Certified Nurse-Midwife/Certified Midwife Homebirth Practice
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CNM Homebirth Practice
Currently, in the U.S., the majority of home-birth attendants are Certified Professional Midwives (CPMs). (See Diversified Midwifery Practice in the United States ,posted on 6/18/24) In nearly every State, Certified Nurse-Midwives and Certified Midwives are licensed to attend home deliveries, if that is their preference. The nature and structure of these homebirth practices do depend on collaborating relationships with cooperating OB/GYN physicians and hospital CNM practices willing to accept care of patients on a referral basis. Hospital CNM practices frequently accept transfers from homebirth CNMs when the transfer is for non-emergent reasons such as labor induction, augmentation, or continuous fetal monitoring. One of the major issues constraining the practice of CNMs in home settings is acquiring affordable malpractice insurance coverage. Some insurance companies impose surcharges on physicians who work with midwives in hospital settings. It is not a stretch to imagine that insurance companies may charge a CNM high rates to cover a homebirth practice. According to one ACNM survey of marketplace insurers, 56% refuse to cover home birth services provided by CNMs.1
CNM Homebirth Requirements and Considerations For Practice
Homebirth requirements for CNMs include physician/CNM collaborative agreements, practice guidelines, and referral/emergency planning similar to every other setting where a CNM may practice. Homebirth CNMs do not practice under any assumptions that this setting necessitates a lower standard of practice. Standards of care for delivery in a home environment are outlined by the ACNM Standards of Practice, Ethics, Core Competencies, State regulations, and evidence-based decision making, establishing the foundation of CNM practice in all settings.To comply with CNM standards of practice for home delivery, there must include a specific emergency plan which outlines the course of action in the event of complications during labor and delivery in a home setting. Contingency plans will include mode of emergency transfer (e.g. ambulance or car), an available collaborating physician/midwife, a cooperating receiving hospital, and other necessary arrangements specific to locale (city or rural).
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As with every birth environment, full disclosure and informed consent must be undertaken for the patient and her support person. Information should include not only the benefits of the birth setting, but also the limitations. Patients, partners and families must be aware of what can and cannot be accomplished in any particular birth setting along with full understanding of emergency plans in the event of complications.
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1 Ensuring Access to High Value Providers. ACNM Survey of Marketplace Insurers Regarding Coverage of Midwifery Services. Sept 2014.
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