ACNM COMPONENTS OF MIDWIFERY CARE

ACNM Components of Midwifery Care

The professional responsibilities of CNMs include, but are not limited to, these components: 

    Knowledge of the history of midwifery

    Knowledge of the legal basis for practice 

    Knowledge of national and international issues and trends in women's health and maternal/newborn health

    Support of legislation and initiatives to promote high quality health care services 

    Knowledge of issues and trends in health care policy and systems 

    Commitment to the ACNM's Philosophy, Standards, and Code of Ethics 

    Participation in midwifery education 

    Systematic collection of practice data to document midwifery care outcomes 

    Ability to evaluate, apply, interpret, and collaborate in research 

    Participation in self-evaluation, peer review, continuing education, and other activities that ensure and validate quality practice

    Development of leadership skills 

Components of Midwifery Care:
Midwifery Management Process

The midwifery management process includes:

    Systematically compiling and updating a complete and relevant data base for the comprehensive assessment of each client's health, including a thorough health history and physical examination 

    Identifying problems and formulating diagnoses based upon interpretation of the data base 

    Identifying health care needs/problems and establishing health care goals in collaboration with the client

    Providing information and support to enable women to make informed decisions and to assume primary responsibility for their own health

    Developing a comprehensive plan of care with the client 

    Assuming primary responsibility for the implementation of individualized plans

    Obtaining consultation, planning and implementing collaborative management, and referral or transferring the care of the client as appropriate

    Initiating management of specific complications, emergencies and deviations from normal

    Evaluating, with the client, the achievement of health care goals and modifying the plan of care as appropriate. 

Components of Midwifery Care:
The Childbearing Family

I. Pre-Conception Care
A. Independently manages care of the woman who is preparing for pregnancy 
B. Applies knowledge of midwifery practice that includes, but is not limited to, the following:
        

    Reproductive anatomy and physiology related to conception

    Impact of health, family and genetic history on pregnancy outcomes 

    Health and laboratory screening to evaluate the potential for a healthy pregnancy

    Assessment of readiness for pregnancy of the woman and her family including emotional,
psychosocial, and sexual factors 

    Nutritional assessment and counseling 

    Influence of environmental and occupational factors, health habits, and behavior on pregnancy
planning 

II.Care of the Childbearing Woman
A. Independently manages care of the woman during pregnancy, childbirth, and the postpartum period 
B. Applies knowledge of midwifery practice in the antepartum period that includes, but is not limited to, the following:

    Anatomy and physiology of conception, pregnancy and lactation

    Diagnosis of pregnancy 

    Genetics, placental physiology, embryology, and fetal development 

    Epidemiology of maternal and perinatal morbidity and mortality

    Influence of environmental and occupational factors, health habits, and maternal behaviors on
pregnancy outcomes 

    Emotional and psychosexual change during pregnancy

 
    Health risks including domestic violence, sexually transmitted diseases, substance, alcohol and
tobacco use 

    Effect of maternal nutrition on pregnancy outcomes

 
    Indicators of normal pregnancy and deviations from normal 

    Assessment of the progress of pregnancy and fetal well-being 

     Etiology and management of common discomforts of pregnancy 

     Management techniques and therapeutics, including complementary therapies** to facilitate
healthy pregnancy and outcome 

     Anticipatory guidance related to birth, lactation, parenthood, and change in the family constellation

    Pharmacokinetics and pharmacotherapeutics of medications commonly used during pregnancy 

    Principles of group education 

C. Applies knowledge of midwifery practice in the intrapartum period that includes, but is not limited to, the following:

    Anatomy and physiology of the structures and processes of labor

    Anatomy and physiology of the fetus 

    Diagnosis and assessment of labor and its progress through the four stages 

    Assessment of maternal and fetal status during labor 

    Indicators of deviations from normal including complications and emergencies 

    Measures to support psychosocial needs during labor and delivery 

    Management techniques and therapeutics, including complementary therapies, to facilitate normal
labor progress 

    Techniques for (i) administration of local anesthesia, including pudendal blocks, (ii) spontaneous
vaginal delivery, (iii) third stage management, and (iv) performance and repair of episiotomy and
repair of lacerations 

    Techniques for management of emergency complications and abnormal birth events 

    Pharmacokinetics and pharmacotherapeutics of medications commonly used during labor and birth 

D. Applies knowledge of midwifery practice in the postpartum period that includes, but is not limited to, the following:

Anatomy and physiology of the puerperium

 

Emotional, psychosocial, and sexual changes of the puerperium 

Postpartum self-care, infant care, contraception, and family relationships 

Management techniques and therapeutics, including complementary therapies, to facilitate a
healthy puerperium 

Methods of facilitation or suppression of lactation 

Deviations from normal and appropriate interventions including management of complications and
emergencies 

Management of discomforts of the puerperium 

Pharmacokinetics and pharmacotherapeutics of medications commonly used during the puerperium 

 

III. Newborn Care
A. Independently manages the care of the newborn 
B. Applies knowledge of midwifery practice that includes, but is not limited to, the following:

    Effect of maternal/fetal risk factors on the newborn

 
    Anatomy and physiology of the newborn

    Nutritional needs of the newborn 

    Bonding and attachment theory 

    Evaluation of neonatal status: (i) physical and behavioral assessment, (ii) gestational age
assessment, and (iii) common screening and diagnostic tests performed on the neonate 

    Methods to facilitate adaptation to extrauterine life: (i) stabilization at birth, (ii) resuscitation, and
(iii) emergency management 

    Promotion and management of breast-feeding 

    Indications of deviation from normal and appropriate interventions 

    Management techniques to facilitate integration of the newborn into the family 

    Pharmacokinetics and pharmacotherapeutics of common medications used in the neonatal period 

Components of Midwifery Care:
The Primary Care of Women

I. Health Promotion and Disease Prevention
A. Independently manages primary health screening of women through the life cycle 
B. Applies knowledge of midwifery practice that includes, but is not limited to, the following:

    Anatomy and physiology 

    Growth and development patterns for the woman across the life span 

    Basic principles of clinical epidemiology as they affect women's health 

    National defined goals and objectives for health promotion and disease prevention 

    Parameters for assessment of physical and mental health 

    Utilization of nationally defined screening recommendations to promote health and detect/prevent disease 

    Management techniques and therapeutics, including complementary therapies, to facilitate health 

    Pharmacokinetics and pharmacotherapeutics of immunizations 

II. Management of Common Health Problems
A. Assumes responsibility for the triage of common health problems presented by women and for
management, collaboration, co-management and/or referral to appropriate levels of health care services within the CNM's or CM's defined scope of practice 
B. Applies the knowledge of midwifery practice that includes, but is not limited to, the following:

    Anatomy and pathophysiology related to frequently occurring conditions 

    Etiology of common health problems of essentially healthy women 

    Parameters for differential diagnosis of common presenting health problems

 
    Management techniques and therapeutics, including complementary therapies, for the treatment of common health problems of essentially healthy women 

    Pharmacokinetics and pharmacotherapeutics of frequently prescribed medications for common
health problems 

    Skills in health care team leadership and management to ensure that presenting health care
concerns are addressed completely by a multi-disciplinary health care team and community services

 

III. Family Planning/Gynecologic Care
A. Independently manages the care of women seeking family planning and/or gynecologic services 
B. Applies knowledge of midwifery practice that includes, but is not limited to, the following:

    Anatomy and physiology of the reproductive systems, including the breast, through the life cycle

 
    Human sexuality 

    Common screening and diagnostic tests 

    Parameters for differential diagnosis of common gynecologic problems including sexually
transmitted diseases 

    Essentials of barrier, hormonal, mechanical, chemical, physiologic, and surgical conception control methods 

    Management techniques and therapeutics, including complementary therapies, for common
gynecologic problems and family planning needs 

    Counseling for sexual behaviors that promote health and prevent disease 

    Resources for counseling and referral for unplanned or undesired pregnancies, sexual concerns,
infertility, and other gynecologic problems 

    Pharmacokinetics and pharmacotherapeutics of frequently prescribed medications for family
planning and gynecologic care 

 

IV. Perimenopause and Post-Menopause
A. Independently manages the care of women during the perimenopause and post-menopause 
B. Applies knowledge of midwifery practice that includes, but is not limited to, the following:

    Anatomy and physiology of the systems as affected by the aging process

 
    The effects of the menopause of physical and mental health

 
    Nutritional needs of the aging woman

 
    Common screening and diagnostic tests pertinent to the evaluation of the health of women with
advancing age

 
    Identification of deviations from normal and appropriate interventions 

    Counseling and education for health maintenance and health promotion in the aging woman

 
    Management techniques and therapeutics, including complementary therapies, for alleviating the
common discomforts that accompany aging 

    Pharmacokinetics and pharmacotherapeutics of frequently prescribed medications and treatments
for the perimenopausal and menopausal woman 


* Midwifery as used throughout this document refers to the education and practice of certified nurse-midwives (CNMs) and certified midwives (CMs) who have been certified by the American College of Nurse-Midwives (ACNM) or ACNM Certification Council, Inc (ACC).
** Complementary therapies as used throughout this document refer to those therapeutic measures for which there issome evidence of safety and effectiveness. 

Source:Education Section, Division of Education. Approved by ACNM Board of Directors May 31, 1999