Joint Statement of Practice Relations Between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives
Statement of Policy
This document was developed jointly by the American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists.
The American College of Obstetricians and Gynecologists (ACOG) and the American College of NurseMidwives (ACNM) affirm our shared goal of safe women’s health care in the United States through the promotion of evidence-based models provided by obstetricians-gynecologists (ob-gyns), certified nurse-midwives (CNMs), and certified midwives (CMs). ACOG and ACNM believe health care is most effective when it occurs in a system that facilitates communication across care settings and among clinicians. Obgyns and CNMs/CMs are experts in their respective fields of practice and are educated, trained, and licensed independent clinicians who collaborate depending on the needs of their patients2.
These clinicians practice to the full extent of their education, training, experience, and licensure and support team-based care2, 3. ACOG and ACNM advocate for health care policies that ensure access to appropriate levels of care for all women4. Quality of care is enhanced by collegial relationships characterized by mutual respect and trust; professional responsibility and accountability; and national uniformity in full practice authority and licensure across all states.
Shortages and maldistribution of maternity care clinicians cause serious public health concerns for women, children, and families5. Ob-gyns and CNMs/CMs working together optimize women’s health care. ACOG and ACNM recommend increasing the number of ob-gyns and CNMs/CMs, utilizing inter-professional education to promote collaboration and team-based care.
Recognizing the high level of responsibility that ob-gyns and CNMs/CMs assume when providing care to women, ACOG and ACNM affirm their commitment to promote the highest standards for education, national professional certification, and recertification of their respective members and to support evidence-based practice. Accredited education and professional certification preceding licensure are essential to ensure skilled providers at all levels of care across the United States.
ACOG and ACNM recognize the importance of options and preferences of women in their health care. Ob-gyns and CNMs/CMs work in a variety of settings including private practice, community health facilities, clinics, hospitals, and accredited birth centers.6 ACOG and ACNM hold different positions on home birth.7
Establishing and sustaining viable practices that can provide broad services to women requires that ob-gyns and CNM/CMs have access to affordable professional liability insurance coverage, hospital privileges, equivalent reimbursement from private payers and under government programs, and support services including, but not limited to laboratory, obstetrical imaging, and anesthesia. To provide highest quality and seamless care, ob-gyns and CNMs/CMs should have access to a system of care that fosters collaboration among licensed, independent providers.
1 Certified Nurse-Midwives (CNMs) are registered nurses who have graduated from a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and have passed a national certification examination administered by the American Midwifery Certification Board, Inc. (AMCB), formerly the American College of Nurse-Midwives Certification Council, Inc. (ACC). Certified Midwives (CMs) are graduates of a midwifery education program accredited by ACME and have successfully completed the AMBC certification examination and adhere to the same professional standards as certified nurse-midwives.Obstetricians-gynecologists (OB-GYNs) pass a national certification exam administered by the American Board of Obstetrics and Gynecology or Osteopathic Board and enter ongoing Maintenance of Certification.
2 American College of Obstetricians and Gynecologists. Collaboration in practice: implementing team-based care. Washington, DC: ACOG; 2016.
3 3 American College of Nurse-Midwives. ACNM position statement: collaborative management in midwifery practice for medical, gynecologic and obstetric conditions. Silver Spring (MD): ACNM; 2014.
4 Levels of maternal care. Obstetric Care Consensus No. 2. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:502-15.
5 Ollove M. A shortage in the nation's maternal health care. Washington, DC: Pew Charitable Trusts; 2016.
6 A birthing center within a hospital complex, or a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, the Joint Commission, or the American Association of Birth Centers [From American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 8th ed. Elk Grove Village (IL): AAP; Washington, DC: American College of Obstetricians and Gynecologists; 2017.], or is accredited by the Commission for the Accreditation of Birth Centers (CABC).
7 American College of Nurse-Midwives. ACNM position statement: planned home birth. Silver Spring (MD): ACNM; 2016.;Planned home birth. Committee Opinion No. 697. American College of Obstetricians and Gynecologists. Obstet Gynecol
Approved by Executive Board of the American College of Obstetricians and Gynecologists
Approved by Board of Directors of the American College of Nurse-Midwives
Reaffirmed July 2014
Reaffirmed July 2017
Revised and Reaffirmed April 2018