It is important to distinguish the different midwives who serve women in this state. The “alphabet soup” of initials can be difficult to navigate and understand. I hope the information provided below aids with clarity:
- Certified Nurse Midwives (CNMs) have completed nursing school, and most have experience providing inpatient hospital care to Labor and Delivery patients. They have additionally completed a Master’s Degree in Certified Nurse Midwifery, which includes intense didactic and clinical training. Most clinical trainings sites are hospital-based, although a lucky few have obtained some training in an out-of-hospital setting such as a birth center. In South Carolina, they work under the direct supervision of a physician, who oversees the protocols they are permitted to follow within the South Carolina Nurse Practice Act for Advanced Nurses. They generally have prescriptive authority(they can write prescriptions) and can admit patients to the hospital(s) within the community, where their supervisory physician also has privileges. There are a few CNMs in Charleston who own and operate our local birth center, but the vast majority of the CNMs in South Carolina attend births within a hospital setting. To my knowledge, none attend home births in SC.
- Licensed Midwives, Certified Professional Midwives (LMs, CPMs): have completed the clinical and didactic training established by the South Carolina Department of Health and Environmental Control (DHEC) Regulation 61-24 After completion of the requirements for CPM certification, including a full apprenticeship and skills verification, a nationally-standardized written exam is administered (NARM). Once this is passed, the CPM may apply for a license to practice midwifery from DHEC. LMs practice within a “consulting relationship” with an obstetrician or CNM, who sees LM clients for 2 visits during the pregnancy to ensure she is appropriate for midwifery care. The consultant is available for any problems that may arise as well. Even in the healthiest pregnancy, a surprise may present that warrants a prescription for medication, such as a raging Urinary Tract Infection, and of course, this always happens on a Friday afternoon
LMs only attend out-of-hospital births; most of the birth centers run outside the LowCountry are operated by Licensed Midwives. The remainder of us attend home births exclusively. We are the experts in normal, out-of-hospital birth in our fine state! - Unlicensed, or “lay” midwives”: Midwives who attend births who have chosen, for a variety of reasons, not to obtain a license from DHEC. They frequently offer services to women who are seeking care for variations in normal pregnancy that LMs are not permitted to attend due to Regulation 61-24. Most commonly,their clients are women seeking Vaginal Birth After Cesarean (VBAC), breech babies, and twins. There is no method to validate any education obtained. Some are highly skilled professionals with years of experience; others read a few books and call themselves a midwife. Many are somewhere in the middle.
- Finally, there are 2 or 3 like me! I am a Registered Nurse with a Bachelor’s Degree in Nursing, and decided to become a Licensed Midwife. This does not make me a CNM, since I have not (nor do I plan to) attained the Masters’ Degree required for that title. I am perfectly happy within my role.
If there are any questions I might answer about the differences in provider types in South Carolina, please contact me. I am happy to fill in the blanks.
