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					               Important Facts Addressing Concerns about Licensing Midwives

                     Information Provided by the North American Registry of Midwives


     The largest study of home births attended by Certified Professional Midwives has found that
      home birth is safe for low risk women and involves far fewer interventions, such as cesarean sections
      and inductions, than similar births in hospitals. “Outcomes of planned home births with certified professional
      midwives: large prospective study in North America.” Kenneth C Johnson and Betty-Anne Daviss. BMJ 2005;330:1416 (18

     “Recognizing the evidence that births to healthy mothers, who are not considered at medical risk
      after comprehensive screening by trained professionals, can occur safely in various settings,
      including out-of-hospital birth centers and homes. ...Therefore, APHA supports efforts to
      increase access to out-of-hospital maternity care services...” American Public Health Association,
      “Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-
      Entry Midwives (Policy Statement)”. American Journal of Public Health, Vol 92, No. 3, March 2002.

     The low CPM rates of intervention are benchmarks for what the majority of childbearing women
      and babies who are in good health might achieve. The Milbank Memorial Fund, a nonpartisan institute devoted
      to health policy analysis, issued a new report titled “Evidence-Based Maternity Care: What It Is and What It Can Achieve.”
      October, 2008


     An economic analysis of the cost benefits of a licensed midwife program indicate that “The cost
      savings to the health care system (public and private) is estimated to be ten times the cost of the
      program.” Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits, (A report
      to the Washington Department of Health), Health Management Associates, October, 2007


     All but three of the states that license direct-entry midwives allow those midwives to carry and
      administer a specific list of emergency or routine medications. This is NOT prescriptive authority.
      Midwives administer these medications only in pre-determined situations, following the
      instructions set out in the rules. No pain medications are in the formulary. The medications are
      either routine (eye meds and vitamin K for the baby) or for limited emergency use, such as to
      prevent excessive bleeding in the mother. Use of emergency medications is rare and strictly
      controlled and accountable.
      Important Facts about the Education of the Certified Professional Midwife

   The education of the CPM follows an extensive curriculum of over 750 topics. All educational
    routes to the CPM must follow the same curriculum, which may be verified through diplomas
    from accredited midwifery schools, licenses from states with equivalent requirements, or an
    extensive evaluation of alternative pathways through the Portfolio Evaluation. Students from all
    routes to certification must meet the SAME extensive educational goals, follow the same
    curriculum, and pass the same nationally standardized examinations. These are equivalent routes
    to the same education.

   Instructors and preceptors are responsible for the education and supervision of student CPMs,
    which may occur in classroom, private, and clinical settings. Instructors must verify that the
    student has mastered all knowledge and skills and has demonstrated competency in the clinical
    setting before proceeding through the testing process. Students then must pass a hands-on Skills
    Assessment and an 8-hour Written Examination.

   The clinical training for CPM certification must cover a minimum of at least one year of
    supervised clinical work, which is equivalent to 1350 hours of supervision. The average length of
    clinical training is 3-5 years. All students must document this supervised clinical work, regardless
    of route of education.

   The excellent outcomes documented in the CPM 2000 study were a result of over 5,000 births
    attended by CPMs, 99% of which were attended by midwives who received the CPM credential
    through the NARM Portfolio Evaluation Process. The results of this study attest to the safety of
    births attended by CPM and the significant cost savings of reduced intervention in birth.

   The process used to create and administer the CPM has been evaluated and accredited by the
    National Commission for Certifying Agencies, the same organization that accredits the credentials
    for the Certified Nurse-Midwife and many other advanced practice nursing credentials.

   All states that license direct-entry midwives to provide home birth services accept the CPM
    credential as meeting all or part of their licensure requirements, and all of these states use the
    NARM exam as the state licensure examination. States with older program that precede the
    establishment of the CPM credential may have some state-specific additional requirements, but all
    states with licensure programs established after 1993 have accepted the CPM credential as the
    eligibility criteria for licensure. This saves the state the administrative expense of evaluating
    varied educational pathways, assures reciprocity with other licensed states, and follows the
    national standards for midwifery education and training.

   Twenty-five states license direct entry midwives to attend home births using the CPM credential
    or equivalent. Many programs have been in existence for over 20 years, and no state has sought to
    terminate the licensure program. This is testimony to the excellence of midwifery care by the
    Certified Professional Midwife.