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This document is an archived version of:

Standards for the Practice of Nurse-Midwifery - 1993

The information contained within this document does not necessarily reflect the current positions or policies of the American College of Nurse-Midwives, however it is provided as a public service for the purpose of research. The current version of this document is: Standards for the Practice of Midwifery and may be found at www.midwife.org.

Standards for the Practice of Nurse-Midwifery - 1993

Nurse-midwifery practice is the independent management of women's health care, focusing particularly on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of women. The Certified Nurse-Midwife (CNM) practices within a health care system that provides for consultation, collaborative management or referral as indicated by the health status of the client. Certified nurse-midwives practice in accord with the Standards for the Practice of Nurse-Midwifery, as defined by the American College of Nurse-Midwives (ACNM).

The nurse-midwife is committed to maintaining a high standard of professional care, to participating in the education of nurse-midwives, and to promoting the concepts of nurse-midwifery practice in the community.

NURSE-MIDWIFERY CARE IS PROVIDED BY QUALIFIED PRACTITIONERS

The practitioner:

1. Is certified by the ACNM approved certifying agent.
2. Shows evidence of continuing competency as required by the American College of Nurse-Midwives.
3. Is in compliance with the legal requirements of the jurisdiction where the nurse-midwifery practice occurs.

NURSE-MIDWIFERY CARE SUPPORTS INDIVIDUAL RIGHTS AND SELF-DETERMINATION WITHIN BOUNDARIES OF SAFETY

The certified nurse-midwife:

1. Practices in accord with the Philosophy and the Code of Ethics of the American College of Nurse-Midwives.
2. Provides clients with a description of the scope of nurse-midwifery services and information regarding the client's rights and responsibilities.
3. Provides clients with information on other providers and services when requested or when care required is not within the scope of practice of the individual nurse-midwife.
4. Promotes involvement of support persons in the practice setting.

NURSE-MIDWIFERY CARE IS COMPRISED OF KNOWLEDGE, SKILLS, AND JUDGMENTS THAT FOSTER THE DELIVERY OF SAFE AND SATISFYING CARE

The certified nurse-midwife:

1. Collects and assesses client care data, develops and implements a plan of management, and evaluates the outcome of care.
2. Demonstrates the clinical skills and judgments described in the ACNM Core Competencies for Basic Nurse-Midwifery Practice.
3. Practices in accord with the ACNM Standards for the Practice of Nurse-Midwifery.
4. Practices in accord with the policies of the nurse-midwifery service/practice that meet the requirements of the particular institution or practice setting.
5. Expands clinical practice in accordance with ACNM Guidelines for the Incorporation of New Procedures into Nurse-Midwifery Practice.

NURSE-MIDWIFERY CARE IS BASED UPON KNOWLEDGE, SKILLS, AND JUDGMENTS WHICH ARE REFLECTED IN WRITTEN POLICIES/PRACTICE GUIDELINES

The certified nurse-midwife:

1. Describes the parameters for the service/practice for nurse-midwifery management, physician management and collaborative management. Establishes practice guidelines for each specialty area, which include but are not limited to:
   

   Antepartum

   1. criteria for admission to the nurse-midwife service.
   2. parameters and methods for assessing the progress of pregnancy.
   3. parameters and methods for assessing fetal well-being.
   4. indicators of risk in pregnancy and appropriate intervention.
   5. parameters for medications prescribed/used during pregnancy.

Intrapartum

1. parameters and methods for assessing progress of labor and birth.
2. parameters and methods for assessing maternal and fetal status.
3. parameters for medications and solutions prescribed/used during labor and birth.
4. management of birth and the immediate postpartum period.
5. methods to facilitate the newborn's adaptation to extrauterine life.
6. significant deviations from normal and appropriate interventions.
7. parameters and methods for assessing the immediate well-being of the newborn.

Postpartum/Newborn

1. parameters and methods for assessing the postpartum status of the mother.
2. parameters and methods for assessing the well-being of the newborn.
3. parameters for medications prescribed/used in the puerperium.
4. significant deviations from normal and appropriate interventions.

Family Planning/Gynecology

1. parameters and methods for assessing general physical and emotional status of the client.
2. parameters for medications and devices prescribed/used.
3. significant deviations from normal and appropriate interventions

STANDARD V

NURSE-MIDWIFERY CARE IS PROVIDED IN A SAFE ENVIRONMENT

The certified nurse-midwife:

1. Demonstrates knowledge of and utilizes federal and state regulations that apply to practice environment and infection control.
2. Promotes adequate staffing in the clinical setting where the nurse-midwife practices.
3. Demonstrates appropriate techniques for emergency management including arrangements for emergency transportation.

NURSE-MIDWIFERY CARE OCCURS WITHIN THE HEALTH CARE SYSTEM OF THE COMMUNITY USING APPROPRIATE RESOURCES FOR REFERRALS TO MEET MEDICAL, PSYCHOSOCIAL, ECONOMIC, AND CULTURAL OR FAMILY NEEDS

The certified nurse-midwife:

1. Demonstrates a safe mechanism for obtaining medical consultation, collaboration and referral.
2. Uses community services.
3. Demonstrates knowledge of medical, psychosocial, economic, cultural, and family factors that may affect care.

NURSE-MIDWIFERY CARE IS DOCUMENTED IN LEGIBLE, COMPLETE HEALTH RECORDS

The certified nurse-midwife:

1. Uses records that facilitate communication of information to consultants and institutions.
2. Facilitates clients' access to their records.
3. Provides written documentation of risk assessment, course of management, and outcome of care.
4. Provides for prompt entry on the health record of laboratory tests, treatments, and consultations.
5. Provides a mechanism for sending a copy of the health record on referral or transfer to other levels of care.
6. Treats records as confidential documents.

NURSE-MIDWIFERY CARE IS EVALUATED ACCORDING TO AN ESTABLISHED PROGRAM FOR QUALITY ASSESSMENT THAT INCLUDES A PLAN TO IDENTIFY AND RESOLVE PROBLEMS

The certified nurse-midwife:

1. Participates in a program of quality assurance/improvement for the evaluation of nurse-midwifery practice within the setting in which it occurs and within legal requirements.
2. Collects client care data systematically and is involved in analysis of that data for the evaluation of the process and outcome of care.
3. Seeks consultation to review problems identified by the quality assurance/improvement program.
4. Acts to resolve problems that are identified.
5. Participates in peer review.