All CPM applicants must affirm they utilize the following documents in their practice:
- Practice Guidelines
- Informed Disclosure for Midwifery Care (given at initiation of care)
- Informed Consent for Waiver of Midwife’s Plan of Care (used for shared decision making during care)
- Emergency Care Form
Audits of certification and/or recertification applicants might be required to submit the actual documents.
Position Statement on Shared Decision Making and Informed Consent
The North American Registry of Midwives recognizes Shared Decision Making and Informed Consent as the cornerstones of woman centered midwifery care. Midwives want their clients to make well-informed choices about their care. For effective informed consent, midwives provide a combination of decision making tools, including verbal communication and well written documents, that are based on evidence-based research and the midwife’s clinical expertise.
The Informed Consent Process occurs throughout care during which the plan of care for each client is continuously explored and explained. The Midwife’s Plan of Care is based on her training, competency, practice guidelines, regional community standards of both medical and midwifery maternity care providers, and legal requirements. Informed consent documents include signed agreements when appropriate.
Glossary for Informed Disclosure and Informed Consent
Philosophy of Birth: A written or verbal explanation that a midwife provides as part of Informed Disclosure for Midwifery Care in which the midwife explains her beliefs and opinions about the process of childbirth and the role of the midwife as care provider.
Informed Disclosure: A form written in language understandable to the client which includes a place for the client to attest that she understands the content by signing her full name. The form must include a description of the midwife’s training and experience (including credentials), legal status, philosophy of practice, list of services provided, transfer/consultation protocols, transport plan, the NARM Accountability Process, and HIPAA Privacy and Security Disclosures.
CPM Informed Consent Process: includes ongoing verbal and written education about risks, benefits and alternatives to the Midwife’s Plan of Care. Alternatives include interventions and treatments (provided by the midwife as well as those available through other resources in the community) and the options of delaying or declining testing or treatment. The midwife utilizes individualized counseling based on her practice guidelines and skill level, the woman’s medical history, and written documentation of a care plan that includes signatures of the client and midwife when appropriate. The Informed Consent Process necessitates revisiting areas of consent over time and as changes occur.
Midwife’s Plan of Care: A midwife provides her clients with a care plan that is informed by her training, competency, practice guidelines, regional community standards of both medical and midwifery maternity care providers, and legal requirements. The Plan of Care includes both written and verbal communication and is revisited throughout the course of care as changes occur.
Education and Counseling: Information and discussion components of the CPM Informed Consent Process, provided in language understandable to the client. Verbal and written communication should free of technical jargon that the client does not comprehend. Written information should be at the client’s reading level.
Shared Decision Making: The collaborative processes that engages the midwife and client in decision-making with information about treatment options, and facilitates the incorporation of client preferences and values into the plan of care.
Resources for Informed Disclosure and Informed Consent
- MANA Core Competencies
- NACPM Standards of Practice
- Professional Ethics in Midwifery Practice, Illysa Foster and Jon Lasser