MIDWIFE SERVICES

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Midwifery as practiced by Certified Nurse-Midwives (CNMs) encompasses a full range of primary health care services for women from adolescence beyond menopause. These services include primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth and the postpartum period, care of the normal newborn during the first 28 days of life, and treatment of male partners for sexually transmitted infections.

CNMs are licensed, independent health care providers with prescriptive authority in all 50 states, the District of Columbia, American Samoa, Guam, and Puerto Rico. CNMs are defined as primary care providers under federal law.

While midwives are well-known for attending births, 53.3% of CNMs identify reproductive care and 33.1% identify primary care as main responsibilities in their full-time positions. Examples include annual exams, writing prescriptions, basic nutrition counseling, parenting education, patient education, and reproductive health visits.

Decades of research indicate that primary care services provided by Certified Nurse-Midwives compare favorably to those provided by physicians. In a recent systematic review of studies comparing midwifery care to physician care, researchers examined multiple outcomes. Results indicated that women cared for by CNMs compared to women of the same risk status cared for by physicians had:
  • Lower rates of cesarean birth,
  • Lower rates of labor induction and augmentation,
  • Significant reduction in the incidence of third and fourth degree perineal tears,
  • Lower use of regional anesthesia, and
  • Higher rates of breastfeeding

Medicaid reimbursement for CNM care is mandatory in all states. Medicare and most Medicaid programs reimburse CNMs at 100% of physician rates. The majority of states also mandate private insurance reimbursement for midwifery services.
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