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Midwife and Ob-Gyn Role Clarity for Team-Based Practice

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Midwife and Ob-Gyn Role Clarity for Team-Based Practice Midwife and Ob-gyn Role Clarity for Team-based Practice Melissa D. Avery, PhD, CNM, FACNM, FAAN Phillip N. Rauk, MD, FACOG Learning Objectives 1. Identify the educational pathways and credentialing of midwives (CNMs/CMs) and Ob-gyns. 2. Identify the scope and values of midwives and Ob- gyns, including areas of overlap and differences. 3. Describe patterns of collaborative practice including appropriate use of language in partnering together and with patients in respectful team-based care. Formal Definitions/Credentials Obstetrician/Gynecologist (Ob-gyn) • Medical doctor (MD) – allopathic medicine, treats disease symptoms using remedies such as drugs or surgery • Doctor of osteopathic medicine (DO) – strong focus on alternative therapies, holistic medicine, and disease prevention Piedmont Healthcare. (n.d.) Your doctor: The difference between an M.D. and D.O. Retrieved from https://www.piedmont.org/living-better/your-doctor-the-difference-between-an-md-and-do UCLA David Geffen School of Medicine. (2017). DO vs. MD: What’s the difference? Retrieved from http://medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=1019 Formal Definitions/Credentials Certified Nurse-Midwife (CNM) • Registered nurse, completion of Accreditation Commission for Midwifery Education (ACME)-accredited graduate midwifery program, national certification by American Midwifery Certification Board (AMCB) • Advanced practice registered nurse (APRN) license in many states • Authorized to practice and prescribe in all U.S. states and territories Certified Midwife (CM) • Completion of ACME-accredited graduate midwifery program, national certification by AMCB (registered nurse not required) • Authorized to practice in 5 states Certified Professional Midwife (CPM) • No specific degree required or granted upon completion, certification by North American Registry of Midwives (NARM) • Apprenticeship education process; some programs accredited by Midwifery Education and Accreditation Council (MEAC) • Work outside of hospital setting, authorized to practice in 32 states American College of Nurse-Midwives. (2017). Comparison of certified nurse-midwives, certified midwives, certified professional midwives clarifying the distinctions among professional midwifery credentials in the U.S. Retrieved from http://www.midwife.org/acnm/files/ccLibraryFiles/FILENAME/000000006807/FINAL-ComparisonChart-Oct2017.pdf What is a CNM/CM? • Primary care provider from adolescence to beyond menopause • Provides primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth, postpartum, normal newborn for first 28 days of life, treatment of male partners for sexually transmitted infections • Educated in discipline of midwifery, CNMs also educated in discipline of nursing What Services are Provided by Midwives? General health Annual Family planning care services gynecologic needs exams Care during Treatment of Care for adolescent years sexually pregnancy, labor, transmitted birth and infections postpartum Menopause care Midwifery Scope of Practice Most CNMs/CMs identify reproductive and primary care as main responsibilities • Initial, ongoing comprehensive assessment, diagnosis, and treatment • Annual physical examinations, reproductive health visits • Prescribe medications including controlled substances and contraceptive methods • Admit, manage, and discharge patients • Order and interpret laboratory, diagnostic tests, medical devices • Individualized prevention, wellness counseling and patient education • Scope varies somewhat by state, some states require MD supervision Practice in ambulatory care clinics, private offices, community and public health systems, homes, hospitals, and birth centers American College of Nurse-Midwives. (2004). Definition of midwifery and scope of practice of certified nurse-midwives and certified midwives. Retrieved from http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000266/Definition%20of%20Midwifery%20and%20Scope%20of%20Practice%20of%20CN Ms%20and%20CMs%20Dec%202011.pdf What is an Ob-gyn? • A physician who has graduated from an accredited residency program who commits their career to comprehensive women’s health including gynecology and obstetrics, medically and surgically • Serve as consultant to other physicians and as primary physicians for women • Subspecialties: maternal-fetal medicine, reproductive endocrinology and infertility, gynecology/oncology, family planning, female pelvic floor and reconstructive surgery Vogt, V.Y. (n.d.) Obstetrics and gynecology. American College of Surgeons. Retrieved from https://www.facs.org/education/resources/residency-search/specialties/obgyn Ob-gyn Scope of Practice Ob-gyns are dedicated to medical and surgical care of women throughout their lifespan • May choose a focused area of specialization, e.g. Fellowship in Gynecologic Oncology, Maternal Fetal Medicine, etc. • Gynecology ▪ Reproductive physiology including factors that influence disease ▪ Gender-specific prevention counseling and health education ▪ Gynecologic surgery - Vulva, vagina, cervix, uterus, tubes, ovaries, pelvic floor (NOT bladder, kidney, GI tract) • Obstetrics ▪ Antepartum, intrapartum, and postpartum care • Patient education and advocacy American Congress of Obstetricians and Gynecologists. (2005). The scope of practice of obstetrics and gynecology. Retrieved from https://www.acog.org/About-ACOG/Scope-of-Practice What do we care about? Midwifery: Philosophy of the Ob-gyn: Core Values of the American American College of Nurse- College of Obstetricians and Midwives Gynecologists Believe in the “strength of women Believe all women should have access and the importance of their health to high quality safe health care. We in the well-being of families, promote best practices in women’s communities and nations. We health care through research and believe in the basic human rights of education. We advocate for women all persons, recognizing that women and the specialty; provide women’s often incur an undue burden of risk health information to patients, when these rights are violated.” providers, organizations and American College of Nurse-Midwives. (2004). Philosophy of the American College of Nurse- Midwives. Retrieved from governments. http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000002729/Philosophy%20of%2 0ACNM%209%202004.pdf American Congress of Obstetricians and Gynecologists. (n.d.). ACOG mission, vision and core values. Retrieved from https://www.acog.org/About-ACOG/About-Us/ACOG-Mission-Vision-and-Core- Values Formal Education Structures CNM/CM OB/GYN Undergraduate Program 4 years, nursing major for 4 years any major (must CNMs include sciences) Graduate Program Master’s (2 years) or 4 years allopathic or Doctoral (3 years) osteopathic medical midwifery program education required for certification (medical school) Includes clinical experience Additional Training 4 years ACGME or DO approved residency program Accreditation Accreditation Commission Accreditation Council for for Midwifery Education Graduate Medical (ACME) Education (ACGME) Physicians: Path to Ob/gyn License to practice (limited College or American license may Post-Bacc Board of be obtained Program Obstetrics earlier Residency in & Ob/Gyn (4 Gynecology years) Medical School (MD or DO – 4 Obtain a years) Bachelor's Degree with pre-reqs Physicians: Path to Ob/gyn License to College or practice (limited license Post-Bacc American Program may be Board of obtained earlier Obstetrics Residency & Gynecology in Ob/Gyn (4 years) Medical School (MD or DO – 4 Obtain a years) Bachelor's Degree with pre-reqs Physicians: Path to Maternal Fetal Medicine Fellowship in MFM License to (3 years) practice American Board of Residency Obstetrics in Ob/Gyn & Medical (4 years) Gynecology School (MD Obtain a or DO – 4 Bachelor's years) Degree with pre- requistes • Perinatology • Obstetrical management of high-risk pregnancy “Specializing in the un-routine” MFM Scope of Practice Certified Nurse-Midwives/Certified Midwives Obtain a +/- Work as an Bachelor's RN, experience Degree and an in other Complete an RN or a BSN. maternal/child Accreditation related fields Commission of American License to Midwifery Midwifery practice as Education Certification CNM/CM* accredited Board Exam program, Programs exist to Direct entry earning a bridge directly to program to graduate degree midwifery certified education midwifery program without nursing *CM credential recognized in DE, ME, MO, NJ, NY, RI, HI • Certified nurse-midwives are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and have passed a national certification examination to receive the professional designation of certified nurse-midwife. • Certified midwives meet the same midwifery education and certification standards as CNMs, but Types of come from a non-nursing background in healthcare. CMs are certified by the same mechanism as CNMs. Midwifery Licensed in states where the credential is recognized: DE, NJ, ME, NY, RI, HI. • Certified Professional Midwives are ”direct entry” midwives without a nursing background. They do not go through the same master’s level education. Training is variable, and licensing is voluntary, not required, in some states. They take a different national certification exam from CNMs/CMs. Comparison of CNM/CM vs CPM CNM/CM CPM Education Accreditation Midwifery Education accreditation Commission for Accreditation Council Midwifery Education
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