EMS World

OCT 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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WOMEN'S HEALTH 28 OCTOBER 2018 | EMSWORLD.com S ince the beginning of time, there have been references to women helping women give birth, the Old English definition of midwifery. Midwifer y continues today and in fact is increasing in the U.S.: Out-of-hospital births now account for approximately 6% of American births, up from 1% in the 1960s. There were almost 60,000 out-of- hospital births in the U.S. in 2014. While most occurred in home settings, 18,000 were in birth centers, which are freestanding, home- like facilities designed for the midwifery model of pregnancy and birth. As more and more women seek alter- native ways to normalize bir th due to the ever-rising rate of inter ventions like c-sections (now at an astounding nation- al average of 34%), midwifer y care will continue to grow. This ar ticle discusses what a midwife is and how EMS and mid- wives can work together. Types of Midwives While the medical model of care views pregnancy and birth as a condition that requires management, the midwifery model views it as a normal function of a woman's reproductive life. A midwife's goal is to keep birth as low-risk as possible. This doesn't mean midwives are opposed to intervention should the need develop, especially if the mother and baby require advanced medi- cal care. The mother's desire for a vaginal or out-of-hospital birth never overrides the safety of her or her child. There are three t y p e s of mid w i ve s in the U.S.: the cer tified nurse midwife (CNM), cer tified midwife (CM), and cer- tified professional midwife (CPM). Each has its own governing body that awards n ati o n al ce r ti f i c ati o n , m u ch like th e National Registr y of Emergency Medi- cal Technicians. As with other licensed medical professionals in the U.S., states regulate the scope of practice within each cla ssification of midwife, usually with boards to oversee licensure. A certified nurse midwife is an RN who has gone back to a graduate school pro- gram, traditional or distance learning, to obtain a master's degree in midwifer y. Their nursing back ground and advanced degree enable them to provide a broad range of women's healthcare ser vices from puber ty to grave. These midwives primarily practice in hospitals, but some practice in out-of-hospital settings. Sub- ject to state law, CNMs can typically con- duct Pap smears, write prescriptions, and attend to pregnant and birthing women, including scrubbing for c-sections. Nurse midwives are cer tified by the American Midwifer y Certification Board (AMCB) and exist in all 50 states. States can adjust the CNM scope of practice to their unique needs. EMS AND MIDWIVES: NAVIGATING THE OUT-OF- HOSPITAL TRANSFER By Jessica Arno, NRP, CPM These specialists can be a big help to EMS and new mothers when something goes wrong

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