A Certified Nurse-Midwife (CNM) is someone who has completed accredited educational programs in the two disciplines of nursing and midwifery. Nurse-midwives are certified by the American College of Nurse-Midwives, a national organization that has established high standards for midwifery practice since 1929. Because of the rigorous educational and certification process, CNMs are licensed to practice in all 50 states. They also must participate in ongoing professional education in order to maintain their licensure.

CNMs specialize in the care of low-risk women during pregnancy, birth and the postpartum period. Their prenatal services include genetic screening, ultrasounds, blood testing and the close monitoring of the health of the pregnancy. They also manage care for the mother and baby during the labor and birth, and continue maternal care during the first six weeks postpartum. Care for the newborn during the first few days after the birth is also provided by the CNM if the baby is born out-of-hospital. CNMs in Washington State are licensed as nurse practitioners. They have prescriptive privileges and may use medications to treat a variety of conditions, including those that are unrelated to pregnancy.

Many CNMs also provide care for women with "moderate-risk" pregnancies, such as women with previous cesareans and women with diet-controlled gestational diabetes. These are managed in consultation with an obstetrician.

The nurse-midwife knows she is caring for a woman and a growing family, not just a "pregnancy". Therefore, the care includes consideration of all aspects of life (cultural, spiritual, social, nutritional, etc.). Appointments include time for discussion of client concerns and the encouragement toward healthy behaviors.

While all CNMs have individual practice styles, they share a common belief that pregnancy and birth are essentially normal and healthy processes. Their goal is to support their clients' innate abilities, while using medical interventions only as necessary. They also believe that women should have a voice in those decisions that affect them.

A study of more than 1,300 low-risk pregnant women in Washington State was conducted in 1997. It concluded that women cared for by nurse-midwives received safe medical care with fewer obstetrical interventions (such as inductions and episiotomies). These women were also significantly less likely to undergo a cesarean section, compared to those women seeing physicians. -American Journal of Public Health, Volume 87, Issue 3, 344-351 The quality of care provided by certified nurse-midwives is equivalent to that of physicians within the same area of expertise. Nurse-midwives, however, are better than physicians at providing services that "depend on communication with patients and preventative action." -Office of Technology Assessment, 1986

"I was unhappy with my OB care and transferred to Cindie late in my pregnancy. Cindie was so knowledgeable and affirming! I looked forward to my appointments with her. During labor and delivery, she explained everything, let me try different positions, and encouraged me to focus on the partnership between my baby and myself -- to work together. I trusted her completely. " - Shelly Smith, Seattle

During any pregnancy or birth, complications can arise at unexpected times. Certified Nurse-Midwives (CNMs) are prepared to manage these situations while eliciting help from appropriate specialists. Obstetricians are available at all times for consultation and/or medical involvement with the midwifery client. Other health professionals are also consulted as needed. If a cesarean is necessary for a safe birth, the CNM usually assists the obstetrician with the surgery and resumes care postpartum.

Certified nurse-midwives (CNMs) want women to have a voice in the decisions that affect them! All technological assistance available in a hospital setting is equally available to clients of the CNM.

To learn more about nurse-midwifery, visit the ACNM website at www.acnm.org.