In 1971, the Board of Directors of the American College of Nurse-Midwives approved a statement that prohibited certified nurse-midwives (CNMs) from performing abortions. In 1990, the statement was superseded by a second "Statement on Abortion," which essentially reworded the 1971 statement with no substantive change. In 1991, 20 years after the first statement was adopted, a resolution was approved at the Annual Meeting recommending that the Board of Directors rescind the statement, thereby allowing individual CNMs to utilize the guidelines for the incorporation of new procedures into nurse-midwifery practice if she/he decides to provide abortions. This article describes the historical basis for the initial 1971 statement in the hope that an understanding of that history will assist nurse-midwives as they reconsider the statement.

Abortion, Legal↗

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Preconception care. An opportunity to maximize health in pregnancy.

In 1990, the United States Public Health Service published Healthy People 2000: National Health Promotion and Disease Prevention Objectives. One of the objectives included in the family planning priority area and repeated in the maternal and infant health priority area is the following: "Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception care and counseling." Drawing on the guidelines proposed by the Public Health Service Expert Panel on the Content of Prenatal Care, this article describes the components of preconception care: 1) appropriate and ongoing risk assessment, 2) health promotion, and 3) medical and psychological interventions and follow-up. The organization of this article is based on a preconception class outline developed by the authors; recommendations included in the article are consistent with those of the Expert Panel. After discussing opportunities for providing preconception care, this article addresses: 1) helping women evaluate their psychological readiness; 2) evaluating physical readiness; 3) the examination and concerns of the father; 4) evaluating the need for genetic counseling; 5) creating a positive environment for conception; 6) discontinuing family planning methods and timing conception; and 7) choosing a provider and birth place.

Aftercare↗

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Nurse-midwifery management of women with human immunodeficiency virus disease.

Primary care for women with human immunodeficiency virus (HIV) disease is appropriately provided by nurse-midwives within a well-coordinated system of medical consultation and referral. The issues of access to care, partner notification, reproductive choice, and breast-feeding are discussed. The nature of the collaborative management of HIV in pregnancy is explained. Management issues include the effects of HIV infection and pregnancy upon each other, perinatal transmission risks and postpartum needs, family planning, and gynecologic needs. Clinical care guidelines are included.

Adaptation, Psychological↗

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Midwifery care for women with human immunodeficiency virus disease in pregnancy. A demonstration project at the Johns Hopkins Hospital.

Nurse-midwives at the Johns Hopkins Hospital, in conjunction with their colleagues in obstetrics, pediatrics, and infectious disease, are participating in a demonstration project designed to provide continuity of care for women with HIV disease in pregnancy. In the past 19 months, 73 women have been enrolled in the project. This article describes how the midwifery model of care has been integrated into the existing system of routine obstetric care and specialized HIV-related care at the institution. This project could serve as a model for others who are redesigning health care delivery systems to include more nurse-midwives, especially those who are trying to adapt to an ever-increasing number of women experiencing some phase of HIV disease during their pregnancy. A companion article explains the midwifery and medical protocols used in the project and discusses other clinically relevant issues.

Adolescent↗

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Primary care for women. Comprehensive assessment of the neurologic system.

This article reviews the essential neuroanatomy and neurophysiology, and summarizes the components of the health history, physical exam, and laboratory tests required for an assessment of the neurologic system within the primary care setting. Brief case studies illustrate the wide range of symptoms associated with neurologic disorders in women and the manner in which the pattern of symptoms can be used to locate the site of pathology and indicate the need for referral and follow-up.

Female↗

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Evaluation survey of the ACNM division of research 1994.

Explore the source record for details and available documents.

Adult↗

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Methods of cervical ripening and labor induction.

The overall rate of induction of labor in the United States in 1993 was 134 per 1,000 live births, or over 527,000 of the four million births that occur annually in the United States. Indications for labor induction include postdate pregnancy, premature rupture of membranes (PROM), and maternal medical complications, such as diabetes mellitus and pregnancy-induced hypertension. This article briefly reviews common indications for induction of labor and the importance of cervical ripening. It then addresses methods used to hasten cervical ripening and to induce labor, ranging from the more "natural" and noninvasive methods, such as nipple stimulation, to the newest commercially available formulation of prostaglandin. Methods well documented in the scientific literature, as well as those commonly used but less well studied, are included. Although one may argue about the "invasive" nature of these methods, they are addressed, in general, from the most natural methods to the latest pharmacologic methods, and they include the following: sexual intercourse, nipple/breast stimulation, herbal preparations, homeopathic solutions, castor oil, enemas, acupuncture, membrane sweeping or stripping, mechanical dilation (balloon catheters, laminaria, and synthetic osmotic dilators), amniotomy, and pharmacologic hormonal preparations (prostaglandin E2, oxytocin, misoprostol, mifepristone, and relaxin).

Amnion↗

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Interdisciplinary teaching. A survey of CNM participation in medical education in the United States.

Nurse-midwives have participated informally in the education of medical students and residents for many years, yet little is known about their formal involvement in medical education. A two-part survey was conducted to investigate the extent and characteristics of nurse-midwifery participation in medical education in the United States. The initial questionnaire was sent to every department of obstetrics and gynecology chair listed in the directory of the Association of Professors of Gynecology and Obstetrics and addressed the use of certified nurse-midwives (CNMs) as educators within their respective departments. A subsequent questionnaire was distributed to CNMs participating in medical education and addressed their demographic characteristics, roles within the medical school faculty, and attitudes regarding work in medical education. More than one half (54%) of U.S. allopathic medical schools are formally using CNMs as educators, with the strongest involvement reported in the West and Northeast. Nearly as many CNM respondents are participating in the education of family medicine residents (57%) as in obstetrics and gynecology (59%). Most CNMs (93%) involved in medical education are also involved in nurse-midwifery education. Eighty percent of CNM respondents perceived congruency between educating student physicians and their philosophy of nurse-midwifery practice.

Adult↗

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It is likely that CNM's prescriptive privileges will, in the near future, cover mifepristone and misoprostol.

Explore the source record for details and available documents.

Abortion, Legal↗

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ACNM essential documents: a midwife's suit of armor.

As the oldest professional midwifery organization in the United States, The American College of Nurse Midwives (ACNM) represents the profession of midwifery in the United States and sets standards for education, certification, and practice. The ACNM has generated and revised several critical documents that provide guidance for the scope of midwifery practice, individually and collectively. This article reviews essential ACNM documents and their role in supporting professional midwifery.

Credentialing↗