A Certified Nurse Midwife, or CNM, is a licensed nurse (RN) with special training and certification to deliver healthcare for pregnancy, childbirth, the postpartum period, and routine reproductive health issues. There are nearly 12,000 Certified Nurse Midwives in the United States who are accredited by the American College of Nurse Midwives (ACNM). Some midwives bear the credential CPM or Certified Practicing Midwife, a less common pathway that does not require a college education or nursing degree. In general, midwives ascribe to the philosophy that birth is a natural process rather than a “medical condition,” and they seek to provide physical and psychological care to mothers throughout all stages of childbearing. Contrary to popular belief, Certified Nurse Midwives perform the majority of newborn deliveries in accredited hospitals; only 3% of midwife-attended births occur in homes. While CNMs have full prescribing authority and can attend to most issues surrounding normal birth, they do not handle high-risk pregnancies and they cannot attend to complications that arise during delivery such as the need to perform Caesarian section. As a result, most CNMs have access to OB-GYN specialists on an as-needed basis, with whom they consult immediately when problems arise.
Midwife expert witnesses are required to address standard of care in a number of situations in medical malpractice litigation. The most common allegations against Midwives involve failing to recognize high-risk pregnancy, lack of informed consent regarding safety, delay in recognizing warning signs of complicated birth, and failure to seek advanced care for emergency delivery. Untoward outcomes can include cerebral palsy, brachial plexus injuries, stillbirth, hypoxic encephalopathy, and postpartum hemorrhage. For issues involving harm and causation, some Midwifery cases require experts from the fields of OB-GYN, Maternal-Fetal Medicine, Neonatology, and other areas.