What is the difference between different kinds of midwives?
There are two types of midwives practicing in Illinois. Certified Nurse Midwives (CNMs) have completed nursing school as well as additional study in nurse-midwifery. Their credential is granted by the American Midwifery Certification Board (ACMB). Most often, CNMs practice in a hospital setting. CNMs can provide home birth care as long as they have a written collaboration agreement with a physician. This type of agreement can be difficult to obtain because it depends entirely on the willingness of the physician to collaborate. Direct-Entry Midwives (DEMs) enter directly into midwifery training, usually through a combination of apprenticeship and formal study. DEMs (sometimes also referred to as community midwives) can choose to take a competency-based exam to become a Certified Professional Midwife (CPM). The CPM credential is administered by the North American Registry of Midwives (NARM). Both NARM and the ACMB are accredited by the National Commission for Certifying Agencies. Midwives, regardless of the type of credential they might have, strive to practice according to the Midwives Model of Care.
What is the Midwives Model of Care?
The Midwives Model of Care sees pregnancy and birth as normal parts of the life cycle. Midwives who adhere to this model will:
-monitor the physical, psychological, and social well-being of the mother throughout the childbearing year.
-provide mothers with individualized education, counseling, prenatal care, continuous hands-on assistance during labor and delivery, as well as postpartum support.
-minimize technological interventions.
-identify and refer women who require obstetric care.
There is an excellent brochure that Citizens for Midwifery has published on the Midwives Model of Care. You can download it for free here.
What is the legal status of midwives in Illinois?
While CNMs can practice throughout the United States, CPMs are regulated on a state-by-state basis. The state of Illinois does not recognize Direct-Entry Midwives even if they have earned a CPM credential. This means they must practice underground. When a midwife practices underground, it can be more difficult for her to access lifesaving medications for her clients, receive insurance reimbursement for her services, and to smoothly transfer clients to a hospital if it becomes necessary. The prohibitive legal regulations surrounding home birth in Illinois act as a disincentive for aspiring midwives who may otherwise set up practices in our state. Such laws can also encourage practicing midwives to leave the state to practice in a state where they are better integrated into the maternity care system.
Why is it important to license Certified Professional Midwives (CPMs) in Illinois?
Many women in Illinois simply do not have access to home birth midwives. Fewer than 10 out of 102 Illinois counties have legally recognized home birth practices run by CNMs or physicians. Outside of the Chicago metropolitan area, women’s home birth options are extremely limited. It is not uncommon for women to search for months to locate an appropriate provider. Some women leave the state to give birth. Others try to find an out-of-state midwife who is willing to cross the border to attend her labor. Still others simply stop searching and opt to give birth unassisted. Those who do find a community midwife have no mechanism for assuring the midwife has met state standards. Nor can they be certain of a smooth transport should the need to go to the hospital arise. Some families have received very poor treatment and delayed medical care upon transport. If the state of Illinois were to use the CPM credential as the basis for offering midwifery licensure, it would set a standard of care for home birth midwifery that would help families choose a safe, well-trained provider and it would integrate existing community midwives into the system. Integration would give CPMs access to consultation with other medical providers, access to life-saving medications and make emergency transports more efficient. By licensing CPMs, the State of Illinois would acknowledge the important role that community midwives can play in providing the high-quality, low-cost, woman-centered maternity care that home birth families seek.