Background: CNM and CM Certification, 1971 to the Present
Certification by examination was initiated for CNMs in 1971. This function was performed by the ACNM Division of Examiners, and then by the Division of Competency Assessment. In keeping with the professional standard that certification functions should be separated from the membership organization, in 1991, the ACNM Certification Council, Inc. (ACC) was incorporated as a separate and independent organization. ACC was charged with managing CNM certification, including initial certification, recertification (certificate maintenance), and discipline. All certificates ever issued by ACNM prior to the formation of ACC were also transferred to ACC at that time. This marked the end of ACNM's activities in certification activities.
Until January 1996, CNM certificates were issued without expiration date and were referred to as "lifetime certificates." From 1986 through the end of 2010, ACNM maintained a Continuing Competency Assessment (CCA) Program as a mechanism for CNMs to demonstrate competency in the provision of care to women, newborns and their families. While participation in the CCA program was originally mandatory, it has been voluntary, since the mid-1990s, except in states that require CCA participation. CNMs would enroll for a five-year CCA cycle; at the end of five years they would turn in a self-reporting form to ACNM listing the continuing education activities or other eligible activities that they had been involved during the five year period. ACNM would audit a small sample of these self-reporting forms each year to verify accuracy.
CNMs who obtained their initial certification after January 1, 1996, were issued a time-limited certificate by ACC. CNMs with time-limited certificates were required to participate in ACC's Competency Maintenance Program (CMP) on an eight-year cycle. In 1998, the ACC began offering CM certification. The requirements for initial certification and certification maintenance for CMs were identical to those of CNMs.
So, in essence, since 1996, there have been two different sets of requirements for CNMs, depending on their date of certification. If they were certified before 1996, they were not required to complete activities to maintain competency; if they were certified in 1996 or after, they were required to fulfill continuing education activities to maintain competency.
In 2005, ACC changed its name to American Midwifery Certification Board to clarify that the membership organization (ACNM) and the certifying body (AMCB) are two distinct organizations. Despite the name change from ACC to AMCB, the mission and goals of the organization remained the same: "to protect and serve the public by establishing and maintaining the certification standards for individuals educated in the profession of midwifery.”
In 2008, AMCB representatives met with the ACNM Board of Directors, providing information which clearly demonstrated that the persistence of lifetime certification posed risks to the credibility and stature of CNMs. Lifetime certification for health care providers was being challenged by consumers and regulatory agencies, and most health care professional organizations required certification cycles not longer than 5 years. Based on the data provided and our knowledge of the current policy environment and our vigorous activities to promote the midwifery profession, the ACNM Board supported AMCB's stated intentions to move to time-limited certification for all CNMs and CMs in active practice beginning January 2011, and the two organizations announced this change to the ACNM membership in 2008. Accordingly, at the end of 2010, ACNM discontinued its support of its CCA program.
"The Past, Present, and Future of Assessing Continuing Competency for Midwives, " by Mary Barger, CNM, MPH, PhD, Barbara Camune, CNM, WHNP, DrPH, Barbara Graves, CNM, MS, MPH, and Jacqueline Lamberto, MPHpublished in September/October 2009 Journal of Midwifery & Women's Health, further describes AMCB's rationale for this change.