Advancing Midwifery: The American College of Nurse-Midwives’ Documents and Publications


As I reviewed the letters to the editor1,2 and replies3–5 that are published in this issue, I also re-read several of the relevant standard setting documents and position statements from the American College of Nurse-Midwives (ACNM). Reading these documents always brings back memories of the first time I read them in detail as a midwifery student. The assignment was to create a personal definition of a profession, describe the history of the development of a professional organization for nurse-midwives, and analyze the development of nurse-midwifery using our definition of a profession with particular attention to the contributions of the professional organization. As I wrote that paper, it became clear that many of the ways in which midwifery was established and remains credible as a profession are outlined in the ACNM's documents and publications.

I identified several essential criteria necessary to define a profession. Two of the criteria for my definition of a profession were 1) a formal and defined educational process to gain entry and 2) standards of practice. The content of the educational process for certified nurse-midwives (CNMs) and certified midwives (CMs) is guided by the Core Competencies for Basic Midwifery Practice,6 and CNMs/CMs have clearly identified Standards for the Practice of Midwifery.7 Another criterion was that a profession's members make autonomous, rational, ethical decisions for which they hold personal responsibility. The independence of the midwifery profession is affirmed in both the Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives8 and the position statement on Independent Midwifery Practice.9 The ACNM Code of Ethics10 describes the ethical mandates for the midwifery profession. My definition also stated that a profession's members participate in interdependent relationships with other professionals. One of the most important groups of other professionals that midwives interact with is physicians. Several ACNM publications speak to the relationships between midwives and physicians, and 2 of the most important ones are the ACNM and American College of Obstetricians and Gynecologists’Joint Statement of Practice Relations between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives11 and the position statement on Collaborative Management in Midwifery Practice for Medical, Gynecological, and Obstetrical Conditions.12 Another criterion in my definition was the existence of a professional organization that promotes the profession and assists with oversight of various aspects of the profession. The ACNM Vision, Mission, and Core Values13 and the Philosophy of the American College of Nurse-Midwives14 clearly articulate these important aspects of the organization.

I have read ACNM's documents and publications many times since I was a midwifery student, and I am always as impressed now as I was then. It has been almost 15 years to the day since I wrote my professionalism paper. During that time, all of the standard setting documents have been updated, many of them more than once and some with significant revisions. For example, the Core Competencies for Basic Midwifery Care now include the primary health care of women, and the ACNM Mission has been expanded to include a Vision and Core Values. More than half of the current ACNM position statements did not exist at the time I was a student. These new position statements span a wide range of topics including midwives further clarifying our interprofessional relationships via publications such as Collaborative Agreement between Physicians and Certified Nurse-Midwives and Certified Midwives15 and Principles for Equitable Compensation Agreements between Midwives and Physicians,16 and ACNM taking a stance on controversial clinical topics such as elective primary cesarean section,17 induction of labor,18 and premature rupture of membranes (PROM) at term.19 As midwifery continues to evolve within a rapidly changing health care system and culture, the new and revised ACNM publications document the profession's growth and maturation as an independent profession upholding its unique hallmarks.

There are currently 7 standard setting documents, more than 40 position statements, 6 clinical bulletins, 4 white papers and reports, 8 professional resource packets, 6 handbooks and practice resources, 5 liability risk reduction statements, 14 issue briefs, and a PowerPoint presentation that can be used for a variety of audiences. This is quite an impressive collection! It is important for those within and outside the midwifery profession to know about the ACNM documents and publications that are available. As one mechanism to make this information available, the Journal began publishing an annual index of ACNM documents and publications in 2007. Recently there have been so many new and revised documents and publications that the Journal's editors decided to publish an updated version of the index prior to a year elapsing. The latest index is included in this issue.20

This issue also contains one of the newest ACNM publications which is the landmark position statement, Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by the American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives.21 This statement defines normal physiologic childbirth; describes the mechanisms and outcomes of physiologic childbirth; identifies factors that influence the ability of women to give birth without intervention; and provides recommendations for policy, education, and research to promote normal physiologic childbirth. This summary of the evidence supporting normal physiologic childbirth is not only essential reading for every midwife and women's health care provider, but it also needs to be read by childbearing women and their families, health profession educators, researchers, policy makers, health care administrators, and insurers.

I hope this new position statement and the index of documents and publications in this issue will inspire you to visit the ACNM Library ( where all of these materials can be found. As you will see, a substantial proportion of these documents and publications have been recently developed or updated. The midwifery profession is built upon and supported by the ACNM documents and publications, and all midwives should be proud of and knowledgeable about these impressive resources.