The Midwife As First Assistant for Cesarean Section


  • Carolyn B. Moes CNM, MSN,

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    • Carolyn Moes is a nurse-midwife with over 25 years experience. Currently, she is in practice with The MacDonald Midwifery Service at University Hospitals of Cleveland, Ohio. She holds clinical appointments on the faculties of the Schools of Medicine and Nursing at Case Western Reserve University. She has presented CNM First Assistant Workshops four times in Ohio, and was a member of the team presenting The Midwife as Surgical Assistant Workshop at the ACNM Annual Meetings in Anchorage in May 2000 and in Washington, DC in June 2001.

  • Frances Thacher CNM, MSN

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    • Frances Thacher formerly served as the Director of Midwifery at New York Presbyterian Hospital and on the faculty of Columbia University. She pioneered the format of the CNM First Assistant Workshop that was presented at the ACNM Annual Meetings in Boston in 1997, San Francisco in 1998, Anchorage in 2000, and Washington, D.C. in 2001. She is presently a trustee of the A.C.N.M. Foundation.

  • *Adapted from presentations made at the 45th Annual Meeting of the American College of Nurse-Midwives, May 12, 2000, Anchorage, Alaska, and the 46th Annual Meeting, June 1, 2001, Washington, DC.

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Across the United States, midwives have expanded their role to include serving as first assistants at cesarean sections. An American College of Nurse-Midwives (ACNM) Position Statement adopted in 1998 recognizes the practice as a “frequently-performed advanced midwifery practice skill.” Workshops have been offered nationally in 1997, 1998, 2000, and 2001 as well as locally in some states to educate and guide the midwife in completing the didactic and clinical preparation. Yet, there is a dearth of published literature on the subject. This article reviews the evolution of the role from its origins in perioperative nursing, including the requirements for the Registered Nurse First Assistant as established by the Association of peri-Operative Registered Nurses that are referenced in the regulations of several states in regard to the practice of midwives as surgical assistants. The authors report the results of a survey of state regulatory agencies that reveals a wide variation in laws, regulations, and interpretations ranging from statutory acceptance to prohibition with suggestions on how to effect needed change. This article also includes a process for credentialing that is consistent with the ACNM “Guidelines for the Incorporation of New Procedures into Midwifery Practice.” The importance of documentation of the educational and credentialing process from a medico-legal perspective is stressed.