1. The American College of Nurse-Midwives, With women, for a lifetime ® A Career in Nurse-Midwifery Presented to the 61 st Annual Convention of the National Student Nurses Association April 5 & 6, 2013 By Elaine Germano, CNM, DrPH, FACNM Senior Education Policy Advisor American College of Nurse-Midwives

2. The American College of Nurse-Midwives, With women, for a lifetime ® What is a Certified Nurse- Midwife? An advanced practice nurse educated in the two professions of nursing and midwifery Licensed to practice and prescribe in all 50 states, DC and most US Territories Provides primary care to women across the lifespan, including care during pregnancy and childbirth

3. The American College of Nurse-Midwives, With women, for a lifetime ® Midwifery: An Ancient Profession

4. The American College of Nurse-Midwives, With women, for a lifetime ® Mary Breckinridge Founded the Frontier Nursing Service (FNS) in1925 Sent British nurse- midwives on horseback to isolated families in Appalachia

5. The American College of Nurse-Midwives, With women, for a lifetime ® FNS midwives cared for women and families in their homes in Appalachia In order to improve the health of families, we must first care for the mothers

6. The American College of Nurse-Midwives, With women, for a lifetime ® The Growth of Midwifery is supported by published research that shows CNMs: Provide high-quality care Have comparable or better outcomes Have high levels of patient satisfaction Lower costs due to fewer interventions

7. The American College of Nurse-Midwives, With women, for a lifetime ® Nurse-midwives provide primary care to women across the lifespan

8. The American College of Nurse-Midwives, With women, for a lifetime ® So, What Exactly Do Nurse-Midwives Do? Well-Woman Annual Exams –Menstrual and sexual history, along with family, medical and social history –Physical exam, including breast and pelvic exams –Pap test, STI screening –Lab, diagnostic tests –Prescriptions

9. The American College of Nurse-Midwives, With women, for a lifetime ® Midwives also provide: Primary Care Visits –Minor complaints, e.g. colds, flu, urinary tract infections –Headache, depression, diabetes, thyroid conditions, etc – Counseling (including preconception counseling)

10. The American College of Nurse-Midwives, With women, for a lifetime ® Prenatal Care Regular individual or group visits Partners encouraged to attend! Vital signs, lab and diagnostic tests Fetal Assessment (heart tones, fundal height) Nutritional/exercise assessment

11. The American College of Nurse-Midwives, With women, for a lifetime ® Labor and Birth Attendance

12. The American College of Nurse-Midwives, With women, for a lifetime ® Post-partum care and Breastfeeding support

13. The American College of Nurse-Midwives, With women, for a lifetime ® A Typical Day in the Office First patient: –First visit of 26 year old woman, 1 st pregnancy, LMP 2/22/12, EGA 6w1d –c/o urinary frequency and intermitant R-sided pain, 7 on scale of 10; decreased appetite –Denies vag bldg, nausea, vomiting or other sx Gather additional data: –PMH, PSH, Gyn hx, Ob hx, Soc hx –Allergies, Meds, Pre-pregnancy wt

14. The American College of Nurse-Midwives, With women, for a lifetime ® First Patient (cont.) Gather objective data: –VS, ht, wt, BMI –Labs –PE –transvaginal u/s What are your concerns? –Ectopic pregnancy –Medications –UTI

15. The American College of Nurse-Midwives, With women, for a lifetime ® First Patient (cont) Assessment –26yo GIP0, EDD 12/1/13 –IUP GA 6w1d –UTI Management Plan –Tx UTI –Counsel re: exercise, diet, expected wt gain, medications; stage of pregnancy expectations

16. The American College of Nurse-Midwives, With women, for a lifetime ® Second Patient Returning client –19yo female, taking ocps x2 mos, c/o bloating, breast tenderness, thinking of stopping pills; also c/o vag discharge x5 d –Denies vag itching or d/c, admits to some dysparuina and dysuria, unsure about partner sx Gather additional data: –Review hx, any changes incl. change in partner? –Use of condoms, correct use of ocps?

17. The American College of Nurse-Midwives, With women, for a lifetime ® Second Patient (cont.) Gather objective data: –VS, wt –Labs, incl. wet prep + GC/CT, UA –Pelvic exam What are your concerns? –UTI –STIs –Correct use of ocps

18. The American College of Nurse-Midwives, With women, for a lifetime ® Second Patient (cont.) Assessment –BV, Trichomoniasis –At risk for pregnancy Management Plan –Tx STI and vag. infection –Counsel re: use of condoms, continuing current ocps, consider change in 1 month

19. The American College of Nurse-Midwives, With women, for a lifetime ® Additional Patients 52yo woman c/o perimenopausal sx, smoker, wants HRT 33yo G3P2, 20 wks GA, no concerns, 28 lb wt gain 28yo G2P2, IUD Paragard x3 yrs c/o excessive bleeding and lower abd pain 27yo G2P1, 37 wks GA, normal pregnancy, tired of being pregnant, wants induction

20. The American College of Nurse-Midwives, With women, for a lifetime ® Healthy Mothers, Healthy Babies, Healthy Families

21. The American College of Nurse-Midwives, With women, for a lifetime ® Philosophy of Care Listening to women – the hallmark of midwifery care Focus on prevention and education View pregnancy as a normal process Provide compassionate and family-centered care Encourage women’s participation in decision-making Use technology and intervention appropriately Consultation, collaboration and referral with members of the health care team

22. The American College of Nurse-Midwives, With women, for a lifetime ® Midwives promote the health and well-being of women and infants within their families and communities

23. The American College of Nurse-Midwives, With women, for a lifetime ® Emphasis on Primary Care Reproductive Care (53.3%) Primary Care (33.1%)

24. The American College of Nurse-Midwives, With women, for a lifetime ®

25. CNMs Have Excellent Outcomes

26. The American College of Nurse-Midwives, With women, for a lifetime ® Midwives Provide Effective Labor Support Twice as much ambulation in labor Twice as much intermittent monitoring Twice as many non-medicated births Half as many episiotomies Supportive care during labor

27. The American College of Nurse-Midwives, With women, for a lifetime ® Midwifery Prenatal Care Contributes to Excellent Outcomes Midwifery Prenatal Care Listen to Women Provide Emotional Support Pregnancy and Birth Education Collaborate with Physicians

28. The American College of Nurse-Midwives, With women, for a lifetime ® Patients Prefer Practices with CNM Providers

29. The American College of Nurse-Midwives, With women, for a lifetime ® Where do midwives attend births? %

30. The American College of Nurse-Midwives, With women, for a lifetime ® Planned Home Birth: A Safe Option with ACNM Midwives Low Infant Mortality - 2.5 per 1000 Transfer to hospital during labor- 8.3% Postpartum/Neonatal Transfers - 1.9%

31. The American College of Nurse-Midwives, With women, for a lifetime ® Number of CNM-Attended Births

32. The American College of Nurse-Midwives, With women, for a lifetime ® Reimbursement for CNMs Medicaid: mandatory coverage of CNMs in all states Medicare: sets standard for all private insurance, CNMs at 100% of physician fee schedule Private insurance: mandated coverage of CNM services in 33 states

33. The American College of Nurse-Midwives, With women, for a lifetime ® Primary Employers Hospitals and medical centers: 35% MD practices: 30% Community health centers: 8.4% Midwife Practice: 7% Academic Institution: 7% Other: 12.6%

34. The American College of Nurse-Midwives, With women, for a lifetime ® Salary Full-time (35 hrs per wk or greater) average $114,152 per year Productivity bonus: 25 % receive, 75% do not

35. The American College of Nurse-Midwives, With women, for a lifetime ® The American College of Nurse-Midwives The professional association representing CNMs and Certified Midwives (CMs) Since 1929 - oldest women's health care organization in the US Ensures foundation of midwifery education through the Core Competencies for Basic Midwifery Practice Sets Standards for the Practice of Midwifery Provides Clinical Bulletins

36. The American College of Nurse-Midwives, With women, for a lifetime ® ACNM’s Department of Global Outreach Since 1982 – projects and technical assistance in 30 developing countries Devised Life Saving Skills Training Program used in Asia and Africa Assists and strengthens midwifery associations

37. The American College of Nurse-Midwives, With women, for a lifetime ® Midwifery Education 39 midwifery education programs nationwide Most onsite; 5 fully distance-based Bridge programs (ADN to MSN) Master’s programs DNP programs

38. The American College of Nurse-Midwives, With women, for a lifetime ®

39. Midwifery Education Trends

40. The American College of Nurse-Midwives, With women, for a lifetime ®

41. Midwifery Certification National certification exam administered by American Midwifery Certification Board Graduate Degree required in order to take certification exam Number of ever-certified CNMs/CMs more than 12,000 Recertification every five years

42. The American College of Nurse-Midwives, With women, for a lifetime ® Learn More… Learn more about midwifery at www.midwife.org See http://midwife.org/become_midwife.cfm for midwifery education information Visit http://midwife.org/find.cfm to find a midwife in your area See www.gotmom.org for ACNM’s online breastfeeding resource

43. The American College of Nurse-Midwives, With women, for a lifetime ® With Women… …For a Lifetime

44. The American College of Nurse-Midwives, With women, for a lifetime ® The American College of Nurse-Midwives www.midwife.org