CNMs and CMs

Midwifery practice as conducted by CNMs and CMs is the independent management of women’s health care, focusing particularly on common primary care issues, family planning and gynecologic needs of women, pregnancy, childbirth, the postpartum period, and care of the newborn. The practice occurs within a health care system that provides for consultation, collaborative management, or referral as indicated by the health status of the woman or newborn. The CNM is a registered nurse who has completed a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and passed a national certification examination administered by the American Midwifery Certification Board to receive the professional designation of CNM. Programs leading to the CM credential require specific health and science courses prior to entry. CMs are educated in the discipline of midwifery and complete a midwifery education program accredited by ACME, and pass the same national certification examination as CNMs to receive the professional designation of CM. Midwifery education programs leading to the CNM and CM credentials involve graduate education. (American College of Nurse Midwives: www.midwife.org )

Nurse practitioners

Nurse practitioners (NPs) are licensed, independent practitioners who practice in ambulatory, acute, and long-term care as primary and/or specialty care providers. They provide nursing and medical services to individuals, families, and groups accordant with their practice specialties. Services include ordering, conducting, supervising, and interpreting diagnostic and laboratory tests, prescribing pharmacological agents and nonpharmacologic therapies, and teaching and counseling patients, among others. As licensed, independent clinicians, NPs practice autonomously and in collaboration with health care professionals and other individuals. NPs are advanced practice nurses–health care professionals who have achieved licensure and credentialing well beyond their roles as registered nurses. All NPs obtain graduate degrees. Didactic and clinical courses provide NPs with specialized knowledge and clinical competency, which enable them to practice in primary, acute, and long-term care settings. Self-directed continued learning and professional development are hallmarks of NP education. The women’s health NP is an advanced practice NP who is prepared through academic and clinical study to provide health care, with an emphasis on reproductive-gynecologic and well-woman health, to women throughout the life span. (American Association of Nurse Practitioners: www.aanp.org ; Association of Women’s Health, Obstetric and Neonatal Nurses: www.awhonn.org; The National Association of Nurse Practitioners in Women’s Health: www.npwh.org )

Physician assistants

A physician assistant (PA) is educated at the graduate level and the majority of PA programs require a bachelors degree, prerequisite science courses, and health care experience prior to acceptance into a PA program. All PAs are required to pass a national certifying exam and be licensed by the governing board in the state where they practice. Once certified and licensed, PAs must also earn continuing education credits, including self-assessment and performance improvement activities, to maintain certification and licensure. PAs are trained and certified in the primary care model as generalists and during the final year of training, all PA students must complete a variety of clinical rotations, including a rotation in obstetrics and gynecology. Within that model, there is room for expertise in women’s health and obstetric care. Individual PA duties are dependent on the scope of their individual supervising physician’s practice and the desire of the physician to delegate certain tasks or responsibilities in obstetric care. (Association of Physician Assistants in Obstetrics and Gynecology: www.paobgyn.org )

Family physicians

Family medicine is the medical specialty that provides continuing and comprehensive health care for the individual and family. It is a specialty that, in its breadth, integrates the biological, clinical, and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system, and every disease entity. The specialty of family medicine is the result of the evolved and enhanced expression of general medical practice and is uniquely defined within the family context.

The family physician is a physician who is educated and trained in family medicine–a broadly encompassing medical specialty. Family physicians possess unique attitudes, skills, and knowledge that qualify them to provide continuing and comprehensive medical care, health maintenance, and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. (American Academy of Family Physicians: www.aafp.org )

Obstetrician-gynecologists

The specialty of obstetrics and gynecology is devoted to the health care of women throughout their lifetime. It encompasses care of the whole patient in addition to focusing on the normal and abnormal processes of the female reproductive system, including the breast. Care provided by the obstetrician-gynecologist includes preventive and primary care, care during pregnancy and childbirth, and medical and surgical management of reproductive-related disorders and diseases. Obstetrician-gynecologists are specialists in obstetrics and gynecology and serve as both primary and consultant physicians to women. Although some, like physicians of the other designated primary care specialties, may choose to provide consultant care only. (American Congress of Obstetricians and Gynecologists: www.acog.org )

Obstetric-gynecologic hospitalist

An obstetric care provider who provides on-site coverage for a labor and delivery unit is referred to as a hospitalist. During the time of coverage, the obstetric-gynecologic hospitalist has no office practice–based responsibility. Several models of hospitalist care exist including community provider models utilizing local obstetricians to provide shared 24-hour on-site labor unit presence, full-time models of physicians without an office practice who solely cover a labor and delivery unit when working, or models that have a hybrid approach. Hospitalist models vary with a spectrum of care responsibilities with minimalist models of care involving coverage of emergencies for other private obstetric providers and provision of care to women with no prenatal care, to full-service hospitalists who provide care for all obstetrical interventions routinely and work in conjunction with the patient’s personal obstetrician; such hospitalists may function as the delivering obstetrician. In some models, the hospitalist may collaborate with the MFM subspecialist and perform some or all of the MFM subspecialists’ deliveries. (Society of OB/GYN Hospitalists: www.obgynhospitalist.com )

MFM subspecialist

The MFM subspecialist is an obstetrician-gynecologist who has completed 2-3 years of additional formal education and clinical experience within an ABOG-approved MFM fellowship program and is eligible for or certified by ABOG as having a special competency in: (1) the diagnosis and treatment of women with complications of pregnancy; (2) preexisting medical conditions that may be impacted by pregnancy; and (3) medical conditions that impact the pregnancy itself. In addition, the AOBOG confers subspecialty certification in MFM to physicians who have primary certification in obstetrics and gynecology, successfully completed a 3-year fellowship and research requirements, and passed the subspecialty clinical examination. MFM subspecialists have the specific training and experience needed to perform complex diagnostic and therapeutic procedures during pregnancy that can involve the fetus and/or mother, such as targeted ultrasound or fetal intravascular transfusions. The MFM subspecialist requires advanced knowledge of the obstetrical, medical, surgical, obstetric, fetal, and genetic complications of pregnancy and their effects on both the mother and fetus. Advanced knowledge of neonatal adaptation is also necessary to ensure a continuum of care from the fetal to the neonatal periods.

As with other obstetric care providers, the MFM subspecialist also provides education and research within the field concerning the most recent approaches and treatments for obstetrical problems. The MFM subspecialist can help promote and deliver optimal and evidence-based care for these complicated pregnancies. (Society for Maternal-Fetal Medicine; www.smfm.org )

CNMs and CMs

Midwifery practice as conducted by CNMs and CMs is the independent management of women’s health care, focusing particularly on common primary care issues, family planning and gynecologic needs of women, pregnancy, childbirth, the postpartum period, and care of the newborn. The practice occurs within a health care system that provides for consultation, collaborative management, or referral as indicated by the health status of the woman or newborn. The CNM is a registered nurse who has completed a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and passed a national certification examination administered by the American Midwifery Certification Board to receive the professional designation of CNM. Programs leading to the CM credential require specific health and science courses prior to entry. CMs are educated in the discipline of midwifery and complete a midwifery education program accredited by ACME, and pass the same national certification examination as CNMs to receive the professional designation of CM. Midwifery education programs leading to the CNM and CM credentials involve graduate education. (American College of Nurse Midwives: www.midwife.org )

Nurse practitioners

Nurse practitioners (NPs) are licensed, independent practitioners who practice in ambulatory, acute, and long-term care as primary and/or specialty care providers. They provide nursing and medical services to individuals, families, and groups accordant with their practice specialties. Services include ordering, conducting, supervising, and interpreting diagnostic and laboratory tests, prescribing pharmacological agents and nonpharmacologic therapies, and teaching and counseling patients, among others. As licensed, independent clinicians, NPs practice autonomously and in collaboration with health care professionals and other individuals. NPs are advanced practice nurses–health care professionals who have achieved licensure and credentialing well beyond their roles as registered nurses. All NPs obtain graduate degrees. Didactic and clinical courses provide NPs with specialized knowledge and clinical competency, which enable them to practice in primary, acute, and long-term care settings. Self-directed continued learning and professional development are hallmarks of NP education. The women’s health NP is an advanced practice NP who is prepared through academic and clinical study to provide health care, with an emphasis on reproductive-gynecologic and well-woman health, to women throughout the life span. (American Association of Nurse Practitioners: www.aanp.org ; Association of Women’s Health, Obstetric and Neonatal Nurses: www.awhonn.org; The National Association of Nurse Practitioners in Women’s Health: www.npwh.org )

Physician assistants

A physician assistant (PA) is educated at the graduate level and the majority of PA programs require a bachelors degree, prerequisite science courses, and health care experience prior to acceptance into a PA program. All PAs are required to pass a national certifying exam and be licensed by the governing board in the state where they practice. Once certified and licensed, PAs must also earn continuing education credits, including self-assessment and performance improvement activities, to maintain certification and licensure. PAs are trained and certified in the primary care model as generalists and during the final year of training, all PA students must complete a variety of clinical rotations, including a rotation in obstetrics and gynecology. Within that model, there is room for expertise in women’s health and obstetric care. Individual PA duties are dependent on the scope of their individual supervising physician’s practice and the desire of the physician to delegate certain tasks or responsibilities in obstetric care. (Association of Physician Assistants in Obstetrics and Gynecology: www.paobgyn.org )

Family physicians

Family medicine is the medical specialty that provides continuing and comprehensive health care for the individual and family. It is a specialty that, in its breadth, integrates the biological, clinical, and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system, and every disease entity. The specialty of family medicine is the result of the evolved and enhanced expression of general medical practice and is uniquely defined within the family context.

The family physician is a physician who is educated and trained in family medicine–a broadly encompassing medical specialty. Family physicians possess unique attitudes, skills, and knowledge that qualify them to provide continuing and comprehensive medical care, health maintenance, and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. (American Academy of Family Physicians: www.aafp.org )

Obstetrician-gynecologists

The specialty of obstetrics and gynecology is devoted to the health care of women throughout their lifetime. It encompasses care of the whole patient in addition to focusing on the normal and abnormal processes of the female reproductive system, including the breast. Care provided by the obstetrician-gynecologist includes preventive and primary care, care during pregnancy and childbirth, and medical and surgical management of reproductive-related disorders and diseases. Obstetrician-gynecologists are specialists in obstetrics and gynecology and serve as both primary and consultant physicians to women. Although some, like physicians of the other designated primary care specialties, may choose to provide consultant care only. (American Congress of Obstetricians and Gynecologists: www.acog.org )

Obstetric-gynecologic hospitalist

An obstetric care provider who provides on-site coverage for a labor and delivery unit is referred to as a hospitalist. During the time of coverage, the obstetric-gynecologic hospitalist has no office practice–based responsibility. Several models of hospitalist care exist including community provider models utilizing local obstetricians to provide shared 24-hour on-site labor unit presence, full-time models of physicians without an office practice who solely cover a labor and delivery unit when working, or models that have a hybrid approach. Hospitalist models vary with a spectrum of care responsibilities with minimalist models of care involving coverage of emergencies for other private obstetric providers and provision of care to women with no prenatal care, to full-service hospitalists who provide care for all obstetrical interventions routinely and work in conjunction with the patient’s personal obstetrician; such hospitalists may function as the delivering obstetrician. In some models, the hospitalist may collaborate with the MFM subspecialist and perform some or all of the MFM subspecialists’ deliveries. (Society of OB/GYN Hospitalists: www.obgynhospitalist.com )

MFM subspecialist

The MFM subspecialist is an obstetrician-gynecologist who has completed 2-3 years of additional formal education and clinical experience within an ABOG-approved MFM fellowship program and is eligible for or certified by ABOG as having a special competency in: (1) the diagnosis and treatment of women with complications of pregnancy; (2) preexisting medical conditions that may be impacted by pregnancy; and (3) medical conditions that impact the pregnancy itself. In addition, the AOBOG confers subspecialty certification in MFM to physicians who have primary certification in obstetrics and gynecology, successfully completed a 3-year fellowship and research requirements, and passed the subspecialty clinical examination. MFM subspecialists have the specific training and experience needed to perform complex diagnostic and therapeutic procedures during pregnancy that can involve the fetus and/or mother, such as targeted ultrasound or fetal intravascular transfusions. The MFM subspecialist requires advanced knowledge of the obstetrical, medical, surgical, obstetric, fetal, and genetic complications of pregnancy and their effects on both the mother and fetus. Advanced knowledge of neonatal adaptation is also necessary to ensure a continuum of care from the fetal to the neonatal periods.

As with other obstetric care providers, the MFM subspecialist also provides education and research within the field concerning the most recent approaches and treatments for obstetrical problems. The MFM subspecialist can help promote and deliver optimal and evidence-based care for these complicated pregnancies. (Society for Maternal-Fetal Medicine; www.smfm.org )