. However, the scope of practice in Arizona requires a formal written supervisory or collaborative agreement with a physician. In my opinion, this requirement is a significant barrier to the full extent of a nurse-midwife's education and training. It implies a dependent relationship that does not reflect the evidence-based practice of modern midwifery and can limit access to care, particularly in rural or underserved areas where physician supervision is not readily available.
Certification, Licensure, and Birth Centers
Certification is a voluntary process that validates a person's knowledge and competency in a specific area of practice, whereas licensure is a mandatory legal process by the state that grants permission to practice. The benefits of certification to me are professional validation and credibility, which in turn gives my clients confidence that I have met the highest standards of the profession.
Arizona does have birth center regulations, and accreditation is required. The pros of accreditation are that it ensures a minimum standard of quality and safety for patients and provides professional legitimacy. A con could be the cost and administrative burden of the accreditation process, which may be a barrier for smaller, independent birth centers.
Collaboration and Legislation
In my area, some CNMs in hospitals collaborate with community birth midwives, but this collaboration is not universal. CNMs can strengthen and improve the safety of transfers from home or a birth center to the hospital by:
Establishing Clear Protocols: Developing and regularly reviewing written transfer protocols between birth centers/home practices and local hospitals.
Building Relationships: Regularly meeting with community midwives and hospital staff to build rapport and trust.
Conducting Drills: Participating in joint simulations and drills to practice and refine transfer procedures.
Arizona's ACNM Affiliate is actively working on legislative issues to remove the requirement for a mandatory written collaborative agreement with a physician to achieve full practice authority. The state nurses' association is also working on legislative issues, such as advocating for nurse staffing ratios and addressing workplace violence, which would indirectly impact nurse-midwives by improving the overall hospital environment.