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Clinical Practice Guidelines are recommendations for clinicians caring for patients with specific conditions or ailments. The Institute of Medicine defines clinical practice guidelines (CPGs) as “statements that include recommendations, intended to optimize patient care, that are informed by a systemic review of evidence and an assessment of the benefits and harms of alternative care options”.1

The court filing of a claim for medical negligence normally occurs after hours and weeks of law firm research, review, and preparation. Initially, a potential plaintiff, or injured party, will contact a law office to discuss whether or not they may have a viable claim.  With personal injury, initial contact from an injured party will typically be fielded by a legal assistant or paralegal with experience evaluating the merits of a potential case.  He or she will interview the caller, take notes, and ask pertinent questions regarding the circumstances of the injury. Essential information will also be noted regarding ongoing health issues that have persisted since the purported negligent event.

Hospitals where CNMs are employed can be university hospitals associated with medical schools, private teaching hospitals, community hospitals, government hospitals, military hospitals or critical access hospitals.

The Core Competencies for Basic Midwifery Practice include the fundamental knowledge, skills, and abilities expected of new midwives certified by the American Midwifery Certification Board (AMCB). They serve as guidelines for educators, students, health care professionals, consumers, employers, and policymakers. The Core Competencies constitute the basic requisites for graduates of all midwifery education programs pre-accredited or accredited by the Accreditation Commission for Midwifery Education (ACME). They are inclusive of the hallmarks of midwifery practice.

Campaigns against midwifery, starting at the beginning of the 19th century, set the table for strained relationships between physicians and midwives, persisting to the present time. Anti-midwifery sentiments, enhanced by the attitudes of J. Whitridge Williams (1912) and Joseph Bolivar DeLee (1915)*, ushered in an age of obstetrics and scientific medicine which were considered the only modern and realistic choice for safe and healthy childbirth in America.

Another example of legislative language describing standard of care can be defined as the “degree of care and skill of the average CNM, taking into account the medical/midwifery knowledge available to her based on customary practices of the average CNM”. It is obvious that statutory legal terms exist to be argued about in court. A CNM provider will never hear this language in any graduate school midwifery classroom. Certified Nurse-Midwives do not acquire knowledge of the science, skills, ethics, and competencies of midwifery based on legislative standards. “Available knowledge” for a CNM/CM will be based on her education from an accredited midwifery education program.

To be negligent is to act or fail to act in a way that causes injury to another person. Accidents happen, but what separates an unintentional accident from a negligent act is the standard of care. By neglecting the applicable and proper standard of care pertaining to a particular incident, an individual may be found liable for any resulting injuries. Negligence is a legal theory in civil law. The concept of negligence is closely related to determination of standard of care. Medical malpractice is considered a specific entity within the domain of negligence.

CNMs and CMs must demonstrate compliance with the Core Competencies for Basic Midwifery Practice of the ACNM upon completion of their midwifery education programs and must practice according to the ACNM Standards for the Practice of Nurse-Midwifery. The Core Competencies define baseline midwifery practice; the collection of skills which every Certified Nurse-Midwife must have. American College of Nurse-Midwife competencies and standards are consistent with or exceed the global competencies and standards for the practice of midwifery as defined by the International Confederation of Midwives. To maintain the designation of CNM or CM, midwives must be recertified every five years through the American Midwifery Certification Board (AMCB) and must also meet specific continuing education requirements.[1]

“I really hate it when a nurse-practitioner is called a mid-level provider”.  Mid-level provider is not a legal or academic term.  It is slang developed to demean or minimize a health professional who is not an MD.  The term “mid-level provider” is aimed at nurse-practitioners (NP’s), as well as physician assistants (PA’s), and certified nurse-midwives.  It is insulting to health professionals as well as to the patients that they serve.  Mid-level implies that he or she provides middle-of-the-road or average care.  Who then delivers high-level care?  It must be the MD, of course.  So who delivers the lowest level of care? Nurses?

Scope of practice refers to the legally permissible boundaries of Certified Nurse-Midwife/Certified Midwife practice which are defined by State statute and regulation and, to a lesser degree, educational accomplishment, and certifying organization. 1 The 10th Amendment of the U.S. Constitution delegates professional regulation to the States for the health, safety and welfare of citizens.

DEFINITION OF MIDWIFERY AND SCOPE OF PRACTICE OF CERTIFIED NURSE-MIDWIVES AND CERTIFIED MIDWIVES Midwifery as practiced by certified nurse-midwives (CNMs) and certified midwives (CMs) encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; and family planning services, including preconception care

Along with other misconceptions regarding nurse-midwifery practice, is the idea the CNMs/CMs are inadequately educated when compared with physicians. Historically, in the medical world and with the medicalization of normal women experiencing normal childbirth, anything short of a traditional medical school education was considered inferior. As previously mentioned, certified nurse-midwifery education has not been designed to confer skills specific to a medical model of care, although there is expected overlap between models for certain aspects of care.