CPM Practice Guidelines

All Certified Professional Midwives are required to have written Practice Guidelines. In the CPM Application, the candidate and their preceptor sign affidavits that the candidate has created Practice Guidelines, Emergency Care Form, Informed Disclosure (given at initiation of care), and Informed Consent documents (used for shared decision making during care), forms and handouts relating to midwifery practice, and an emergency care form. In the recertification application, the CPM again signs a statement verifying that they have written Practice Guidelines and will utilize Informed Consent in sharing these protocols with their clients. NARM does not require these documents be turned in with every application.

Audits require candidates to send copies of their Practice Guidelines and other documents to the NARM Application Office to verify compliance with NARM’s standards.

NARM recognizes that each midwife is an individual with specific practice protocols that reflect their 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 use their own practice guidelines in written form.

Practice guidelines are a specific description of protocols that reflect the care given by a midwife, starting with the initial visit, prenatal, labor/delivery and immediate postpartum, newborn exam and postpartum care. Practice Guidelines should include an explanation of routine care and protocols for transports.

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 Midwives 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 the midwife base the practice guidelines on documents such as:

• The NARM Written Test Specifications in the Candidate Information Booklet (CIB)
• The MANA Standards and Qualifications for the Art and Practice of Midwifery;
• The MANA Statement of Values and Ethics;
• The MANA Core Competencies;
• ICM Global Standards, Competencies and Tools;
• The Midwife Model of Care;
• 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 the midwife’s state, if licensed may define the scope of practice and serve as a base for individual Practice Guidelines.