Thursday, May 31, 2012

Why Evidence-Based Practice is Important: The Hague, A New Book, and More!



Welcome to the final day of Childbirth Today's 2012 Blog Carnival - honoring the busy month of May and all of the celebrations of midwives, nurses, doulas and childbirth educators...AND mothers!  I will be closing this amazing month with a look at evidence-based practice, the Human Rights in Childbirth Conference at the Hague and the new book, Optimal Care in Childbirth: The Case for a Physiologic Approach.  

Thank you to everyone who sent in a guest post and for the thousands who read them!


The undercurrent of maternity care practice, whether one is a physician, midwife, nurse, childbirth educator, doula or lactation consultant, is the question of evidence based practice.

As defined by Childbirth Connection, evidence based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns.

But it is not just in the US that professionals are talking about evidence.  Currently (May 31, 2012) the Human Rights in Childbirth Conference (www.humanrightsinchildbirth.com)  at the Hague (May 31 – June 1) is occurring to discuss and clarify the practical implications of the European Court of Human Rights 2010 holding that women have a human right to choose the circumstances and location in which they give birth.  Speakers from all over the world, including our own Ina May Gaskin, Jennie Joseph, Robbie Davis-Floyd, Barbara Harper, Barbara Katz Rothman, Dr. Raymond de Vries ~ and others such as Michel Odent will be in on this groundbreaking conference.  You can follow the activities by following their Tweets at #birthhr or attending their webinar (http://www.humanrightsinchildbirth.com/webinar), both live-streamed and an online webinar afterwards.  Their Facebook page will also have updates at www.facebook.com/HumanRightsinChildbirth

For independent practitioners, implementation of new practices based on evidence may not be as cumbersome as in large facilities or institutions.  Researching and rewriting current policies, procedures and practice guidelines takes dedication to the health and well-being of mothers and babies, funding, time and consensus amongst those in the approval process.  These long processes are a challenge to translating the evidence into practice and prolong the adverse reactions to increased intervention and keep the US maternal and infant mortality/morbidity rates in the substandard category.

Foremost in the minds of care providers must be the fact that for most childbearing women in the US (and for that matter world-wide), pregnancy and birth are conditions of health and most women are at low risk for complications.  A broad knowledge base is needed to provide care and support for physiologic birth – an instinctual and hormonally driven process.  The body has the potential of producing high levels of pain-relieving opiate beta-endorphins and endogenous oxytocin, which both facilitate labor and birth, inhibits postpartum hemorrhage and promotes fierce bonding and newborn wellness. 

However, lacking from 99% of nursing school curriculum and residency programs are the skills necessary to promote physiologic birth.  Underused practices include skilled labor support, facilitation of labor through the use of gravity positive positioning, enhancement of Second Stage through gravity positive positioning, labor comforts including aromatherapy, relaxation and hydrotherapy, delayed cord clamping and uninterrupted skin-to-skin contact.

Although not just iatrogenic, blame can also be placed in the area of inadequate informed consent practices AND a lack of preparation by expectant women and their partners.  An embarrassing 25% of women attend any type of childbirth education classes in the US, making them uninformed, unprepared and uneducated.  With the biased view of birth presented by the media, clients come to childbirth education class with nearly ridiculous views of their body, pain in labor and birth itself.

If it is the evidence that you need to stay committed in the midst of adversity, there are several avenues to explore.  As stated before, Childbirth Connection is a valuable international tool from which to obtain information (www.childbirthconnection.org).  You can also find, coming tomorrow –June 1- Optimal Care in Childbirth: The Case for a Physiologic Approach by Amy Romano and Henci Goer.  This dynamic book should be on the shelf of every Labor/Delivery unit and every birth professional! (Read the reviews, including my own on their website http://www.optimalcareinchildbirth.com/reviews-praise/  To order, click here http://www.optimalcareinchildbirth.com/shop/single-copy/  Bulk discounts are available!

It is evident that women do not know their options because they often do not have credible sources of information at their fingertips.  What they read in books, hear in childbirth class, or are told by their care providers often clash and send the expectant mother into confusion ~ who can she believe, who should she believe? 
Putting the mother or family between a rock and a hard place is our fault.  There should be consistency in the evidence-based material given to women.  And we should begin being consistent NOW!

About the Author:
Connie Livingston has spent her entire adult life as an advocate for evidence-based care in obstetrics and putting this information in the hands of both expectant parents and birth professionals.  You can find her most often writing in her office or teaching a Lamaze Seminar or other workshop, but also online (Facebook, Twitter, Linkedin, and 3 websites: www.birthsource.com; www.thebirthfacts.com; www.childbirthexperts.com.  And you may occasionally find her at the local Starbucks.

Wednesday, May 30, 2012

Aromatherapy in Pregnancy


Welcome to Childbirth Today's 2012 Blog Carnival - honoring the busy month of May and all of the celebrations of midwives, nurses, doulas and childbirth educators...AND mothers!  Our guest blogger today is Donna Walls RN, BSN, IBCLC who is a Master Herbalist and Certified Aromatherapist.  She shares about aromatherapy and essentials oils in pregnancy.


Aromatherapy is the practice of using essential oils to affect mind and body. The essential oils are, literally, the plant oils distilled from aromatic plants. This concentrated oil can be used in many ways, but like the plants, must be used respectfully. Essential oils produce a pleasant aroma and are often thought of as medicinally benign. Just the opposite is true as these oils are 75-100 times more potent than the plant.

These oils are distilled or expressed from the plant glands. Oils change in character depending on the part of the plant used. The oils from the orange peel (orange essential oil) are distinctly different from the oils from the leaves (petitgrain essential oil) or blossoms (neroli essential oil).

Choosing Essential Oils
The therapeutic effects of essential oils are well documented, but these effects are derived only from 100% pure and natural oils. Synthetic oils may have a pleasant aroma, but do not demonstrate the same positive effect on mind and body. Synthetics are often labeled “perfume” or “fragrance” oils. When selecting and using essential oils, choose only a “pure essential oil” which is stored in dark amber bottles. Pure essential oils most often are more expensive, have a fuller, deeper aroma and evaporate within minutes when placed on paper.

Some general safety guidelines for use in pregnancy are:

1) Do not use oils undiluted on the skin- do a patch test if prone to sensitivities
2) Do not take internally unless under the direct supervision of a knowledgeable
     practitioner
3)  Use only in small amounts- formulas for essential oils are given in drops only,
      do not exceed recommended number of drops
4) Do not use in or near eyes
5)  Use only pure essential oils
6)  Use very dilute formulas for children and during pregnancy
      
7) Use extra care on broken or damaged skin


How to Use Essential Oils-

Inhalation- with electric, battery or candle diffusers, or placing a small amount on small piece of fabric or cotton ball. This is good for relaxation and calming essential oils. 
Topical- diluted with a base oil (olive, sweet almond, jojoba, apricot kernel, or any cold pressed oil) or distilled water for direct application or misting of the skin.
Hydrotherapy- drops added to baths, foot or sitz baths. 


Dilutions for Topical Use 
   Carrier Oil                                            Essential Oil and dilution %
½ oz or 1 TBSP                       3-5 drops = 1%         6-8 drops= 2%         12-15 drops= 4%           
1 oz or 2 TBSP                       6-10drops= 1%        12-16 drops=2%         24-30 drops=4%
Most healthy adults will use the 4% dilution for most topical applications. Pregnant women should use the 2% or lower range of 4% dilutions.

Essential Oils Which are Considered Toxic and Harmful
                          Bitter melon                   Rue
                          Buchu                             Sassafrass
                          Camphor                        Tansy
                          Cassia                             Thuja
                          Mugwort                        Wintergreen
                          Pennyroyal                     Wormwood



Essential Oils to Avoid in Pregnancy

Thyme
Mugwort
Pennyroyal
Thuja
Tansy
Wormwood
Ginger (not in 1st trimester)
Nutmeg
Juniper


Essential Oils Generally Regarded as Safe in Pregnancy
Cypress                                 Citrus (in small amounts)
Lavender                               Chamomile
Jasmine                                 Patchouli
Ylang ylang                          Sandalwood
Clary sage                             Rosemary
Bergamot                              Eucalyptus
Rose geranium                      Neroli
Tea tree                                 Marjoram
Rose 
Marjoram                            Cedarwood



Striae Gravidum (Stretch marks)
Massage abdomen with enriching oils and butters such as wheat germ or jojoba oils or shea or cocoa butters.

Pregnant Belly Massage Oil
2 oz carrier oil
10 drops each lavender and sandalwood essential oils
5 drops chamomile essential oil
Mix well and apply to abdomen 1-2 times daily


Respiratory and Sinus Congestion

Eucalyptus essential oil diffused in the air in diffuser, inhale 2-3 drops on a cottonball or make a steam by placing about 1-2 cups water on the stove. Bring to a gentle simmer and add 5-7 drops of eucalyptus essential oil and turn off heat. Inhale the vapors for 3-4 minutes to clear congestion.

Relaxation in Pregnancy
Calming essential oils to diffuse in the air, place 5-7 drops in a warm tub bath or make into massage oil:
Sandalwood, lavender, marjoram, patchouli, rose geranium

Energizing, uplifting for Pregnancy
Energizing essential oils which can be diffused in the air for energy:
Rosemary, bergamot, peppermint, orange, or tangerine


Insomnia
Incorporate relaxation breathing- slow, deep, deliberate breaths, focusing on the exhale will help with relaxation at sleep time.

Diffuse in the air or on a cotton ball next to the bed, relax in a tub, or make a massage oil with essential oils of:
Lavender, ylang ylang or sandalwood, marjoram


Emotional balancing
Rose geranium is a natural hormone balancer
Clary sage reduces anxiety and promotes calm


About the author:
Donna Walls RN, BSN, IBCLC, Master Herbalist and Certified Aromatherapist has been a registered Nurse for 40 years, and for 38 years has worked with pregnant and new parents. She became a Certified Childbirth Educator in 1984 and a Certified Lactation Consultant in 1987. She continues to practice as a clinical Lactation Consultant, teaches the Certified Lactation Counselor course for the Healthy Children Project and teaches many women’s health classes and workshops for patients and professionals. Team leader for successful Baby Friendly designation at Southview Hospital in 2008 and is currently project leader for the Baby Friendly process at Miami Valley Hospital (Dayton, OH). In 1995, she developed and opened the first Alternative Birth Center within a hospital setting in the state of Ohio, Family Beginnings.  In 1997, she graduated as a Master Herbalist from the Australasian College with a Diploma Degree in Herbal Sciences and in 1998 became a Certified Aromatherapist. She has been in private practice as an Herbalist since 1997. She has presented programs on wholistic care, including natural therapies for women’s health, herbal medicines, aromatherapies, nutritional healing and environmental health both locally and nationally for many years.  She published her first book “Natural Families- Healthy Homes” in 2007, focusing on the connection between the health of the environment and personal health.

Tuesday, May 29, 2012

For Aspiring Midwives....Part 2

Welcome to Childbirth Today's 2012 Blog Carnival - honoring the busy month of May and all of the celebrations of midwives, nurses, doulas and childbirth educators...AND mothers!  We are honored to have a two part blog post from Justine Clegg MS, LM, CPM, the President of AME, the Association of Midwifery Educators.  Learn all about midwives...whether you aspire to become one or just need updated information! 



More about: CERTIFICATION ORGANIZATIONS FOR MIDWIVES




NATIONAL DIRECT-ENTRY MIDWIFERY ORGANIZATIONS
·         MANA: Midwives Alliance of North America  (http://www.mana.org )  
·         NARM: North American Registry of Midwives (http://www.narm.org 
·         NACPM: National Association of Certified Professional Midwives (http://www.nacpm.org)
·         MEAC: Midwifery Education Accreditation Council  (http://www.meacschools.org
·         AME: Association of Midwifery Educators (http://www.associationofmidwiferyeducators.org)
These are separate organizations with separate boards of directors.  Each supports the work of the other organizations but they function independently.  They meet jointly twice a year at the MANA conference in the fall and at a joint board meeting in April.  Each Board has a representative to a “Liaison Group” which meets periodically by telephone.

MANA
Established in 1982, the Midwives Alliance of North America (http://www.mana.org) represents all North American midwives.   MANA recognizes the diversity of educational backgrounds and practice styles within midwifery.  Its goal is to unify and strengthen the profession of midwifery.   Committees such as Research, Midwifery Education and Advocacy, Legislative, Fundraising, Insurance and others oversee areas of interest to the profession.  Members receive the MANA News published quarterly.   MANA has Core Competencies for Basic Midwifery Practice that include guiding principles, professional and legal aspects, knowledge and skills for pregnancy, labor, delivery, the newborn, postpartum, well woman care  (http://mana.org/manacore.html) and a Statement of Values and Ethics.  MANA hosts an annual conference in the fall where midwives can obtain continuing education and stay current with best maternity care practices (http://mana.org/valuesethics.html). 

MANA FOR STUDENTS
MANA has a committee especially by and for students.  The committee publishes a quarterly newsletter through a link on MANA’s website.  There is also a yahoo group where students can network and share experiences:  MANAStudentsandNewMidwives@yahoogroups.com.   All memberships on the list are approved by the moderator.  Students do not need to be members of MANA to participate in this group.   Contact the MANA Committee Chair at students@mana.org for more information. 

NARM
The North American Registry of Midwives (http://www.narm.org) is the national certification agency for Certified Professional Midwives (CPMs).    Candidates for certification may complete midwifery education through accredited and non-accredited midwifery schools or through apprentice programs.   

Education programs may be intensive short-term workshops or 1 – 3 years combined classroom instruction and clinical training.  All must have clinical birth experience outside of the hospital, in birth centers and/or homebirths.  All candidates for certification must pass a written exam. Graduates from non-accredited schools or apprenticeships must take a practical skill

The National Association of Certified Professional Midwives is the professional organization specifically developed to represent CPMs.  They have developed Standards of Practice for CPMs and advocate for the profession on a national level. (http://www.nacpm.org/Resources/nacpm-standards.pdf).

MEAC
The Midwifery Education Accreditation Council (http://www.meacschools.org) accredits direct-entry midwifery schools and programs within schools.  They can be free-standing or within an institution.  Midwifery educational programs must also be licensed by the state Department of Education and approved by the state midwifery licensing agency.  Midwifery programs must teach MANA’s core competencies and provide out-of-hospital clinical education.  Graduates of MEAC accredited schools are eligible to take the North American Registry of Midwives national certification examination to earn the credential CPM.   To learn more about how students benefit from attending an accredited educational program  visit MEAC’s website at http://meacschools.org/prospective_students.php?ID=35.

AME
The Association of Midwifery Educators seeks to strengthen schools and support teachers and school administrators through connection, collaboration and coordination.  AME publishes a newsletter “Giving Birth to Midwives” and provides a forum for inter-educational networking and sharing of best practices in education.s exam as well as the written exam to become certified (http://www.narm.org/htb.htm).

NACPM
The National Association of Certified Professional Midwives is the professional organization specifically developed to represent CPMs.  They have developed Standards of Practice for CPMs and advocate for the profession on a national level. (http://www.nacpm.org/Resources/nacpm-standards.pdf).

MEAC
The Midwifery Education Accreditation Council (http://www.meacschools.org) accredits direct-entry midwifery schools and programs within schools.  They can be free-standing or within an institution.  Midwifery educational programs must also be licensed by the state Department of Education and approved by the state midwifery licensing agency.  Midwifery programs must teach MANA’s core competencies and provide out-of-hospital clinical education.  Graduates of MEAC accredited schools are eligible to take the North American Registry of Midwives national certification examination to earn the credential CPM.   To learn more about how students benefit from attending an accredited educational program  visit MEAC’s website at http://meacschools.org/prospective_students.php?ID=35.

AME
The Association of Midwifery Educators seeks to strengthen schools and support teachers and school administrators through connection, collaboration and coordination.  AME publishes a newsletter “Giving Birth to Midwives” and provides a forum for inter-educational networking and sharing of best practices in education.



NATIONAL NURSE-MIDWIFERY ORGANIZATIONS
  ACNM:  American College of Nurse Midwives(http://www.acnm.org)
  AMCB:  American Midwifery Certification Board.  (http://www.amcbmidwife.org )
  ACME: The Accreditation Commission for Midwifery Education (http://www.midwife.org/acme.cfm)

ACNM
The  American College of Nurse-Midwives (http://www.acnm.org) is the professional association for CNMs and CMs.   Divisions within ACNM oversee specific specialty areas such as the Division of Standards and Practice, Division of Research, Division of Education and Division of Women’s Health Policy.  The ACNM has regional chapters throughout the US.  In the 1940s the National Organization of Public Health Nurses (NOPHN) established a section for nurse-midwives.   In 1955 this organization incorporated as the American College of Nurse-Midwives.  They added Certified Midwives in 1994.    ACNM publishes the Journal of Midwifery & Women's Health and has developed Core Competencies for midwifery education and practice.  ACNM hosts a national convention every year during the spring where midwives can earn continuing education credits and stay current with the latest evidence-based practice information (http://www.midwife.org/core_competencies.cfm).

ACME
The Accreditation Commission for Midwifery Education (http://www.midwife.org/acme.cfm) accredits nurse-midwifery educational programs.  In 1994 they added certified (non-nurse) midwifery education programs.   Students are required to complete a bachelors degree before enrolling in an ACME accredited educational program.   There are two tracks to the ACME accredited midwifery programs:
  • Bachelors Degree + general science courses + 2 years graduate midwifery education (masters degree or post-baccalaureate certificate program) = CM
  • RN + Bachelors Degree OR BSN + 2 years graduate nurse-midwifery education (masters degree or post-baccalaureate certificate program) = CNM
Educational programs must be housed in an institution of higher education.  Hospital based clinical experience is required.  Upon graduation, the student has completed at least 6 years of education. 

AMCB
The  American Midwifery Certification board (http://www.amcbmidwife.org) separated from the ACNM In 1991.  They provide CNM certification for nurse-midwives and CM certification for non-nurse midwives who have graduated from an ACME accredited midwifery program  (http://www.acnm.org/map.cfm).    CNMs and CMs who were certified after January 1996 are certified for a maximum of eight years after which they must renew certification.  For more information on the Certification Maintenance Program requirements, contact AMCB (http://www.amcbmidwife.org) or call 410/694-9424.






STATE LICENSING
To practice legally in any community, a midwife must apply for a license.   Midwives are licensed differently in each jurisdiction (country, province, state).   In the US, a midwife must be licensed to practice by each individual state.    Nurse-midwives are licensed in all 50 states.   The legal status and requirements for direct-entry (non-nurse) midwives vary from state to state.  The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives  (http://mana.org/laws.html).    

Each state’s law will require that the applicant for a midwife license do some or all of the following:
  • complete specific education
  • pass an examination
  • obtain national certification
  • submit practice protocols
  • identify a physician to back up the midwife’s practice
  • pay certain licensing fees
  • some jurisdictions allow reciprocity, meaning a midwife can use a license from another state or country to get a license in that state/country. 
The state law identifies what agency regulates midwives, usually part of the state’s Department of Health.   Typically states have laws against licensing anyone who has had a health care practitioner license revoked in another state or has been convicted of a felony which could impact safe practice.  

HOW TO BECOME A MIDWIFE
There are several ways to become a midwife in the United States.   Choosing the path that best fits your personal philosophy and professional goals will require you to decide what you want to do as a midwife and which avenue of preparation will best get you where you want to go.

What is your philosophy about health care and childbirth?
What are your own personal experiences in health care and childbirth?  Do you personally prefer the medical model of health care or holistic, “alternative” or “traditional” modalities?   Would you be more comfortable practicing midwifery in a medical setting or outside of a hospital?   What kind of a professional relationship do you want to have with medical doctors?   Do you want to learn how to open your own practice?  Do you want your education to include holistic approaches such as herbs, homeopathy, chiropractic and oriental medicine in addition to drugs and medical treatments?  Do you want your clinical training to be hospital based or do you want to learn how midwifery is practiced in birth centers and homebirths? 

Where do you want to practice?
How do you envision your midwifery practice?  Do you want to work in a hospital, or deliver babies outside of the hospital, in a birth center or in clients’ homes?   Do you want to be an employee?  Do you want to set up your own independent practice?   Are you willing to be on call or do you want a “9-to-5” job?  Do you want to serve a particular population?   The more specific you are about your midwifery goals, the better you will be able to choose the training method and community that fits your needs.

In what state do you want to become licensed?
Start by finding out the requirements to become a midwife where you want to practice midwifery.   Does the state license direct-entry midwives, and if so do they have to be CPMs or CMs?   What are the educational requirements?  What will you be able to do when you get licensed: work in a clinic, deliver babies in a hospital, open your own homebirth practice, start a birth center?   The MANA website tracks the laws and regulations in each state for direct-entry midwives  (http://mana.org/laws.html).  The Childbirth Resource Center lists the midwifery associations in each state.  Visit their website at: http://www.socalbirth.com/resource/contacts.html

What kind of a learner are you?
Do you learn best in structured situations or do you do better with self-teaching?  Do you like going to classes with face-to-face interaction or do you prefer online learning?  Are you organized and disciplined enough to set your own schedule?   Are there any constraints on your ability to go to school such as financial, family, career, location?  Can you attend full time or part time?   Choosing a program that fits your learning style and accommodates your personal situation will maximize your ability to succeed.

HOW TO CHOOSE A MIDWIFERY SCHOOL
There are a variety of midwifery schools and programs.  Some are accredited by one of the two national midwifery accrediting agencies, the Midwifery Education Accreditation Council or the Accreditation Commission for Midwifery Education.  Some are not accredited.  Some are state licensed.  Some are run by a state or community midwifery group.  The program may be classroom-based, correspondence, online or “hybrid” which refers to a combination of online and onsite education.  The program may be anywhere from a few months to 3 years long.  Some will have hospital-based clinical training, some will place students with midwives in birth centers and homebirth practices, some will include a center as part of the school, some will offer students the opportunity to gain clinical experience abroad, and some correspondence courses do not include a clinical component.  

An excellent resource for anyone thinking about what kind of midwife you want to be and what training options are best for you is a book “Paths to Becoming a Midwife: Getting an Education” which is published by Midwifery Today.   Visit the website and learn more about this book at http://www.midwiferytoday.com/merchant2/merchant.mv?Store_Code=MT&Screen=PROD&Product_Code=C514PM

Some questions you might want to ask when considering a midwifery school or program:
  • What education and training are required in the state in which you want to become licensed?  Does the school/program you’re considering meet these requirements? 
  • Does the program teach you what you want to learn about midwifery? 
  • How well does it fit with your personal philosophy and orientation to health care: Is its orientation primarily medical?  Does it include holistic “alternative” modalities?
  • Who are the teachers, what kind of credentialing and experience do they have?
  • What clinical placements does the school provide, and where?
  • Does graduation enable you to become nationally certified?
  • Is the school/program licensed by the state Department of Education?  Is it approved by the agency that licenses midwives in your state?
  • Is the school/program accredited by a national or regional accrediting agency?  Does it offer financial aid?
  • How transferrable is the education to meet the licensing requirements in any other state, province or country in which you might want to practice in the future?
  • Is the program in a free-standing private proprietary school or in a larger institution: a private or public college or university?
  • Who owns the school?  How long has it been in existence?  What kind of a reputation does it have, what do graduates, practicing midwives, and those who didn’t complete the course have to say about it?
  • What are the prerequisites for admission?  How large are the classes?  How many apply and how many are accepted? 
  • What is their graduation rate, their pass rate on the national certification exam and where do their graduates work?
  • What is the cost for tuition, books, equipment, supplies and other requirements such as health insurance and liability insurance?
  • Will I need a computer and internet access?
  • Does the class schedule fit in with my personal, family and job demands?  Will I be able to work and go to school?  If not how will I support myself?
  • If I want to go on to another health care field, will the credits or course content be accepted by other schools?

CHOOSING AN ACCREDITED MIDWIFERY EDUCATION PROGRAM
A program that is accredited:
  • has met educational standards for the profession so that graduates know they have completed the academic and clinical requirements for national certification and licensing for the state in which the school’s home campus is located.
  • has met administrative, financial and performance requirements.
  • is in compliance with state educational laws and regulations including refund and teach-out policies in case the student withdraws or the school closes while students are in progress.
  • teaches the philosophy and ethics of the profession.
  • reports outcomes regarding student retention, graduation, national exam pass rates, and successful practice in the field.
  • has a mechanism which includes the accreditation agency to address student concerns
Other benefits may include:
  • access to federal financial aid if the school participates in Title IV funding
  • easier transfer of credit for course content completion from one school to another which is similarly accredited
The US Department of Education has information online for consumers about accreditation: “Prepare for my future: Diploma Mills and Accreditation” on the web at: http://www.ed.gov/students/prep/college/diplomamills/index.html
For more information on accreditation in the United States, please visit: http://www.ed.gov/admins/finaid/accred/index.html

LINKS
National Professional organizations for maternity care providers
  AABC – American Association of Birth Centers.  Contact AABC at www.birthcenters.org 
  ACNM – American College of Nurse Midwives.  Contact ACNM at www.acnm.org
  ACOG - American College of Obstetricians & Gynecologists.  Contact ACOG at www.acog.org 
  ACME – Accreditation Commission for Midwifery Education.  Contact ACME at www.midwife.org/acme.cfm
  AMA - American Medical Association.  Contact AMA at www.ama-assn.org/
  AMCB – American Midwifery Certification Board.  Contact AMCB at www.amcbmidwife.org
  AME – Association of Midwifery Educators.  Contact AME at www.associationofmidwiferyeducators.org
  MEAC - Midwifery Education Accreditation Council. Contact MEAC at www.meacschools.org 
  NACPM – National Association for Certified Professional Midwives.  Contact NACPM at www.nacpm.org
  NARM - North American Registry of Midwives.  Contact NARM at www.narm.org   

National organizations: Maternity-Related & Consumer Advocacy
  ALACE –Association of Labor Assistants and Childbirth Educators and Doulas.  Contact ALACE at http://www.alace.org/
  APHA – American Public Health Association.  Contact APHA at http://www.apha.org/
  Childbirth Solutions, Inc.  “What is a Certified Professional Midwife?”  http://www.childbirthsolutions.com/articles/birth/cpm/index.php
  CfM – Citizens for Midwifery.  Contact CfM at http://cfmidwifery.org/index.aspx
  CIMS – Coalition to Improve Maternity Services.  Contact CIMS at  http://www.motherfriendly.org/
  CRC - Childbirth Resource Center.   Contact CRC at http://www.socalbirth.com/resource/contacts.html
  DONA – Doulas of North America.  Contact DONA at http://www.dona.org/
  ICAN – International Cesarean Awareness Network.  Contact ICAN at http://www.ican-online.org/
  ICEA – International Childbirth Education Association.  Contact ICEA at http://www.icea.org/
  LLLI – La Leche League International.  Contact LLLI at http://www.llli.org/

National educational organizations
·         ACE – American Council on Education. http://www.acenet.edu//AM/Template.cfm?Section=Home
·         National Center for Public Policy and Higher Education. http://www.highereducation.org/  
·         NCCA - The National Commission for Certifying Agencies.  Contact NCCA at http://www.noca.org/Resources/NCCAAccreditation/tabid/82/Default.aspx
·         National Commission For Certifying Agencies Accredited Certification Programs http://www.noca.org/NCCAAccreditation/AccreditedCertificationPrograms/tabid/120/Default.aspx 
·         NOCA - National Organization for Competency Assurance.  Contact NOCA at http://www.noca.org
·         NPEC - National Postsecondary Education Cooperative.  http://nces.ed.gov/ipeds/research/
·         UNESCO - The United Nations Educational, Scientific, and Cultural Organization. http://www.unesco.org/en/higher-education/
·         USDOE – United States Department of Education.  Home page http://www.ed.gov/index.jhtml
·         US Department of Education database of accredited post-secondary institutions and programs. http://ope.ed.gov/accreditation/
·         US Department of Education Links to Educational Associations and Organizations.  http://www.ed.gov/about/contacts/gen/othersites/associations.html

International midwifery and related organizations
·         ICM - International Confederation of Midwives.  ICM is an organization representing 85 national associations from more than 75 countries which promotes women’s health worldwide.  Contact ICM at  http://www.internationalmidwives.org/  

CONTACT US
The Association of Midwifery Educators
24 S. High Street, Bridgton, Maine 04009
Phone: 207-647-5968





Friday, May 25, 2012

For Aspiring Midwives....Part 1

Welcome to Childbirth Today's 2012 Blog Carnival - honoring the busy month of May and all of the celebrations of midwives, nurses, doulas and childbirth educators...AND mothers!  We are honored to have a two part blog post from Justine Clegg MS, LM, CPM, the President of AME, the Association of Midwifery Educators.  Learn all about midwives...whether you aspire to become one or just need updated information!  Look for Part 2 on Tuesday, May 29.





WHAT IS A MIDWIFE
Midwives take care of women during pregnancy, labor, birth and the postpartum.  When delivery takes place out of the hospital setting, the midwife is also responsible for taking care of the newborn.  Midwives may also provide well women gynecology services.

MIDWIVES MODEL OF CARE
The Midwives Model of CareTM (http://cfmidwifery.org/mmoc/define.aspx)  is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

TYPES OF MIDWIVES
There are two types of midwife in the United States: 
  • Nurse-midwives are educated and licensed as nurses first, and then complete additional education in midwifery.    They are known as Certified Nurse-Midwives (CNMs).   CNMs are licensed to practice in all 50 states.   They are usually licensed in individual states as Nurse Practitioners (NPs).   
  • Direct-entry midwives are educated or trained as midwives without having to become nurses first.  They may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs).   The legal status and requirements for direct-entry (non-nurse) midwives vary from state.   They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs).  The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives (http://mana.org/laws.html).

NATIONAL MIDWIFERY ORGANIZATIONS
Each of the national professional organizations plays an important part in the existence of a profession.   Aspiring midwives must first receive some kind of education and clinical training.   Educational programs are able to become accredited through a professional accreditation agency.   Graduates can become nationally certified, which may be a requirement to obtain a license to practice in a state, province or country.   Professional organizations support practicing midwives through core competencies, standards of practice, ethical guidelines, continuing education, research, advocacy and networking.

ACCREDITATION
Pre-accreditation and accreditation are voluntary processes between the education program or institution and the accrediting agency.   The goal of accreditation is to provide quality education so when students graduate they are well prepared to become credentialed and practice their chosen profession.  Accreditation assesses the quality of education relative to the national professional core competencies and standards of practice, student services, the financial stability of the institution, and other student safeguards.  

ACCREDITATION ORGANIZATIONS FOR MIDWIVES
The two organizations in the United States that provide national accreditation for midwifery education programs are:
  • The Midwifery Education Accreditation Council (http://www.meacschools.org).   Midwifery education programs accredited by MEAC fulfill the requirements for national certification by the North American Registry of Midwives.
  • The Accreditation Commission for Midwifery Education (http://www.midwife.org/acme.cfm).  Midwifery education programs accredited by ACME fulfill the requirements for national certification by the American Midwifery Certification Board.

The US Department of Education recognizes select accrediting agencies as reliable authorities regarding the quality of education or training offered by the institutions or programs they accredit.   Accreditation by a recognized accrediting agency allows institutions to participate in federal student aid programs  (http://www.ed.gov/admins/finaid/accred/index.html ).   Both MEAC (Midwifery Education Accreditation Council) and ACME (Accreditation Commission for Midwifery Education) are recognized by the US Department of Education.    MEAC’s website explains how students benefit from attending an accredited program  (http://meacschools.org/prospective_students.php?ID=35).

CERTIFICATION
Certification agencies are made up of consumers and experts in the profession.   They develop criteria  for education, training and  clinical experience based on what experts in the field determine is necessary for someone to practice safely as an “entry level” practitioner.   An “entry level” midwife has completed education and training to know how to care for healthy women with a normal pregnancy, labor and delivery, how to risk screen for problems, when to consult, refer or transfer care, and how to handle emergencies while getting medical help.   Certification agencies administer a written examination and in some cases also a skills practicum examination.  

CERTIFICATION ORGANIZATIONS FOR MIDWIVES
The two organizations in the United States that provide national certification for midwives are:

A Certified Professional Midwife (CPM) has earned national certification through the North American Registry of Midwives (http://www.narm.org).   Client continuity of care and clinical birth experiences in out-of-hospital settings  (birth center or home) are required for certification.  Education can be obtained through a MEAC accredited or non-accredited school or program, or through apprenticeship.   Midwifery practice guidelines, an informed consent document, and an emergency care plan are required.  Graduates of a MEAC accredited program must pass the NARM national written certification examination.   Graduates of other educational programs or routes must complete the NARM PEP Process and pass a skills practical examination in addition to the written examination.

A  Certified Nurse-Midwife or Certified Midwife has earned national certification through the American Midwifery Certification Board (http://www.amcbmidwife.org).   They must complete a graduate-level educational program accredited by the Accreditation Commission for Midwifery Education (http://www.midwife.org/acme.cfm) that provides clinical birth experiences in hospitals, and pass the AMCB national certification examination.

The National Commission for Certifying Agencies (NCCA) was created in 1987 by the National Organization for Competency Assurance (http://www.noca.org) to ensure the health, welfare and safety of the public through accrediting a variety of certification program/agencies that assess professional competence.  NCCA accredits over 200 programs from more than 100 organizations.  NCCA accredited programs certify individuals in a wide range of professions and occupations.   Both the North American Registry of Midwives and the American Midwifery Certification Board are recognized by the National Commission for Certifying Agencies (NCCA).   (http://www.noca.org/Resources/NCCAAccreditation/tabid/82/Default.aspx)