Two French midwives (sages-femmes)
|Midwifery, obstetrics, newborn care, women's health, reproductive health|
|Competencies||Knowledge, professional behaviour and specific skills in family planning, pregnancy, labour, birth, postpartum period, newborn care, women's health, reproductive health, and social, epidemiologic and cultural context of midwifery|
|obstetrician, gynecologist, pediatrician|
A midwife is a professional in midwifery. In addition to providing care to women during pregnancy, birth, and postpartum period, midwives may also provide primary care related to reproductive health, including annual gynecological exams, family planning, and menopausal care. Many developing countries are investing money and training for midwives and other community health workers so that they can provide well-woman primary care services that are currently lacking.
Midwives are specialists in pregnancy, childbirth, postpartum, and well-woman health care. They are educated and trained to recognize the variations of normal progress of labor and deal with deviations from normal to discern and intervene in high risk situations, such as breech births, twin births and births where the baby is in a posterior position, using non-invasive techniques. When a pregnant woman requires care beyond the midwife's scope of practice, they refer women to obstetricians or perinatologists who are specialists in complications related to pregnancy and birth, including surgical and instrumental deliveries. In many parts of the world, these professions work in tandem to provide care to childbearing women. In others, only the midwife is available to provide care, and in yet other countries many women elect to utilize obstetricians primarily over midwives.
- 1 Definition and etymology
- 2 Scope of practice
- 3 Male midwives
- 4 Education, training, regulation and practice
- 5 See also
- 6 References
- 7 External links
Definition and etymology
According to the definition of the International Confederation of Midwives, which has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics:
A midwife is a person who has successfully completed a midwifery education programme that is recognised in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.
The word derives from Old English mid, "with" and wif, "woman", and thus originally meant "with-woman", that is, the woman who is with the mother at childbirth. In spite of its origins, the word is used to refer to both male and female midwives.
Scope of practice
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics or health units.
Men rarely practice midwifery for cultural and historical reasons. In the United States and the United Kingdom, fewer than 1% of nurse-midwives are men. In some Southeast Asian cultures, some or even most of the traditional midwives are men.
In ancient Greece, midwives were required by law to have given birth themselves, which prevented men from joining their ranks. In 17th century Europe, some barber-surgeons, all of whom were male, specialized in births, especially births requiring the use of surgical instruments. This eventually developed into a professional split, with women serving as midwives and men becoming obstetricians.
Education, training, regulation and practice
Education, training and regulation
The undergraduate midwifery programs are three-year full-time university programs leading to a bachelor's degree in midwifery (Bachelor of Midwifery) with additional one-year full-time programs leading to an honours bachelor's degree in midwifery (Bachelor of Midwifery (Honours)). The postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (Master in Midwifery, Master in Midwifery (Research), MSc Midwifery). There are also postgraduate midwifery programs (for registered nurses who wish to become midwives) leading to a bachelor's degree or equivalent qualification in midwifery (Bachelor of Midwifery, Graduate Diploma in Midwifery).
Midwives in Australia must be registered with the Australian Health Practitioner Regulation Agency in order to practice midwifery and use the title 'midwife' or 'registered midwife'.
Midwives work in a number of settings including hospitals, birthing centres, community centres and women’s homes. They may be employed by health services or organisations, or self-employed as privately practising midwives. All midwives are expected to work within a defined scope of practice and conform to ongoing regulatory requirements that ensure they are safe and autonomous practitioners.
- Australian College of Midwives (ACM).
Midwifery was reintroduced as a regulated profession in most of Canada's ten provinces in the 1990s. After several decades of intensive political lobbying by midwives and consumers, fully integrated, regulated and publicly funded midwifery is now part of the health system in the provinces of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, and Nova Scotia, and in the Northwest Territories and Nunavut. Midwifery legislation has recently been proclaimed in New Brunswick where the government is in the process of integrating midwifery services there. Only Prince Edward Island, Yukon and Newfoundland and Labrador do not have legislation in place for the practice of midwifery.
Education, training and regulation
The undergraduate midwifery programs are four-year full-time university programs leading to bachelor's degrees in midwifery (B.H.Sc. in Midwifery, Bachelor of Midwifery). In British Columbia, the program is offered at the University of British Columbia. Mount Royal University in Calgary, Alberta offers a Bachelor of Midwifery program. In Ontario, the Midwifery Education Program (MEP) is offered by a consortium of McMaster University, Ryerson University and Laurentian University. In Manitoba the program is offered by University College of the North. In Quebec, the program is offered at the Université du Québec à Trois-Rivières. In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities. There are Bridging programs for internationally educated midwives in Ontario at Ryerson University and in British Columbia at the University of British Columbia. A federally funded pilot project called the Multi-jurisdictional Midwifery Bridging Program has been offered in Western Canada.
Midwives in Canada must be registered, after a process of assessment by the provincial regulatory bodies, in order to practice midwifery and use the title 'midwife', 'registered midwife' or, the French-language equivalent, 'sage femme'.
From the original 'alternative' style of midwifery in the 1960s and 1970s, midwifery practice is offered in a variety of ways within regulated provinces: midwives offer continuity of care within small group practices, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care. When women or their newborns experience complications, midwives will work in consultation with an appropriate specialist. Registered midwives have access to appropriate diagnostics like blood tests and ultrasounds and can prescribe some medications. Founding principles of the Canadian model of midwifery include informed choice, choice of birthplace, continuity of care from a small group of midwives and respect for the woman as the primary decision maker. Midwives typically have hospital privileges and support women's right to choose where she will have her baby.
The legal recognition of midwifery has brought midwives into the mainstream of health care with universal funding for services, hospital privileges, rights to prescribe medications commonly needed during pregnancy, birth and postpartum, and rights to order blood work and ultrasounds for their own clients and full consultation access to physicians. To protect the tenets of midwifery and support midwives to provide woman-centered care, the regulatory bodies and professional associations have legislation and standards in place to provide protection, particularly for choice of birth place, informed choice and continuity of care. All regulated midwives have malpractice insurance. Any unregulated person who provides care with 'restricted acts' in regulated provinces or territories is practicing midwifery without a license and is subject to investigation and prosecution.
Prior to legislative changes, very few Canadian women had access to midwifery care, in part because it was not funded by the health care system. Legalizing midwifery has made midwifery services available to a wide and diverse population of women and in many communities the number of available midwives does not meet the growing demand for services. Midwifery services are free to women living in provinces with regulated midwifery.
- Canadian Association of Midwives (CAM).
The BC government announced on 16 March 1995 the approval of regulations governing midwifery and establishing the College of Midwives of BC. In 1996, the Health Professional Council released a draft of Bylaws for the College of Midwives of BC which received Cabinet approval on 13 April 1997. In 1998, midwives were officially registered with the College of Midwives of BC.
In BC midwives are primary care providers for women in all stages of pregnancy, from prenatal to six weeks postpartum. Midwives also care for newborns. To see the approximate proportion of women whose primary birth attendant was a midwife in British Columbia see, "What Mothers Say: The Canadian Maternity Experiences Survey. Public Health Agency of Canada. Ottawa, 2009, p. 115. In BC midwives deliver natural births in hospitals or homes and if a complication arises in a pregnancy, labour, birth or postpartum, a midwife will consult with a specialist such as an obstetrician or paediatrician. Core competencies and restricted activities are included in the BC Health Professions Act Midwives Regulation. As of April 2009, the scope of practice for midwives allows them to prescribe certain prescription drugs, use acupuncture for pain relief, assist a surgeon in a caesarean section delivery and to perform a vacuum extraction delivery. These specialized practices require additional education and certification.
As of November 2015, the College of Midwives of British Columbia reported 247 General, 2 Temporary, 46 Non-practicing Registrant midwives. There were 2 midwives per 100,000 people in BC in 2006.
A midwife must be registered with the College of Midwives of BC in order to practice. To continue licensure midwives must maintain regular recertification in neonatal resuscitation and management of maternal emergencies, maintain the minimum volume of clinical care (40 women), participate in peer case reviews and continuing education activities.
Midwives education in BC: The University of British Columbia (UBC) has a four-year Bachelor of Midwifery program. The UBC midwifery program is poised to double in size thanks to an increase in government funding. Graduation of students will increase to 20 per year.
Education, training and regulation
The undergraduate midwifery programs are five-year full-time university programs (four years in midwifery schools after a first year of medical studies common with Medicine, Odontology and Pharmacy) leading to an accredited master's degree in midwifery (Diplôme d'Etat de Sage-Femme).
Midwives in France must be registered with the Ordre des sages-femmes in order to practice midwifery and use the title 'sage-femme'.
In France, midwives (sage-femmes "wise women" or maïeuticien/maïeuticienne) are independent practitioners, specialists in birth and women's medicine.
- Collège National des Sages-Femmes de France (CNSF).
- Société Française de Maïeutique (SFMa).
In Hong Kong the Midwives Registration Ordinance requires midwives to be registered with the Midwives Council.
Education, training and regulation
The undergraduate midwifery programs are four-year full-time university programs, with an internship in the final year, leading to an honours bachelor's degree in midwifery (BSc (Hons) Midwifery). The postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (MSc Midwifery, MSc Midwifery Practice). There are also postgraduate midwifery programs (for registered general nurses who wish to become midwives) leading to a qualification in midwifery (Higher Diploma in Midwifery).
Midwives in Ireland must be registered with the Nursing and Midwifery Board of Ireland (NMBI) in order to practice midwifery and use the title 'midwife' or 'registered midwife'.
The first male midwife was registered in 2009.
Education, training and regulation
In Japan, midwifery was first regulated in 1868. Today midwives in Japan are regulated under the Act on Public Health Nurse, Midwife and Nurse (No. 203) established in 1948. Japanese midwives must pass a national certification exam. Up until 1 March 2003 only women could be midwives.
- Japanese Midwives Association (JMA).
- Japan Academy of Midwifery (JAM).
- Japanese Nursing Association (JNA), Midwives' Division.
When a 16-year civil war ended in 1992, Mozambique's health care system was devastated and one in ten women were dying in childbirth. There were only 18 obstetricians for a population of 19 million. In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. These midwives now perform major surgeries including Cesareans and hysterectomies. As the figures now stand, Mozambique is one of the few countries on track to achieve the United Nations Millennium Development Goal (MDG) of reducing the maternal death rate by 75 percent by 2015.
Education, training and regulation
The undergraduate midwifery programs are four-year full-time university programs leading to a bachelor's degree in midwifery (HBO-bachelor Verloskunde). There are four colleges for midwifery in the Netherlands: in Amsterdam, Groningen, Rotterdam and Maastricht. Midwives are called vroedvrouw (knowledge woman), vroedmeester (knowledge master, male), or verloskundige (deliverance experts) in Dutch.
Midwives are independent specialists in physiologic birth. In the Netherlands, home birth is still a common practice, although rates have been declining during the past decades. Between 2005-2008, 29% of babies were delivered at home. This figure fell to 23% delivered at home between 2007-2010 according to Midwifery in the Netherlands, a 2012 pamphlet by The Royal Dutch Organization for Midwives. Midwives are generally organized as private practices, some of those are hospital-based. In-hospital outpatient childbirth is available in most hospitals. In this case, a woman's own midwife delivers the baby at the delivery room of a hospital, without intervention of an obstetrician. In all settings, midwives will transfer care to an obstetrician in case of a complicated childbirth or need for emergency intervention.
Apart from childbirth and immediate postpartum care, midwives are the first line of care in pregnancy control and education of mothers-to-be. Typical information that is given to mothers includes information about food, alcohol, life style, travel, hobbies, sex, etc. Some midwifery practices give additional care in the form of preconceptional care and help with fertility problems.
All care by midwives is legal and it is totally reimbursed by all insurance companies. This includes prenatal care, childbirth (by midwives or obstetricians, at home or in the hospital), as well as postpartum/postnatal care for mother and baby at home.
- Royal Dutch Organisation of Midwives | Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV).
Midwifery regained its status as an autonomous profession in New Zealand in 1990. Midwifery is a profession with a distinct body of knowledge and its own scope of practice, code of ethics and standards of practice. The midwifery profession has knowledge, skills and abilities to provide a primary complete maternity service to childbearing women on its own responsibility.
Education, training and regulation
The undergraduate midwifery programs are three-year full-time university programs leading to a bachelor's degree in midwifery (Bachelor of Midwifery). These programs are offered by Otago Polytechnic in Dunedin, Christchurch Polytechnic Institute of Technology (CPIT) in Christchurch, Waikato Institute of Technology in Hamilton and Auckland University of Technology (AUT) in Auckland. Several schools have satellite programmes such as Otago with a programme in Invercargill and AUT with student cohorts in various sites in the upper North Island. The postgraduate midwifery programs (for registered midwives) lead to postgraduate degrees or equivalent qualifications in midwifery (Postgraduate Certificate in Midwifery, Postgraduate Diploma in Midwifery, Master of Midwifery, PhD Professional Doctorate).
The Midwifery First Year of Practice Programme (MFYP) is a compulsory national programme for all New Zealand registered midwifery graduates, irrespective of work setting. The New Zealand College of Midwives (the NZCOM) is contracted by the funder, Health Workforce New Zealand (HWNZ), to provide the programme nationally in accordance with the programme specification.
Midwives in New Zealand must be registered with the Midwifery Council of New Zealand, after pass the national examination, in order to practice midwifery and use the title 'midwife'.
Women may choose a midwife, a General Practitioner or an Obstetrician to provide their maternity care. About 78 percent choose a midwife (8 percent GP, 8 percent Obstetrician, 6 percent unknown). Midwives provide maternity care from early pregnancy to 6 weeks postpartum. The midwifery scope of practise covers normal pregnancy and birth. The midwife will either consult or transfer care where there is a departure from a normal pregnancy. Antenatal care is normally provided in clinics, and postnatal care is initially provided in the woman’s home. Birth can be in the home, a primary birthing unit, or a hospital. Midwifery care is fully funded by the Government. (GP care may be fully funded. Private obstetric care will incur a fee in addition to the government funding.)
- New Zealand College of Midwives.
Education, training and regulation
The undergraduate midwifery programs are three-year full-time university programs leading to honours bachelor's degrees in midwifery (BSc (Hons) Midwifery, Bachelor of Midwifery (Hons)). The postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (MSc Midwifery, MSc Advanced Practice Midwifery). There are also undergraduate and postgraduate midwifery programs (for graduates with a relevant degree who wish to become midwives) leading to degrees or equivalent qualifications in midwifery (BSc (Hons) Midwifery, Bachelor of Midwifery (Hons), Graduate Diploma in Midwifery, Postgraduate Diploma in Midwifery, MSc Midwifery). Midwifery training consists of classroom-based learning provided by select universities in conjunction with hospital- and community-based training placements at NHS Trusts.
Midwifery students do not pay tuition fees and are eligible for additional financial support while training. Funding varies depending on which country within the UK the student is located in: students are eligible for NHS bursaries in addition to a grant of 1,000 pounds a year, and neither has to be repaid. Shortened-course students, who are already registered adult nurses, have different funding arrangements, are employed by the local NHS Trust via the Strategic Health Authority (SHA), and are paid salaries. This varies between universities and SHAs, with some students being paid their pre-training salaries, while others are employed as a Band 5 and still others are paid a proportion of a Band 5 salary.
Midwives in the UK must be registered with the Nursing and Midwifery Council in order to practice midwifery and use the title 'midwife' or 'registered midwife', and must also have a Supervisor of Midwives through their local supervising authority.
Midwives are practitioners in their own right in the United Kingdom. They take responsibility for the antenatal, intrapartum and postnatal care of women up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional attending the majority of births, whether at home, in a midwife-led unit or in a hospital (although most births in the UK occur in hospitals).
In December 2014 the National Institute for Health and Care Excellence updated its guidance regarding where women should give birth. The new guidance states that midwife-led units are safer than hospitals for women having straightforward (low risk) pregnancies. Its updated guidance also confirms that home birth is as safe as birth in a midwife-led unit or a traditional labour ward for the babies of low-risk pregnant women who have already had at least one child previously.
Many midwives also work in the community. The role of community midwives includes making initial appointments with pregnant women, managing clinics, undertaking postnatal care in the home and attending home births. A community midwife typically has a pager, is responsible for a particular area and can be contacted by ambulance control when needed. Sometimes they are paged to help out in a hospital when there are insufficient midwives available.
Most midwives work within the National Health Service, providing both hospital and community care, but a significant proportion work independently, providing total care for their clients within a community setting. However, recent government proposals to require insurance for all health professionals is threatening independent midwifery in England.
Midwives are at all times responsible for the women they are caring for. They must know when to refer complications to medical staff, act as the women's advocate, and ensure that mothers retain choice and control over childbirth.
- Royal College of Midwives (RCM).
- Independent Midwives UK (IMUK).
- Association of Radical Midwives (ARM).
Education, training and regulation
- There are undergraduate and postgraduate (for midwives) midwifery programs, accredited by the Midwifery Education Accreditation Council (MEAC), leading to the Certified Professional Midwife (CPM) credential, certified by the North American Registry of Midwives (NARM), that is at the level of a degree in midwifery (AS Midwifery, BSc Midwifery, MSc Midwifery). Completion of a Portfolio Evaluation Process (PEP) or a state licensure program also are considered. CPMs have to apply for recertification every three years.
- There are postgraduate midwifery programs (for graduates with a relevant degree who wish to become midwives), accredited by the Accreditation Commission for Midwifery Education (ACME), leading to the Certified Nurse Midwife (CNM) and Certified Midwife (CM) credentials, certified by the American Midwifery Certification Board (AMCB), that are at the level of a master's degree in midwifery (MSc Midwifery). CNMs and CMs have to apply for recertification every five years.
Midwives work with women and their families in many settings. They generally support and encourage natural childbirth in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state. Many states have birthing centers where a midwife may work individually or as a group, which provides additional clinical opportunities for student midwives.
CPMs practice as autonomous health professionals working within a network of relationships with other maternity care professionals who can provide consultation and collaboration when needed. They have particular expertise in out-of-hospital settings.
CNMs and CMs work in a variety of settings including private practices, hospitals, birth centers, health clinics, and home birth services. It is also possible for CNMs/CMs with entrepreneurial spirits to set up their own practices, establishing themselves as health care providers in the community of their choice.
- Midwives Alliance of North America (MANA).
- National Association of Certified Professional Midwives (NACPM).
- American College of Nurse-Midwives (ACNM).
- "International Definition of the Midwife". International Confederation of Midwives. Retrieved 2015.
- "Essential Competencies for Basic Midwifery Practice". International Confederation of Midwives (ICM). Retrieved 2015.
- Jim Campbell; et al. (2011). Fauveau, Vincent, ed. The State of the World's Midwifery 2011 – Delivering Health, Saving Lives (PDF). [New York]: United Nations Population Fund (UNFPA). p. 10. ISBN 978-0-89714-995-2. Retrieved 18 February 2014.
- Epstein, Abby (9 January 2008). "The Business of Being Born (film)". The New York Times. Retrieved 30 October 2009.
- "Global Standards for Basic Midwifery Education". International Confederation of Midwives (ICM). Retrieved 2015.
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- "Midwives Associations Worldwide". International Confederation of Midwives. Retrieved 2015.
- Pilkenton, Deanna; Schorn, Mavis N (February 2008). "Midwifery: A career for men in nursing". Men In Nursing.
- Gianno, Rosemary (2004). "'Women are not brave enough' Semelai male midwives in the context of Southeast Asian cultures". Bijdragen tot de Taal-, Land- en Volkenkunde 160 (1): 31–71. doi:10.1163/22134379-90003734.
- "Approved Programs of Study". Australian Health Practitioner Regulation Agency.
- "Australian College of Midwives (ACM)".
- Schroff, F. (1997). The New Midwifery. Toronto: Women's Press. ISBN 0-88961-224-2.
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- "Register of Current & Former Registrants". College of Midwives of British Columbia. Retrieved 12 November 2015.
- Canadian Institute for Health Information document titled, Number of Health Personnel in Selected Professions by Registration Status, 2006. This data has the following proviso, “Due to the variation in regulatory requirements, interprofessional comparison should be interpreted with caution.”
- "bcmidwives.com". bcmidwives.com. Retrieved 10 December 2012.
- "La formation initiale". Ordre des sages-femmes.
- "Ordre des sages-femmes".
- "Collège National des Sages-Femmes de France (CNSF)".
- "Pre-Registration Programmes". The Nursing and Midwifery Board of Ireland (NMBI).
- "Japanese Midwives Association" (in Japanese).
- "Japanese Midwives Association (JMA)".
- "Japan Academy of Midwifery (JAM)".
- "Japanese Nursing Association (JNA), Midwives' Division".
- PBS documentary Birth of a Surgeon
- "Midwifery in the Netherlands". The Royal Dutch Organisation of Midwives (KNOV):.
- "Fewer women give birth at home". CVZ,Central Bureau of Statistics.
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- "Obstetric Practice in the City of Groningen" (in Dutch).
- "Preconceptional care" (in Dutch).
- "Having a baby in the Netherlands".
- "Care package". CVZ, College for Healthcare Insurances.
- "Royal Dutch Organisation of Midwives - Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV)".
- "Where to Start... Becoming a Midwife". New Zealand College of Midwives.
- "New Zealand College of Midwives".
- "The Midwifery First Year of Practice Programme". New Zealand College of Midwives. Retrieved 2015.
- New Zealand Health Information Service: "Report on Maternity - Maternal and Newborn Information 2003."
- "Becoming a midwife". The Nursing and Midwifery Council.
- Midwifery Universities in the UK
- "Student Finance, Loans and Universities - GOV.UK". Direct.gov.uk. 1 September 2012. Retrieved 10 December 2012.
- "Care of Healthy Women and Their Babies During Childbirth". National Collaborating Centre for Women's and Children's Health. National Institute for Health and Care Excellence. December 2014. Retrieved 21 December 2014.
- "Career Profile: Community Midwife - Royal College of Midwives". Rcm.org.uk. Retrieved 10 December 2012.
- "Threat to Independent Midwifery". BBC News. 10 March 2007. Retrieved 10 December 2012.
- "Royal College of Midwives (RCM)".
- "Independent Midwives UK (IMUK)".
- "Association of Radical Midwives (ARM)".
- "Comparison of professional midwifery credentials in the U.S.". American Midwifery Certification Board (AMCB). Retrieved 2015.
- "Midwifery Education Accreditation Council (MEAC)". Retrieved 2015.
- "The CPM Credential". National Association of Certified Professional Midwives (NACPM). Retrieved 2015.
- "North American Registry of Midwives (NARM)".
- "The Credentials CNM and CM". American College of Nurse-Midwives (ACNM). Retrieved 2015.
- "American Midwifery Certification Board (AMCB)".
- "Midwifery State-by-State Legal Status". Mana.org. Retrieved 21 November 2015.
- "Birth Center Regulations | American Association of Birth Centers". Birthcenters.org. Retrieved 10 December 2012.
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- "National Association of Certified Professional Midwives (NACPM)".
- "American College of Nurse-Midwives (ACNM)".
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