Hospital Credentialing of Midwives
CNM Skills Unique and Apart
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In order to practice in a clinical setting, CNMs/CMs must be credentialed by a hospital or clinic. Hospital credentialing is a process where midwives apply to the medical staff for privileges to independently admit, manage, treat and discharge patients. The lengthy and often burdensome requirement usually requires renewal every two years. Requirements include evidence of current certification by the ACNM and, if required by State statute, evidence of a collaborative agreement with an obstetrician member of the hospital staff.
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Other required certifications include basic or advanced life support, a current neonatal resuscitation certificate and evidence of recent certification for interpretation of fetal monitoring tracings. Many institutions require a certain number of continuing medical education units to be completed within the two-year intervals between re-credentialing. For CNMs, the State Board of Nursing also requires evidence of continuing education. The number of required units varies from State to State but averages between 35-45 units.
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Criminal History, Malpractice, and Insurance for Midwives
Criminal background checks and fingerprinting are usually required by credentialing institutions. Credentialing also requires evidence of medical malpractice coverage and requires ongoing competence and skill with midwifery procedures associated with care, such as episiotomy and repair of vaginal/cervical lacerations, amniotomy, placement of internal monitoring electrode to the infant scalp, insertion and placement of intrauterine pressure catheter, external and vaginal ultrasound examination, mechanical cervical dilation, vacuum extraction of the fetal head, management of shoulder dystocia, removal of retained placenta, management of maternal hemorrhage, newborn care, circumcision, and diagnosis and management of non-reassuring fetal monitor tracings.
CNM/CM New Procedures and Competencies
Any new procedure in addition to core competencies like, vacuum extraction, surgical first-assist, or circumcision will require evidence of education, training, and experience prior to the CNM being credentialed to perform the procedure. While most health care entities are similar in their credentialing requirements, each hospital will have its own, specific re-credentialing process and requirements for its nurse-midwives and other professional staff.
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The skills outlined above are a representative sample of those that also contribute to the nurse-midwifery scope of practice. Some of these skills derive from scholarly and practical interaction with other maternity care specialties. However, it needs to be understood that CNM practice is unique and apart from the practice of registered nurses, neonatal nurse practitioners, neonatologists, obstetricians and perinatologists. 1
Scope of Practice
Scope of practice among the specialties that care for women and newborns will, necessarily, overlap in certain areas so it is essential to understand that CNM/CMs comprise a distinct specialty within women’s healthcare. When determining alleged liability and negligent conduct, attorneys representing midwives must understand the precise relationships between nurse-midwives and differing specialty co-providers, particularly in multi-defendant lawsuits. Multi-specialty team functioning must be examined in the context of the role of each member of the team and how they delineate duty among themselves in acute situations.
1 See ACNM Guidelines for Incorporation of New Procedures.
http://www.midwivesontrial.com