The midwife as first assistant for cesarean section.
Across the United States, midwives have expanded their role to include serving as first assistants at cesarean sections. An American College of Nurse-Midwives (ACNM) Position Statement adopted in 1998 recognizes the practice as a "frequently-performed advanced midwifery practice skill." Workshops have been offered nationally in 1997, 1998, 2000, and 2001 as well as locally in some states to educate and guide the midwife in completing the didactic and clinical preparation. Yet, there is a dearth of published literature on the subject. This article reviews the evolution of the role from its origins in perioperative nursing, including the requirements for the Registered Nurse First Assistant as established by the Association of peri-Operative Registered Nurses that are referenced in the regulations of several states in regard to the practice of midwives as surgical assistants. The authors report the results of a survey of state regulatory agencies that reveals a wide variation in laws, regulations, and interpretations ranging from statutory acceptance to prohibition with suggestions on how to effect needed change. This article also includes a process for credentialing that is consistent with the ACNM "Guidelines for the Incorporation of New Procedures into Midwifery Practice." The importance of documentation of the educational and credentialing process from a medico-legal perspective is stressed.
Moes
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The MacDonald Midwifery Service at University Hospitals of Cleveland, Ohio, USA.
Thacher
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D002585:Cesarean Section / Q000451:nursing*; D002983:Clinical Competence; D003406:Credentialing; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008880:Midwifery / Q000592:standards*; D009721:Nurse Midwives / Q000592:standards*; D010823:Physician Assistants / Q000592:standards; D011247:Pregnancy; D014481:United States