All Certified Professional Midwives are required to have written Practice Guidelines. In the CPM Application, the candidate and her preceptor sign affidavits that the candidate maintains these documents. In the recertification application, the CPM again signs a statement verifying that she has written Practice Guidelines and utilizes Informed Consent in sharing these protocols with her clients. NARM does not require that these protocols be turned in with every application, but random audits of applications and recertifications are conducted. Audits require candidates to send copies of their Practice Guidelines and other documents to the NARM Board to verify compliance with NARM’s standards.
NARM recognizes that each midwife is an individual with specific practice protocols that reflect her own style and philosophy, level of experience, and legal status, and that practice guidelines may vary with each midwife. NARM does not set protocols for all CPMs to follow, but requires that they develop their own practice guidelines in written form.
Practice guidelines are a specific description of protocols that reflect the care given by a midwife. Protocol may contain absolutes, such as, “I will not accept as a client a mother who does not agree to give up smoking,” or may list conditions under which a midwife will make this decision, such as: “I will accept a client who smokes only if she agrees to cut down on smoking, maintains an otherwise exceptional diet, and reads the literature on smoking which I will provide for her.” (The example concerning smoking is given only as an example and is not meant to convey that smoking must be covered in a midwife’s practice protocols.) Another example of a protocol could reflect action taken when a client completes 42 weeks gestation. The protocols could state that at 43.1 weeks, the client will be referred to a back-up physician for further care. Or they could read that at 43.1 weeks the client will be given information on the risks and benefits of continuing to wait for labor, and on options such as home induction or referral to a physician. It is Informed Consent that allows the mother and midwife to work together in developing a plan of care.
Practice guidelines are the specific protocols of practice followed by a midwife, and they should reflect the Midwifery Model of Care. Standards, values, and ethics are more general than practice guidelines, and they reflect the philosophy of the midwife. Practice guidelines are based upon the standards, values and ethics held by the midwife. NARM recommends that the midwife base the practice guidelines on documents such as:
- The MANA Standards and Qualifications for the Art and Practice of Midwifery;
- The MANA Statement of Values and Ethics;
- The MANA Core Competencies;
- The Midwives Model of Care;
- NACPM Essential Documents;
- Standards for the Practice of Nurse-Midwifery;
- Core Competencies for Basic Midwifery Practice;
- Code of Ethics for Certified-Nurse Midwives;
- Rules and regulations governing the practice of licensed midwifery in the midwife’s state, if licensed.
Sample Practice Guidelines
NARM provides links below to Practice Guidelines of people or organizations who have consented to have them shared.
Tennessee Midwives’ Association Practice Guidelines
Standards, Duties, and Guidelines for Practice written and used by Debbie Pulley, CPM
Sample Emergency Care Form