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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Page 30 of 87

30 OCTOBER 2018 | EMSWORLD.com WOMEN'S HEALTH The American College of Nurse-Mid- wives recognizes that being a nurse may not be feasible for all possible midwives and created the certified midwife path as an alternative. CMs take the same AMCB test as CNMs but have a bachelor's degree in a healthcare-related field other than n u r sin g an d have grad uate d f ro m an accredited program with a master's degree in midwifer y. These midwives will have the exact same scope of practice and ability to work in hospitals, birth centers, and homes as certified nurse midwives. This cer tification is still in its infancy and, though a national cer tification, is currently only recognized in six states: Delaware, Maine, Missouri, New Jersey, New York, and Rhode Island. Cer tified profes sional midwives may or may not have a medical education in something other than nursing. These midwives obtain either a master's degree (by attending a university) or cer tificate (through distance learning) that allows them to take a board exam established by the Nor th American Registr y of Mid- wives. CPMs are recognized in most but not all states, and their scope of practice can var y dramatically. For the most part, CPMs practice in out- of-hospital settings—either homes or birth centers. These midwives focus on care for the pregnant female during pregnancy, labor, and birth, as well as for both mom and baby up to approximately six weeks postpartum. Midwives and Emergencies All midwives are educated in neonatal resus- citation, CPR, and birth complications (e.g., nuchal cord, breech birth, postpartum hem- orrhage, vaginal birth after c-section). For a woman to be a good candidate for out-of- hospital birth, both she and the baby must be low-risk. There are protocols all midwives use at ever y prenatal appointment to evaluate the patient's status. Should some aspect of it be outside of normal, depending on the issue, either referral for more testing with an OB-GYN or a complete transfer of care would be in order. For example, if a patient's glucose screening was out- side normal limits, then retesting would be scheduled, and their diet would be evaluated. If a second test still returned abnormal re sult s , then fur ther te s ting would be needed, and the patient would be referred to an OB-GYN. Another exam- ple would be a mom who's healthy, with all tests and evaluations within normal limits, but a sonogram of the baby reveals heart defects. The proper course of action would be a referral to a neonatologist and OB-GYN care. The reasons for an out-of-hospital mid- wife to call 9-1-1 can var y based on proto- cols and state laws. While midwives are educated and skilled in difficult births and emergencies that can arise during preg- nancy and deliver y, there will be a time in ever y midwife's career when help will be needed. While 9-1-1 can be called for almost any emergency that arises, four common reasons are seizures of any kind (eclampsia), a prolapsed cord, postpar- tum hemorrhage, and newborn respirator y distress. While screening is performed through- For More Information Circle 25 on Reader Service Card

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