ACNM's Commentary on the Midwifery Workforce in the US.

The American College of Nurse-Midwives (ACNM) represents certified nurse-midwives (CNMs) and certified midwives (CMs) who are graduate-prepared advanced practice providers. They attend educational programs accredited by the American Commission for Midwifery Education (ACME) and are certified by the American Midwifery Certification Board (AMCB). Their scope of practice as defined by ACNM includes primary care, reproductive services beginning with menarche through menopause, gender-affirming services, contraception, abortion, prenatal, birth, postpartum, and care of the newborn. CNMs/CMs attend 10.9% of US births, but other high-income countries have the reverse proportion of midwives to obstetricians. The CNM/CM workforce is growing, but retirements and attrition slow the growth. Research demonstrates good outcomes from care provided by midwives, and ACNM's primary goal is to expand the midwifery workforce and increase consumer access to midwifery care to mitigate the persistent rise in maternal mortality and morbidity. Barriers to workforce expansion include restricted practice at the state level, inability to expand the number of seats in education programs due to lack of clinical preceptors, and a lack of diversity in the workforce. Strategies to address these barriers may allow the workforce to grow, increasing access to high-quality, equitable sexual and reproductive care for people in the United States.

Evaluation of a method to identify midwives in national provider identifier data.

OBJECTIVES: Comparison of national midwife workforce data from the National Provider Identifier file determined it undercounted midwives compared to national data available from the American Midwifery Certification Board. This undercount may be due to the existence of three taxonomy categories for midwives when registering for the National Provider Identifier. The objective of this study was to obtain an accurate count of advanced practice midwives using the National Provider Identifier Data. METHODS: A recode strategy was created using the NPPES Data Dissemination File for November 7, 2021. The strategy identified advanced practice midwives using education and certification information provided in the "credentials" field. The strategy was validated using the NPPES Data Dissemination File for August 7, 2022 and the gold standard was the American Midwifery Certification Board count of midwives by state for August, 2022. Validation compared the accuracy and precision of the recode to the accuracy and precision of using the advanced practice midwife taxonomy category. RESULTS: The recode strategy improved the accuracy and precision of the count of advanced practice midwives compared to the identification of advanced practice midwives using the advanced practice midwife taxonomy category. CONCLUSIONS FOR PRACTICE: Recoding the NPPES Data Dissemination File provides a more accurate and precise count of advanced practice midwives than relying on the existing advanced practice midwife taxonomy classification. Researchers can use the NPPES Data Dissemination File when studying the midwifery workforce.

Making the Argument for Intact Cord Resuscitation: A Case Report and Discussion.

We use a case of intact cord resuscitation to argue for the beneficial effects of an enhanced blood volume from placental transfusion for newborns needing resuscitation. We propose that intact cord resuscitation supports the process of physiologic neonatal transition, especially for many of those newborns appearing moribund. Transfer of the residual blood in the placenta provides the neonate with valuable access to otherwise lost blood volume while changing from placental respiration to breathing air. Our hypothesis is that the enhanced blood flow from placental transfusion initiates mechanical and chemical forces that directly, and indirectly through the vagus nerve, cause vasodilatation in the lung. Pulmonary vascular resistance is thereby reduced and facilitates the important increased entry of blood into the alveolar capillaries before breathing commences. In the presented case, enhanced perfusion to the brain by way of an intact cord likely led to regained consciousness, initiation of breathing, and return of tone and reflexes minutes after birth. Paramount to our hypothesis is the importance of keeping the umbilical cord circulation intact during the first several minutes of life to accommodate physiologic neonatal transition for all newborns and especially for those most compromised infants.

Let complete numbers speak for themselves.

The authors describe the challenges they encountered, having attempted to retrospectively complete a home birth outcome data set for New York State. In addition, they provide a compelling argument for a midwifery data collective that would bring together health record data for all midwife-attended births nationwide, regardless of setting.

Knowledge of US Midwifery Credentials Among Members of the American College of Nurse-Midwives.

INTRODUCTION: Three midwifery credentials are granted in the United States: certified nurse-midwife (CNM), certified midwife (CM), and certified professional midwife (CPM). Confusion about US midwifery credentials may restrict growth of the midwifery profession. This survey assessed American College of Nurse-Midwives (ACNM) members' knowledge of US midwifery credentials. METHODS: ACNM members (N = 7551) were surveyed via email in 2017. The survey asked respondents to report demographic information and to identify correct statements about the education, certification, and scope of practice of CNMs, CMs, and CPMs. Responses to 17 items about all midwives certified in the United States, a 5-item subset specific to CNMs/CMs, and one item related to location of midwifery practice by credential were analyzed. RESULTS: Nearly a quarter of the membership (22.1%) responded to the survey. Higher scores on the survey indicated greater identification of correct statements about the education, certification, scope, and location of practice of CNMs, CMs, and CPMs. Significant differences in scores were found among ACNM members based on their level of education, degree of professional involvement in midwifery, and prior practice as a nurse. ACNM members with higher scores on the survey held a doctorate, worked in Region I, and had greater professional leadership involvement in midwifery organizations. Participants with less nursing experience prior to their midwifery education also scored significantly higher on the survey. DISCUSSION: Although two-thirds of respondents correctly answered items on the preparation, credentialing, and scope of practice of CNMs, CMs, and CPMs, a significant minority had gaps in knowledge. Results of this survey suggest the need for outreach about US midwifery credentials. Future research to replicate and expand upon this survey may benefit the profession of midwifery in the United States.

Midwifery education in the U.S. - Certified Nurse-Midwife, Certified Midwife and Certified Professional Midwife.

US midwifery education is provided through graduate education for the CNM/CM and didactic education with apprenticeship for the CPM. Clinical practice varies throughout the country depending on the credential held and current state legislation. A lack of clinical sites for midwifery education is a significant challenge to all programs and a barrier to meeting the national maternity care provider shortage.

Concurrent group treatment for hepatitis C: implementation and outcomes in a methadone maintenance treatment program.

Chronic hepatitis C virus (HCV) infection is highly prevalent among current and former drug users. However, the minority of patients enrolled in drug treatment programs have initiated HCV treatment. New models are needed to overcome barriers to care. In this retrospective study, we describe the implementation and outcomes of 42 patients treated in a concurrent group treatment (CGT) program. Patients participated in weekly provider-led group treatment sessions which included review of side effects; discussion of adherence and side effect management; administration of interferon injections; brief physical examination; and ended with brief meditation. Of the first 27 patients who initiated CGT, 42% achieved a sustained viral response. In addition, 87% (13/15) of genotype-1 infected patients treated with direct acting antiviral agent achieved an undetectable viral load at 24 weeks. The CGT model may be effective in overcoming barriers to treatment and improving adherence and outcomes among patients enrolled in drug treatment programs.