Certified nurse midwives (CNMs) are advanced-practice nurses who specialize in the care of women's health and labor/ delivery. As a mid-level provider, they can prescribe medications, order and interpret tests, and, depending on the state, act as a primary care provider.

They have many responsibilities, which include:

  • Family planning
  • Monitoring pregnancy
  • Assisting with labor and delivery
  • Postpartum and newborn care

Many families choose CNMs to assist with labor and delivery. Many parents-to-be are interested in a CNM-assisted birth, but understandably have concerns about the qualifications of a CNM if something unexpected occurs during labor. It's important to realize that while CNMs are trained to handle certain aspects of labor and recognize potential complications, they also know when to seek collaboration with an OBGYN MD. For example, pregnancy and labor could be going along perfectly; then a complication arises such as a drop in fetal heart rate or excessive bleeding. The midwife is trained to bring an OBGYN in to manage the situation and perform the necessary interventions that are outside his or her scope of practice. But what happens if labor fails to progress and interventions are needed to deliver a newborn?

Vacuum-assisted delivery involves using a suction device to guide the baby through the birth canal. This procedure is done to help avoid a C-section. As with any medical intervention, there are risks associated with vacuum-assisted births such as minor scalp injuries, skull injuries, hematomas, and hemorrhage. Depending on the state and employer, CNMs can perform vacuum-assisted deliveries if trained to do so, and if comfortable to do so. However, CNMs prefer that mothers deliver with as little procedural intervention as possible.

Forceps delivery involves using forceps to extract the baby as the mother pushes. As with vacuum-assisted delivery, there are risks involved which include soft tissue damage in both mother and baby, as well as lacerations. As with vacuum-assisted births, CNMs can perform forceps delivery if trained to do so and if comfortable with the procedure. Again, this privilege depends on the state's nurse practice act as well as the employer.

C-sections are a more invasive and risky procedure. CNMs are not permitted to perform C-sections. However, some states and organizations allow nurse midwives to act as first-assist during the procedure. This means they can help apply pressure to remove the baby, keep the surgical field clear of blood (via suction and blotting), suturing, and even sometimes closing.

Whether nurse midwives perform these procedures or not, they are trained to recognize complications and refer to an OBGYN when necessary. While OBGYNs must care for women with high-risk pregnancies, CNMs can work alongside them and order labs and other monitoring/ screening tests. They cannot manage a high-risk pregnancy independently, as it is outside their scope of practice. Using the team approach to labor and delivery promotes positive outcomes for patients.

Read about labor and delivery nurses.

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