Go Back | PDF Download

This document is an archived version of

Core Competencies for Basic Nurse-Midwifery Practice - February 1992

The information contained within this document does not necessarily reflect the current positions or policies of the American College of Nurse-Midwives, however it is provided as a public service for the purpose of research. The current version of this document is: Core Competencies For Basic Midwifery Practice - May 2002 and may be found at www.midwife.org.

Core Competencies for Basic Nurse-Midwifery Practice - February 1992

Nurse-midwifery education is based upon theoretical preparation in the sciences and clinical preparation for the judgment and skills necessary for management of the care of women and newborns. The care as defined by the American College of Nurse-Midwives (ACNM) includes antepartum, intrapartum, postpartum, neonatal, family planning and well woman gynecology, and occurs within a health care system that provides for collaboration (co-management) and referral. Nurse-midwifery practice is based on these Core Competencies, the Standards for the Practice of Nurse-Midwifery and the ACNM Code of Ethics. Nurse-midwives assume responsibility and accountability for practice by applying their knowledge and skills in a process for clinical decision-making: the management process.

Core competencies delineate the fundamental knowledge, skills, and behaviors expected of a new graduate. Because nurse-midwifery practice continues to be a dynamic and changing discipline, these core competencies are presented as guidelines only for educators, students, physicians and other professionals, consumers, and employers of nurse-midwives. The guidelines will continue to evolve with the practice of nurse-midwifery. The concepts and skills identified below and the aspects of the nurse-midwifery management process outlined in the following sections apply to all components of nurse-midwifery care. This document must therefore be used in its entirety.

Because creativity and individuality in nurse-midwifery education are essential to the vitality of the profession, educational programs are encouraged to be innovative. Each program will develop its own characteristics and may extend into other areas of health care. Each graduate is responsible for practicing in accordance with state laws and institutional protocols. Core competencies remain, however, as the basic requisites for the graduate of any educational program.

Certain concepts and skills from the social sciences and public health permeate all aspects of nurse-midwifery practice. The following have been identified:

1. Promotion of family centered care.
2. Facilitation of healthy family and interpersonal relationships.
3. Constructive use of communication and of guidance and counseling skills.
4. Communication and collaboration with other members of the health team.
5. Provision of health education.
6. Promotion of continuity of care.
7. Use of appropriate community resources.
8. Promotion of health and prevention of disease throughout the life cycle.
9. Recognition of pregnancy as a normal physiologic and developmental process.
10. Advocacy for informed choice and decision making.
11. Consideration of bioethical issues related to women's health.
12. Knowledge of and respect for cultural variations.

Nurse-Midwifery Management

The process for nurse-midwifery management of care has three aspects: primary management, collaborative management (co-management), and referral of management. Implicit in this process is timely action and the documentation of all its aspects.

I. Primary Management

A. Systematically obtains or updates a complete and relevant data base for assessment of the client's health status.

B. Accurately identifies problems and diagnoses based upon correct interpretation of the data base.

C. Delineates health care goals and formulates and communicates a complete needs/problems list in collaboration with the woman.

D. Identifies need for consultation with or referral to appropriate members of the health care team.

E. Provides information and support to enable women to make appropriate decisions and to assume appropriate responsibility for their own health.

F. Develops a comprehensive plan of care with the woman based on supportive rationale.

G. Assumes direct responsibility for implementing the plan of care.

H. Initiates management of deviation from normal, including emergencies and specific complications.

I. Evaluates, with the woman, the achievement of health care goals and modifies the plan of care accordingly.

II. Collaboration (Co-Management)

A. Identifies problems and related complications requiring consultation and collaboration (co-management).

B. Obtains consultation. Plans and implements collaborative management (co-management) with other providers.

C. Continues management of midwifery aspects of care.

D. Serves as consultant or co-manager for other providers.

III. Referral

A. Identifies the need for comprehensive management and care outside the scope of practice.

B. Selects appropriate sources of care in collaboration with the woman.

C. Transfers the care of the client as appropriate.

Components Of Nurse-Midwifery Care

Implicit in a nurse-midwifery knowledge base is the ability to perform skills pertinent to each of the outlined areas of practice.

I. Preconception Care

A. Assumes responsibility for management of care of the woman who is preparing for pregnancy.

B. Uses a foundation for nurse-midwifery practice that includes but is not limited to the knowledge of:

1. Female and male reproductive anatomy and physiology related to conception.
2. Health history, family history and relevant genetic history.
3. Health and laboratory screening to evaluate the potential for a healthy pregnancy.
4. Assessment of emotional, psychosocial, sexual status and readiness for pregnancy of the woman and her support system.
5. Nutritional assessment and counseling.
6. Influence of environmental and occupational factors, health habits and behavior on pregnancy planning.

II. Antepartum Care

A. Assumes responsibility for management of care of the pregnant woman.

B. Uses a foundation for nurse-midwifery practice that includes but is not limited to the knowledge of:

1. Female anatomy and physiology.
2. Anatomy and physiology of conception, pregnancy, and lactation.
3. Clinical application of genetics, embryology, and fetal development.
4. Diagnosis of pregnancy.
5. Assessment of the emotional status of the woman and of her support system.
6. Common screening/diagnostic tests used during pregnancy.
7. Indicators of normal pregnancy.
8. Causes of maternal morbidity and mortality.
9. Indicators of risk and complications in pregnancy and appropriate interventions.
10. Parameters and methods for assessing the progress of pregnancy.
11. Parameters and methods for assessing fetal well-being.
12. Nutritional assessment and counseling of the pregnant woman.
13. The influence of environmental and occupational factors, health habits and maternal behaviors on the family.
14. The etiology and management of common discomforts of pregnancy.
15. Pharmacokinetics of medications commonly used during pregnancy.
16. Prescription of medications and treatments.
17. Psychosocial, emotional, sexual changes during pregnancy.
18. Planning and implementation of individual and/or group education.
19. Counseling on the physical and emotional changes of pregnancy; preparation for birth, lactation, parenthood and change in the family constellation.

III. Intrapartum Care

A. Assumes responsibility for management of care of the woman and fetus during the intrapartum period.

B. Uses a foundation for nurse-midwifery practice that includes but is not limited to the knowledge of:

1. Anatomy and physiology of normal and abnormal labor processes through the four stages.
2. Anatomy of the fetal skull and its critical landmarks.
3. Parameters and methods for assessing progress of labor through the four stages.
4. Parameters and methods for assessing maternal and fetal status.
5. Common screening/diagnostic tests used during labor.
6. Emotional changes during labor and delivery.
7. Physical and emotional support measures used during labor and birth.
8. Pharmacokinetics of medications commonly using during labor and birth, including effects on mother and fetus.
9. Prescription or administration of appropriate medications/solutions during labor and birth.
10. Techniques for administration of local and pudendal anesthesia.
11. Techniques for spontaneous vaginal delivery.
12. Indicators of deviations from normal and appropriate interventions.
13. Diagnosis and assessment of labor and its progress through the four stages.
14. Techniques for management of abnormal birth events.
15. Anatomy, physiology, and indicators of normal adaptation of newborn to extrauterine life.
16. Techniques for placental expulsion.
17. Techniques for performance and repair of episiotomy and repair of lacerations.

IV. Postpartum Care

A. Assumes responsibility for management of care of the woman during the postpartum period.

B. Uses a foundation for nurse-midwifery practice that includes but is not limited to the knowledge of:

1. Anatomy and physiology of the puerperium, including the involutional process.
2. Anatomy and physiology of lactation and methods for its facilitation or suppression.
3. Parameters and methods for assessing the puerperium.
4. Emotional, psychosocial, and sexual changes of the puerperium.
5. Etiology and methods for managing discomforts of the puerperium.
6. Common screening/diagnostic tests used during the puerperium.
7. Indicators of deviations from normal and appropriate interventions.
8. Pharmacokinetics of medications commonly used during the puerperium.
9. Prescription or administration of appropriate medications, treatments and solutions.
10. Appropriate anticipatory guidance regarding self-care, infant care, family planning, and family relationships.

V. Neonatal Care

A. Assumes responsibility for management of care of the neonate.

B. Uses a foundation for nurse-midwifery practice that includes but is not limited to the knowledge of:

1. Anatomy and physiology of adaptation to extrauterine life and stabilization of the neonate.
2. Parameters and methods for assessing neonatal status, including emotional and psychosocial needs.
3. Parameters and methods for assessing gestational age of the neonate.
4. Nutritional needs of the neonate.
5. Indicators of deviations from normal and appropriate intervention.
6. Screening/diagnostic tests performed on the neonate.
7. Pharmacokinetics of medications commonly used for the neonate.
8. Prescription of medications and treatments.
9. Methods to facilitate adaptation to extrauterine life including resuscitation and emergency care of the newborn.
10. Factors influencing neonatal behavior and parental interaction.

VI. Family Planning/Gynecological Care

A. Assumes responsibility for management of care of women seeking family planning and/or gynecologic services.

B. Uses a foundation for nurse-midwifery practice that includes but is not limited to the knowledge of:

1. Anatomy and physiology of the reproductive systems through the life cycles.
2. Anatomy and physiology of the female breast.
3. Anatomy, physiology, and psychosocial components of human sexuality.
4. Provision of counseling regarding general health promotion.
5. Common screening and diagnostic tests.
6. Factors relating to barrier, steroidal, mechanical, chemical, physiologic, and surgical conception control methods, including:
   a. Rationale for use.
   b. Contraindications to use.
   c. Effectiveness rates.
   d. Mechanisms of action.
   e. Advantages/disadvantages.
   f. Risks/side effects/complications.
   g. Comparative cost.
   h. Instructions/counseling.
   i. Psychological and sexual considerations.
   j. Provision of appropriate method.
   k. Discontinuation or change of method.
7. Indicators of developmental changes of women throughout the life cycle and health promotion measures specific to these changes.
8. Indicators of problems of sexuality, methods for counseling, and indications for consultation or referral.
9. Factors involved in decision making regarding unplanned or undesired pregnancies and resources for counseling and referral.
10. Indicators of deviations from normal, risk factors, and appropriate preventive measures and interventions for selected pathology.

VII. Professional Aspects

Assumes the role and professional responsibilities of nurse-midwifery practice. As a leader or change agent, the nurse-midwife demonstrates:

1. Knowledge of the historical development of nurse-midwifery in the U.S., structure and function of the American College of Nurse-Midwives, and the legal base for nurse-midwifery practice.
2. Knowledge of contemporary issue and trends in maternal-child health care nationally and internationally.
3. Knowledge of standards for quality maternal and child health services.
4. Knowledge of current and pending health legislation.
5. Knowledge of the role and responsibilities of the nurse-midwife in supporting legislative contributions to high-quality maternal and child health services.
6. Knowledge of the various nurse-midwifery practice options and the resources available for their development and evaluation.
7. The ability to carry out the philosophy of the American College of Nurse-Midwives.
8. Respect for the dignity and rights of health care providers and clients.
9. Responsibility and accountability for:
   a. Personal management decisions made in caring for clients.
   b. Periodic self-evaluation and participation in peer review to maintain currency in practice.
   c. Delivery of services to families in collaboration with other health care providers.
10. The ability to evaluate, apply and collaborate in research.
11. Awareness of the professional responsibility to participate in nurse-midwifery education.

Source: Education Committee

Approved by the ACNM Board of Directors, February 3, 1992

(Supersedes ACNM Core Competencies in Nurse-Midwifery, May 1985)