United States Midwifery Scope of Practice

The scope of midwifery practice used throughout this document is based on the ICM definition of the midwife. The ICM recognizes the scope of midwifery practice to include:

1. education and counselling on sexual health and provision of contraceptive methods
2. provision of support, care and advice during pregnancy, labor and the
   postpartum period

• • the conduct of births on the midwife’s own responsibility
  • the provision of care for the newborn and the infant

Midwifery care may be provided in any setting, including the home, community, hospital, clinic, or health unit, depending on how maternity care is organized within a given country. Midwifery care is linked with the care provided by health providers in referral centers (doctors, nurses and specialists). Midwifery care is provided with consideration given to the context of care, i.e., the health care system in which she practices, and the special circumstances of the country of practice, such as specific health concerns and epidemiological challenges (e.g., HIV/AIDS).

Selected functions within the scope of midwifery practice may also be shared with other cadres of community-based health providers. The titles of these individuals may vary widely, depending on the specific country context. Certain functions might be delegated to health workers who may have received very specific training to conduct certain tasks related to the provision of pregnancy and birth care. The essential similarity between the various cadres of providers is the set of skills that promote the ability to provide safe (i.e. competent) care.

Midwifery as practiced by certified nurse-midwives (CNMs) and certified midwives (CMs)
encompasses the independent provision of care during pregnancy, childbirth, and the
postpartum period; sexual and reproductive health; gynecologic health; and family planning
services, including preconception care. Midwives also provide primary care for individuals from
adolescence throughout the lifespan as well as care for the healthy newborn during the first 28
days of life.

Midwives provide care for all individuals who seek midwifery care, inclusive of all
gender identities and sexual orientations. Midwives provide initial and ongoing comprehensive
assessment, diagnosis, and treatment. They conduct physical examinations; independently
prescribe medications including but not limited to controlled substances, treatment of substance use disorder, and expedited partner therapy; admit, manage, and discharge patients; order and interpret laboratory and diagnostic tests; and order medical devices, durable medical equipment, and home health services. Midwifery care includes health promotion, disease prevention, risk assessment and management, and individualized wellness education and counseling.

These services are provided in partnership with individuals and families in diverse settings such as ambulatory care clinics, private offices, telehealth and other methods of remote care delivery, community and public health systems, homes, hospitals, and birth centers.
CNMs and CMs are educated in graduate-level midwifery programs accredited by the
Accreditation Commission for Midwifery Education (ACME). CNMs and CMs pass a national
certification exam administered by the American Midwifery Certification Board (AMCB) to
receive the professional designation of CNM (if they have an active registered nurse [RN]
credential at the time of the certification exam) or CM.

Certified Nurse Midwives and Certified Midwives must demonstrate that they meet the Core Competencies for Basic Midwifery Practice of the American College of Nurse-Midwives (ACNM) upon completion of their midwifery education programs and must practice in accordance with ACNM Standards for the Practice of Midwifery. ACNM competencies and standards are consistent with or exceed the global competencies and standards for the practice of midwifery as defined by the International Confederation of Midwives. To maintain the designation of CNM or CM, midwives must be recertified every 5 years through AMCB and must meet specific continuing education requirements.

The Core Competencies for Basic Midwifery Practice include the fundamental
knowledge, skills, and abilities expected of new midwives certified by the American
Midwifery Certification Board (AMCB). They serve as guidelines for educators,
students, health care professionals, consumers, employers, and policymakers. The Core
Competencies constitute the basic requisites for graduates of all midwifery education
programs pre-accredited or accredited by the Accreditation Commission for Midwifery
Education (ACME). They are inclusive of the hallmarks of midwifery practice.
Midwifery practice is based on the Core Competencies for Basic Midwifery Practice, the
Standards for the Practice of Midwifery, the Philosophy of the American College of
Nurse-Midwives, and the Code of Ethics developed and disseminated by the American
College of Nurse-Midwives (ACNM). Midwives certified by the AMCB assume
responsibility and accountability for their practice as primary health care providers for the
individuals they serve as defined in the Definition of Midwifery and Scope of Practice of
Certified Nurse-Midwives and Certified Midwives.
ACNM defines the midwife’s role in primary health care based on the Institute of
Medicine’s report, Primary Care: America’s Health Care in a New Era, the Philosophy of the American College of Nurse-Midwives, and the ACNM position statement, “Midwives are Primary Care Providers and Leaders of Maternity Care Homes.” Primary health care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing the majority of health care needs, developing a sustained partnership with clients, and practicing within a context of family and community. As primary health care providers, midwives certified by AMCB assume responsibility for the provision of and referral to appropriate health care services, including prescribing, administering, and dispensing of pharmacologic agents.

The concepts, skills, and midwifery management processes identified in the Core Competencies form the foundation upon which practice guidelines and educational curricula are built. Midwives provide health care that incorporates appropriate consultation, collaborative management, and/or referral, as indicated by the health status of the individual. ACNM endorses that health care is most effective when it occurs in a system that facilitates communication across care settings and providers.

Individual education programs are encouraged to develop their own methods to address health care issues beyond the scope of the current Core Competencies. Each graduate is responsible for complying with the ACNM Standards for the Practice of Midwifery and the laws of the jurisdiction where they practice. The basis of midwifery education includes an understanding of health science theory and clinical preparation that provide a framework for the development of the necessary clinical competence. The scope of midwifery practice may be expanded beyond the Core Competencies to incorporate additional skills and procedures that improve care for the individuals that midwives serve. Following the completion of basic midwifery education, midwives may choose to expand their practice following the guidelines outlined in Standard VIII of the Standards for the Practice of Midwifery.