Texas Midwives: The Two Types of Midwives in Texas

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There are two types of midwives who may legally practice in the state of Texas: Certified Nurse Midwives (CNM) and Licensed Midwives (LM).  A third credential is the Certified Professional Midwife (CPM).  Both CNMs and LMs may also be a CPM.  A CPM must also have a Texas license or CNM credential to practice legally in Texas.

Lay midwifery is illegal in Texas.

Scope of Practice

  • CNMs independently manage women's health care services relating to pregnancy, childbirth, the postpartum period, family planning, and routine gynecological needs. They may also provide normal newborn care and primary health care for women.
    They consult, collaborate, or refer to other health professionals for patient care issues outside of their area of competency.
    CNMs may have prescriptive authority delegated by a collaborating physician if the CNM meets the requirements of the BNE.

  • Licensed Midwives may independently manage women's health care services relating to pregnancy, childbirth, and the postpartum period. They also provide normal newborn care for up to six weeks of age. A licensed midwife with appropriate training and experience may also provide family planning and routine well-woman care according to her individual protocols.
    They consult, collaborate, or refer to other health professionals for patient care issues outside of their area of competency.
    Licensed Midwives have authority to purchase and use oxygen as well as eye ointment for the newborn.

Education

CNMs

CNMs are registered nurses that have completed a graduate level program in nurse-midwifery. CNM educational programs are accredited by the American College of Nurse Midwives (ACNM) and recognized by the U.S. Department of Education. These programs must also meet the standards of the Board of Nurse Examiners for the State of Texas (BNE).

There are two nurse midwifery educational programs in Texas: 

  1. Parkland School of Nurse Midwifery, Dallas (affiliated with UT Southwestern Medical Center) 
  2. The U.T. Collaborative Nurse Midwifery Education Program, U.T.M.B., Galveston.
  3. The BNE also has continuing education requirements for advanced practice nur

Licensed Midwives

Licensed midwives are direct-entry midwives. This means they are not required to be nurses. Their education in Texas is based on the Midwives Alliance of North America (MANA) Standards of Practice, MANA Core Competencies, the North American Registry of Midwives (NARM) test and skill specifications, and the Texas Midwifery Basic Information and Instructor Manual, which is created and approved by the Texas Department of Licensing and Regulation. In addition, all licensing candidates must meet minimum clinical education requirements, be certified in healthcare provider CPR, and neonatal resuscitation. Ongoing continuing education is requirement for re-licensure every two years.

There are currently two direct-entry midwifery programs approved by TDLR:

  1.         The Association of Texas Midwives Midwifery Program - A distance-education program
  2. Maternidad la Luz, El Paso

For more information on the ATM Midwifery Training Program visit the Education page.

Regulation

• Certified Nurse-Midwives are regulated by the BNE. CNMs are licensed as registered nurses authorized to practice as a category of advanced practice nurse (APN).
Approximately 350 CNMs are authorized by the BNE to practice in Texas.

 • Licensed Midwives in Texas are regulated by Texas Department of Licensing and Regulation
There are approximately 200 Licensed Midwives in Texas.

Certification/Licensing

• The BNE requires that nurse midwives be certified, and recognizes the ACNM Certification Council, Inc. (ACC) as the certification body for CNMs. The ACC develops the certification exam and sets the requirements for ongoing certification.

• To become licensed in Texas, a midwife must:

 1.  Be Certified by the North American Registry of Midwives (Certified Professional Midwife or C.P.M.) and pass a course covering the Midwifery Basic Information and Instructor Manual

          OR

2.  Complete a midwifery education program through a Texas TDLR-approved midwifery school and then pass the North American Registry of Midwives (NARM) exam (This process also qualifies her to become a CPM).

Standards of Practice

• The BNE requires CNMs to follow the Standards of Practice of Nurse-Midwifery created by the ACNM.

• Licensed Midwives must practice according to rules and standards of care as stated in the Texas Midwifery Rules, approved by the TDLR.

Practice Settings

• CNMs work in a wide variety of settings such as clinics, hospitals, medical offices, and their own private practices. The majority of CNM assisted births are in hospitals but they also deliver in birth centers and homes. Licensed Midwives work in a variety of settings such as clinics, midwifery offices, and their own private practices.

• Licensed Midwife assisted births are in birth centers or homes.

Medicaid Reimbursement

• In Texas, Medicaid recognizes CNMs as primary care providers for women. Medicaid reimburses CNMs at 85% of the rate paid to a physician for the same service.

• In Texas, Medicaid only recognizes Licensed Midwives as providers if they work in licensed birth centers.

Professional Organizations

Texas:
Consortium of Texas Certified Nurse Midwives (CTCNM)
4000 Sunflower Lane
Belton, TX 75613
gale@infohwy.com

National:
American College of Nurse Midwives (ACNM)
8403 Colesville Rd, Suite 1550
Silver Spring, MD 20910
Phone 240-485-1800 Fax: 240-485-1818
www.midwife.org

Texas:
Association of Texas Midwives
P.O.Box 887
Elmendorf, TX 78112
Phone: 432-664-8815
www.texasmidwives.com

National/International:
The North American Registry of Midwives (NARM)
5257 Rosestone Dr.
Lilburn, GA 30047
Phone: 1-888-842-4784
www.narm.org

 

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Contact Details

Association of Texas Midwives

P.O.Box 887 Elmendorf, TX 78112

Tel: 432-664-8815

Email:  ATMOffice@texasmidwives.com

 

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Webmaster: webmaster@texasmidwives.com

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Goal Statement

"To advance the quality and accessibility of midwifery in Texas."