Three Rivers Midwifery Service, PLLC
Cindi Wylie, CNM
Heather Murray, CNM
Supporting Gentle Birth in Hampton Roads
Education and Training
Nurse-midwives are registered nurses with additional education in midwifery and women's health. A graduate degree (master's or doctoral) is required for entry into practice. Education programs are accredited by the Accreditation Commission for Midwifery Education. Education generally consists of rigorous didactic and clinical training.
Certification and Licensure
Nurse-midwives must graduate from an accredited midwifery program and pass a national certification exam in order to be certified by the American Midwifery Certification Board. This certification (CNM) is nationally recognized and CNMs are licensed to practice and prescribe in all 50 states. Each state regulates the license of nurse-midwives independently. In Virginia, CNMs are licensed as Advanced Practice Nurses (APRNs). They may practice independently within their full scope of practice as defined by the American College of Nurse-Midwives (ACNM) with a physician agreement for consultation when the need arises.
Scope of Practice
"Midwifery as practiced by certified nurse-midwives (CNMs) encompasses a full range of primary health care services for women from adolescence beyond menopause. These services include primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth and the postpartum period, care of the normal newborn during the first 28 days of life, and treatment of male partners for sexually transmitted infections. Midwives provide initial and ongoing comprehensive assessment, diagnosis and treatment. They conduct physical examinations; prescribe medications including controlled substances and contraceptive methods; admit, manage and discharge patients; order and interpret laboratory and diagnostic tests and order the use of medical devices. Midwifery care also includes health promotion, disease prevention, and individualized wellness education and
counseling. These services are provided in partnership with women and families in diverse settings such as ambulatory care clinics, private offices, community and public health systems, homes, hospitals and birth centers." -- ACNM, 2011
The state of Virginia recognizes the above as the scope of practice of a CNM. As such, I am able to provide independent care to low-risk women. If complications develop, I will work in consultation and/or collaboration with a physician or provide a referral for care that is out of my scope of practice or practice setting. We are able to prescribe and carry prescriptions medications, including (but not limited to) antibiotics, anti-hemorrhagics, oxygen, Vitamin K, erythromycin eye ointment, and IV fluids.
Shared Decision Making
Nurse-midwifery care embraces the idea that a woman has a right to her autonomy. In keeping with this philosophy, decisions about your care will be made collaboratively. In shared decision making, the midwife presents clinical evidence and may offer recommendations. You and your family then discuss the information and consider your personal family values and preferences before making decisions. This fosters thoughtfulness, individualized care, and encourages personal responsibility.
Philosophy of Care
"We, the midwives of the American College of Nurse-Midwives, affirm the power and strength of women and the importance of their health in the well-being of families, communities and nations. We believe in the basic human rights of all persons, recognizing that women often incur an undue burden of risk when these rights are violated.
We believe every person has a right to:
Equitable, ethical, accessible quality health care that promotes healing and health
Health care that respects human dignity, individuality and diversity among groups
Complete and accurate information to make informed health care decisions
Self-determination and active participation in health care decisions
Involvement of a woman's designated family members, to the extent desired, in all health care experiences
We believe the best model of health care for a woman and her family:
Promotes a continuous and compassionate partnership
Acknowledges a person's life experiences and knowledge
Includes individualized methods of care and healing guided by the best evidence available
Involves therapeutic use of human presence and skillful communication
We honor the normalcy of women's lifecycle events. We believe in:
Watchful waiting and non-intervention in normal processes
Appropriate use of interventions and technology for current or potential health problems
Consultation, collaboration and referral with other members of the health care team as needed to provide optimal health care
We affirm that midwifery care incorporates these qualities and that women's health care needs are well-served through midwifery care.
Finally, we value formal education, lifelong individual learning, and the development and application of research to guide ethical and competent midwifery practice. These beliefs and values provide the foundation for commitment to individual and collective leadership at the community, state, national and international level to improve the health of women and their families worldwide." -- ACNM, 2017