Monday, August 17, 2009

Florida Midwifery

August 4, 2009 by midwiferobyn

The State of Florida is a great place for moms looking for a home birth midwife. Florida has established laws and regulations that govern midwifery, making it legal. During my years as a Licensed Midwife I am often asked questions like, what is the difference between midwives, what type of training do midwives have, and how do all these acronyms affect my choices in Florida? So let me elaborate on paths to midwifery to help you understand all those letters behind our names!

There are several types of Midwives through out the nation. There are Certified Nurse Midwives (CNM), Licensed Midwives (LM), Certified Professional Midwives (CPM) and Lay midwives. In the State of Florida only two types of Midwives are legal to practice, CNM’s and LM’s. This is where it all gets a bit interesting! In Florida, in order to be a LM, you must also become a CPM, even though you couldn’t be a CPM by itself in Florida. Let me explain further.

Certified Nurse Midwives have gone through a educational process that includes becoming an RN, and then continuing on through a Master’s degree program in Nursing, with a focus on Midwifery. This program can take up to 6 years or longer to complete. The focus of Nurse Midwifery is in primary care, and not just midwifery. They are not independent practitioners and need to have physician oversight. However, they do have additional privileges that other midwives do not, such as the ability to write prescriptions, and deliver babies in the hospital. They are legal in all 50 states. They may also be known as Advanced Registered Nurse Practitioners or ANRP’s depending on their education path. There are very few, if any CNM’s that are currently attending homebirths in Florida. There are many that are Birth Center Midwives. The vast majority practice in the hospital setting.

Licensed Midwives are also required to complete an education process to become licensed by the State of Florida. Licensed Midwifery is not legal in all 50 states. Florida LM’s are legal, independent practitioners and do not require physician oversight. They are able to care for low risk pregnant moms only. LM’s do not have prescription privileges and while they are legally allowed to deliver babies in a hospital, no hospital uses LM’s, and most prefer homebirth to hospital practice.

The road to becoming a licensed midwife requires a 3 year educational process. This 3 year program is comprehensive and includes hard sciences like biology, embryology and soft sciences like psychology. It of course also covers extended course work in midwifery and newborn care. LM students are required to be skilled in determining risk status, normal pregnancy, labor & delivery, postpartum and newborn care. They are well versed in complication management as well. During their 3 years in school they will observe 25 births out of the hospital, and then deliver 50 babies under the supervision of a Licensed Midwife. Once a LM student has graduated, they are required to take the state test, this is where that CPM credential comes in to play.

The North American Registry of Midwives (NARM) is an international certification agency whose mission is to establish and administer certification for the credential “Certified Professional Midwife” (CPM). CPM certification validates entry-level knowledge, skills, and experience vital to responsible midwifery practice.

Many States, including Florida, use this as their licensure exam. So in addition to meeting the minimum Florida requirements for licensure, you must also meet the NARM national requirements. So each midwife in Florida is an LM, CPM. ( ahhh ..So that’s what all those initials are!) In order to maintain these, each midwife must also have a minimum number of continuing education credits each year. Some midwives also have extra training, such as being an EMT or other certification that add to the value of their services. All licensed and certified midwives are required to have certification in CPR and Neo Natal Resuscitation.

Lay midwives are those women who have no formal training, but have apprenticed with experienced midwives. These ladies gain their education through self study and observation, and then by doing. Often they become CPM’s, through NARM, although some do not and practice without a formal license in those states where that is legal. This type of midwifery is not legal in Florida.

When choosing a midwife it is important to understand the type of midwife and her training. You can feel confident that whether you choose a CNM or a Florida Licensed Midwife you are in very capable and trained hands to guide you through your journey in childbirth.

Robyn Mattox, LM, CPM, EMT