Texas Midwives: The Two Types of Midwives in Texas

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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 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: 

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

• Licensed Midwives are direct-entry midwives. This means they are not required to be nurses. Their education in Texas is based on the current Core Competencies and Standards of Practice of the Midwives Alliance of North America (MANA) and the Texas Midwifery Basic Information and Instructor Manual, which is created and approved by the Texas Department of Health.
There are currently three direct-entry midwifery programs approved by the Texas Midwifery Board:

  • The Association of Texas Midwives Midwifery Program, Killeen
  • Maternidad la Luz, El Paso
  • Medical Training Institute of America Midwifery Program, Dallas

The Midwifery Board also has continuing education requirements for Licensed Midwives.

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 The Texas Midwifery Board under the Texas Department of Health (now the Department of State Health Services) Professional Licensing and Certification Division.
There are approximately 150 Licensed Midwives in Texas.

Certification/Documentation

• 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. Become Certified by the North American Registry of Midwives (Certified Professional Midwife or C.P.M.) or 
  2. Complete midwifery training through a state approved midwifery program 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.

• The Texas Midwifery Board creates Standards of Practice for Licensed Midwives. These standards must also be approved by the Texas Board of Health.

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 does not recognize Licensed Midwives as providers and does not reimburse for their services.

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

 

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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Goal Statement

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