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ACNM Ultrasound Education

Ellen Margles, CNM
The scope of midwifery practice may be expanded beyond the core competencies to incorporate additional skills and procedures that improve care for women and their families. The performance of ultrasound examinations is one skill which can be integrated into midwifery care according the expansion of practice guidelines outlined in Standard VIII of the Standards for the Practice of Midwifery (ACNM, 2011).

In 1996, ACNM published the first clinical bulletin providing guidelines for midwives who expressed an interest in incorporating third trimester ultrasound examinations into their clinical practice. The document was retired in 2009 yet clinical practice has changed in that many midwives are now adding all trimesters of ultrasound examination and gynecologic ultrasound to their clinical practice (ACNM Survey, 2010). ACNM published an updated position statement in 2012 titled “Midwives’ Performance of Ultrasound in Clinical Practice." The statement reviews scope of practice, expansion of practice beyond the core competencies, avenues for practice expansion, reimbursement, licensing and regulation. The statement posits “With appropriate additional training as outlined by ACNM, AIUM, ACOG or AWHONN, midwives may perform ultrasound examinations within the scope of midwifery practice. It is not necessary for midwives to achieve competency in all types of ultrasound; they may tailor their education and training to the specific type of ultrasound examination(s) they wish to perform.”

Expanded guidelines for the performance of all types of obstetric ultrasounds have been published and updates maintained by three professional organizations: The American Institute of Ultrasound in Medicine (AIUM), the American College of Obstetricians and Gynecologists (ACOG), and the Association of Women’s Health, Obstetric, and Neonatal Nursing (AWHONN).

In August of 2013, a survey was presented to all ACNM members to determine clinician demand. The results of the survey validated a call for action as evidenced in the following:

  • 91% of respondents agreed that there is a need for the development of a credential/certificate examination in women's health ultrasound.

  • 95% of those in favor of a credential/certificate believe that improved patient care would be the biggest benefit to the midwife community.

  • 83% of respondents said they would be interested in obtaining a credential/certificate examination in women's health ultrasound.

  • Of these, only 9% felt that their current level of knowledge would be sufficient to take a credentialing/certification examination in ultrasound.

Midwives who wish to incorporate ultrasound examinations into their scope of clinical practice should have the appropriate education and training, acquire the necessary skills, and demonstrate the specific competencies to master the studies they perform. With the appropriate training as outlined by ACNM, AIUM, ACOG or AWHONN, midwives may perform ultrasound examinations within the scope of midwifery practice. As nurses, midwives, and nurse practitioners take on more responsibility in providing first-line care to women, the need to incorporate sophisticated technology as an adjunct to clinical assessment has become greater (ACNM, 2010, 2011).

The ACNM New Mexico Affiliate has developed a toolkit to guide members on expanding their practice following Standard VIII of the ACNM Standards for the Practice of Midwifery.

Ultrasound Education Task Force

In 2013, the ACNM Board of Directors approved the formation of a joint task force with the American Registry for Diagnostic Medical Sonography (ARDMS) to explore how best to support midwives’ ability to become credentialed and reimbursed for performing ultrasound. Learn more.










American College of Nurse-Midwives.
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