ACNM Core Competencies for Basic Midwifery Practice

Approved March 20, 2020

The Core Competencies for Basic Midwifery Practice include the fundamental

knowledge, skills, and abilities expected of new midwives certified by the American

Midwifery Certification Board (AMCB). They serve as guidelines for educators,

students, health care professionals, consumers, employers, and policymakers. The Core

Competencies constitute the basic requisites for graduates of all midwifery education

programs pre-accredited or accredited by the Accreditation Commission for Midwifery

Education (ACME). They are inclusive of the hallmarks of midwifery practice.

Midwifery practice is based on the Core Competencies for Basic Midwifery Practice, the

Standards for the Practice of Midwifery, the Philosophy of the American College of

Nurse-Midwives, and the Code of Ethics developed and disseminated by the American

College of Nurse-Midwives (ACNM). Midwives certified by the AMCB assume

responsibility and accountability for their practice as primary health care providers for the

individuals they serve as defined in the Definition of Midwifery and Scope of Practice of

Certified Nurse-Midwives and Certified Midwives.

ACNM defines the midwife’s role in primary health care based on the Institute of

Medicine’s report, Primary Care: America’s Health Care in a New Era,

the Philosophy

of the American College of Nurse-Midwives,

and the ACNM position statement,

“Midwives are Primary Care Providers and Leaders of Maternity Care Homes.”

Primary health care is the provision of integrated, accessible health care services by

clinicians who are accountable for addressing the majority of health care needs,

developing a sustained partnership with clients, and practicing within a context of family

and community. As primary health care providers, midwives certified by AMCB assume

responsibility for the provision of and referral to appropriate health care services,

including prescribing, administering, and dispensing of pharmacologic agents. The

concepts, skills, and midwifery management processes identified in the Core

Competencies form the foundation upon which practice guidelines and educational

curricula are built.

Midwives provide health care that incorporates appropriate consultation, collaborative

management, and/or referral, as indicated by the health status of the individual. ACNM

endorses that health care is most effective when it occurs in a system that facilitates

Approved March 20, 2020

communication across care settings and providers.

Individual education programs are

encouraged to develop their own methods to address health care issues beyond the scope

of the current Core Competencies. Each graduate is responsible for complying with the

ACNM Standards for the Practice of Midwifery and the laws of the jurisdiction where

they practice.

The basis of midwifery education includes an understanding of health science theory and

clinical preparation that provide a framework for the development of the necessary

clinical competence. The scope of midwifery practice may be expanded beyond the Core

Competencies to incorporate additional skills and procedures that improve care for the

individuals that midwives serve. Following the completion of basic midwifery education,

midwives may choose to expand their practice following the guidelines outlined in

Standard VIII of the Standards for the Practice of Midwifery.

Since 2012, ACNM has recognized the role of midwives in caring for transgender and

gender non-conforming (TGNC) individuals. The term “TGNC” is used in this document

as an umbrella term for all individuals whose gender expression and/or identity differs

from their sex assigned at birth.

Additionally, midwives are aware of the increased risks,

barriers to care, and disparities in health outcomes faced by many marginalized

communities due to systems of oppression and discrimination. Midwives work to

eliminate those obstacles and therefore need a thorough understanding of fundamental

concepts related to discrimination and oppression experienced by people of color,

women, individuals of diverse gender identities and sexual orientation, immigrants and

refugees, and people with disabilities in order to provide culturally safe care. As

midwives, we also recognize the threat of increasing maternal mortality, particularly for

women of color. The Core Competencies for Basic Midwifery Practice acknowledge the

basic and applied sciences, health systems and policy issues, and clinical skills that serve

as the fundamental mechanisms for the profession of midwifery to improve the status and

health care for all our clients.

Given this information, we consider the use of inclusive non-discriminatory language a

powerful tool that may be used to address inequities. We understand that individuals are

influenced by how they are perceived as well as how they identify. We have chosen to

use both gendered and gender-neutral terms to represent the full diversity of people who

experience pregnancy, birth, and lactation. We also acknowledge and support people who

are not childbearing, but are accessing sexual and/or reproductive health care. These

language choices were intended to ensure respect and visibility for all individuals --

including all people who identify as women as well as transgender, gender non-

conforming, and intersex individuals.

The Core Competencies for Basic Midwifery Practice are reviewed and revised regularly

to incorporate changing trends in midwifery practice. This document must be adhered to

in its entirety and applies to all settings where midwifery care is provided.

Approved March 20, 2020

I. Hallmarks of Midwifery

The art and science of midwifery are characterized by the following hallmarks:

A. Recognition, promotion, and advocacy of menarche, pregnancy, birth, and

menopause as normal physiologic and developmental processes

B. Advocacy of non-intervention in physiologic processes in the absence of

complications

C. Incorporation of evidence-based care into clinical practice

D. Promotion of person-centered care for all, which respects and is inclusive of

diverse histories, backgrounds, and identities

E. Empowerment of women and persons seeking midwifery care as partners in

health care

F. Facilitation of healthy family and interpersonal relationships

G. Promotion of continuity of care

H. Utilization of health promotion, disease prevention, and health education

I. Application of a public health perspective

J. Utilizing an understanding of social determinants of health to provide high-quality

care to all persons including those from underserved communities

K. Advocating for informed choice, shared decision making, and the right to self-

determination

L. Integration of cultural safety into all care encounters

M. Incorporation of evidence-based integrative therapies

N. Skillful communication, guidance, and counseling

O. Acknowledgment of the therapeutic value of human presence

P. Ability to collaborate with and refer to other members of the interprofessional

health care team

Q. Ability to provide safe and effective care across settings including home, birth

center, hospital, or any other maternity care service

II. Components of Midwifery Care

The professional responsibilities of midwives certified by AMCB include but are not

limited to the following components:

A. Promotion of the hallmarks of midwifery

B. Knowledge of the diverse history of midwifery

C. Knowledge of the legal basis for practice

D. Knowledge of national and international issues and trends in women's, TGNC,

perinatal, and neonatal care

E. Support for legislation and policy initiatives that promote quality health care

F. Knowledge of health disparities

G. Knowledge of issues and trends in health care policy and systems

H. Advocacy for health equity, social justice, and ethical policies in health care

I. Appropriate use of technology and informatics to improve the quality and safety

of health care

J. Broad understanding of the bioethics related to the care of women, TGNC

individuals, neonates, and families

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K. Practice in accordance with the ACNM Philosophy, Standards, and Code of

Ethics

L. Ability to evaluate, apply, interpret, and collaborate in research

M. Participation in self-evaluation, peer review, lifelong learning, and other activities

that ensure and validate quality practice

N. Development of critical thinking and leadership skills

O. Knowledge of certification, licensure, clinical privileges, and credentialing

P. Knowledge of practice management and finances

Q. Promotion of the profession of midwifery, including participation in the

professional organization at the local and national level

R. Support of the profession’s growth by understanding the importance of precepting

midwifery students and demonstrating basic teaching skills

S. Knowledge of the structure and function of ACNM

T. Ability to consult, collaborate, and refer with other health care professionals as

part of a health care team

III. Components of Midwifery Care: Midwifery Management Process

The midwifery management process guides all areas of clinical care. When engaging in

the management process, the midwife:

A. Obtains all necessary data for the complete evaluation of the client

B. Identifies problems or diagnoses and health care needs based on correct

interpretation of the subjective and objective data

C. Anticipates potential problems or diagnoses that may be expected based on the

identified risk factors

D. Evaluates the need for immediate intervention and/or consultation, collaborative

management, or referral to other health care team members as dictated by the

condition of the client

E. Develops a comprehensive evidence-based plan of care in partnership with the

client that is supported by a valid rationale, is based on the preceding steps, and

includes therapeutics as indicated

F. Assumes responsibility for the safe and efficient implementation of a evidenced-

based plan of care including the provision of treatments and interventions as

indicated

G. Evaluates effectiveness of the treatments and/or interventions, which includes

repeating the management process as needed

IV. Components of Midwifery Care: Fundamentals

Knowledge of the following subject areas is fundamental to the practice of midwifery:

A. Anatomy and physiology, including pathophysiology

B. Normal physical, psychological, emotional, social, and behavioral development,

including growth and development related to gender identity, sexual development,

sexuality, and sexual orientation

C. Reproductive and perinatal epidemiology and basic epidemiologic methods

relevant to midwifery practice

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D. Research and evidence-based practice

E. Nutrition and physical activity

F. Pharmacokinetics and pharmacotherapeutics

G. Principles of individual and group health education and counseling

H. Health care ethics

I. Clinical genetics and genomics

J. Diversity, equity, and inclusion

V. Components of Midwifery Care

Midwifery care includes the independent management of primary health screening, health

promotion, and the provision of care from adolescence through the lifespan as well as the

neonatal period using the midwifery management process. While each person’s life is a

continuum, midwifery care can be divided into primary, preconception,

gynecologic/reproductive/sexual health, antepartum, intrapartum, and post-pregnancy

care.

A. A midwife demonstrates the knowledge, skills, and abilities to provide primary care

of the individuals they serve, including but not limited to:

1. Applies nationally defined goals and objectives for health promotion and

disease prevention

2. Provides age-appropriate physical, mental, genetic, environmental, sexual, and

social health assessment

3. Utilizes nationally defined screening and immunization recommendations to

promote health and detect and prevent diseases

4. Applies management strategies and therapeutics to facilitate health and

promote healthy behaviors

5. Utilizes advanced health assessment skills to identify normal and deviations

from normal in the following systems:

a. Breast

b. Cardiovascular and hematologic

c. Dermatologic

d. Endocrine

e. Eye, ear, nose, oral cavity, and throat

f. Gastrointestinal

g. Genitourinary

h. Mental health

i. Musculoskeletal

j. Neurologic

k. Respiratory

l. Renal

6. Applies management strategies and therapeutics for the treatment of common

health problems and deviations from normal, including infections, self-limited

conditions, and mild and/or stable presentations of chronic conditions, utilizing

consultation, collaboration, and/or referral to appropriate health care services

as indicated

Approved March 20, 2020

7. Assesses for safety, including dysfunctional interpersonal relationships, sexual

abuse and assault, intimate partner violence, structural violence, emotional

abuse, and physical neglect

B. A midwife demonstrates the knowledge, skills, and abilities to provide

preconception care, including but not limited to:

1. Performs thorough evaluation including complete health history, dental history,

family history, relevant genetic history, and physical exam

2. Assesses individual and family readiness for pregnancy, including physical,

emotional, psychological, social, cultural, and sexual factors

3. Identifies and provides appropriate counseling and education related to

modifiable and non-modifiable risk factors, including but not limited to

immunization status, environmental and occupational factors, nutrition,

medications, mental health, personal safety, travel, lifestyle, family, genetic,

and genomic risk

4. Performs health and laboratory screenings

5. Counsels regarding fertility awareness, cycle charting, signs and symptoms of

pregnancy, pregnancy spacing, and timing of discontinuation of contraceptive

method

6. Addresses infertility, gamete banking, and assisted reproductive technology,

utilizing consultation, collaboration, and/or referral as indicated

C. A midwife demonstrates the knowledge, skills, and abilities to provide

comprehensive gynecologic/reproductive/sexual health care, including but not

limited to:

1. Understands human sexuality, including biological sex, intersex conditions,

gender identities and roles, sexual orientation, eroticism, intimacy, conception,

and reproduction

2. Utilizes common screening tools and diagnostic tests, including those for

hereditary cancers

3. Manages common gynecologic and urogynecologic problems

4. Provides comprehensive care for all available contraceptive methods

5. Screens for and treats sexually transmitted infections including partner

evaluation, treatment, or referral as indicated

6. Provides counseling for sexual behaviors that promotes health and prevents

disease

7. Understands the effects of menopause and aging on physical, mental, and sexual

health

a. Initiates and/or refers for age and risk appropriate screening

b. Provides management and therapeutics for alleviation of common

discomforts

8. Identifies deviations from normal and appropriate interventions, including

management of complications and emergencies utilizing consultation,

collaboration, and/or referral as indicated

Approved March 20, 2020

D. A midwife demonstrates the knowledge, skills and abilities to provide care in the

antepartum period, including but not limited to:

1. Confirmation and dating of pregnancy using evidence-based methods

2. Management of unplanned or undesired pregnancies, including:

a. Provision of or referral for options counseling, supporting individualized

decision-making based on patient needs

b. Provision of or referral for medication abortion as consistent with the

individual’s ethics in support of patient autonomy and in line with state

scope of practice and licensing statutes

c. Referral for aspiration or surgical abortion as indicated

3. Management of spontaneous abortion, including:

a. Recognizing threatened, inevitable, complete, or incomplete spontaneous

abortion

b. Supporting physiologic processes for spontaneous abortion and addressing

emotional support needs

c. Counseling, management, and/or referral for inevitable or incomplete

spontaneous abortion, as appropriate - including options for medication

management, aspiration, and surgical care procedures

d. Recognizing indications for and facilitating collaborative care or referral, as

appropriate

e. Providing follow-up services for preconception or pregnancy prevention

depending on patient need

4. Uses management strategies and therapeutics to promote normal pregnancy as

indicated

5. Utilizes nationally defined screening tools and diagnostics as indicated

6. Educates client on the management of common discomforts of pregnancy

7. Examines the influence of environmental, cultural, and occupational factors,

health habits, and maternal behaviors on pregnancy outcomes

8. Screens for health risks, including but not limited to intimate partner gender-

based violence, infections, and substance use and/or dependency

9. Provides support and education regarding emotional, psychological, social, and

sexual changes during pregnancy

10. Provides anticipatory guidance related to birth, lactation and infant feeding,

parenthood, and change in the family constellation

11. Identifies deviations from normal and institutes appropriate interventions,

including management of complications and emergencies

12. Applies knowledge of placental physiology, embryology, fetal development,

and indicators of fetal well-being

E. A midwife demonstrates the knowledge, skills, and abilities to provide care in the

intrapartum period, including but not limited to the following:

1. Confirms and assesses labor and its progress

2. Performs ongoing evaluation of the laboring person and fetus

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3. Identifies deviations from normal and implements appropriate interventions,

including management of:

a. Complications

b. Abnormal intrapartum events

c. Emergencies

4. Facilitates the process of physiologic labor and birth

5. Provides support for physical, psychological, emotional, spiritual, and social

needs during labor and birth

6. Applies pharmacologic and non-pharmacologic strategies to facilitate coping of

the person in labor

7. Performs the following skills independently:

a. Administration of local anesthesia

b. Management of spontaneous vaginal birth

c. Management of the third stage of labor

d. Episiotomy, as indicated

e. Repair of episiotomy, first and second-degree lacerations

F. A midwife demonstrates the knowledge, skills, and abilities to provide care in the

period following pregnancy, including but not limited to:

1. Manages physical involution following pregnancy ending in spontaneous or

induced abortion, preterm birth, or term birth

2. Utilizes management strategies and therapeutics to facilitate a healthy

puerperium, including managing discomforts

3. Identification and management of postpartum mental health

4. Explains postpartum self-care

5. Discusses psychological, emotional, and social coping and healing following

pregnancy

6. Counsels regarding the readjustment of significant relationships and roles

7. Facilitates the initiation, establishment, and continuation of lactation where

indicated; and/or counseling about safe formula feeding when indicated

8. Advises regarding resumption of sexual activity, contraception, and pregnancy

spacing

9. Identifies deviations from normal and appropriate interventions, including

management of complications and emergencies

G. A midwife demonstrates the knowledge, skills, and abilities to independently

manage the care of the well neonate (newborn immediately after birth and up to 28

days of life), including, but not limited to, the following:

1. Understands the effect of prenatal and fetal history and risk factors on the

neonate

2. Prepares and plans for birth based on ongoing assessment

3. Utilizes methods to facilitate physiologic transition to extrauterine life that

includes, but is not limited to, the following:

a. Establishment of respiration

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b. Cardiac and hematologic stabilization, including cord clamping and cutting

c. Thermoregulation

d. Establishment of feeding and maintenance of normoglycemia

e. Bonding and attachment through prolonged contact with neonate

f. Identification of deviations from normal and their management

g. Emergency management, including resuscitation, stabilization, and

consultation and referral as needed

4. Evaluates the neonate, including:

a. Initial physical and behavioral assessment of term and preterm neonates

b. Gestational age assessment

c. Ongoing assessment and management of term, well neonate during first 28

days

d. Identification of deviations from normal and consultation and/or referral to

appropriate health services as indicated

5. Develops a plan in conjunction with the neonate’s primary caregivers for care

during the first 28 days of life, including the following nationally-defined goals

and objectives for health promotion and disease prevention:

a. Teaching regarding normal behaviors and development to promote

attachment

b. Feeding and weight gain, including management of common lactation and

infant feeding problems

c. Normal daily care, interaction, and activity

d. Provision of preventative care that includes, but is not limited to:

i. Therapeutics according to local and national guidelines

ii. Testing and screening according to local and national guidelines

iii. Need for ongoing preventative health care with pediatric care providers

e. Safe integration of the neonate into the family and cultural unit

f. Provision of appropriate interventions and referrals for abnormal conditions,

including, but not limited to:

i. Minor and severe congenital malformation

ii. Poor transition to extrauterine life

iii. Symptoms of infection

iv. Infants born to mothers with infections

v. Postpartum depression and its effect on the neonate

vi. Stillbirth

vii. Palliative care for conditions incompatible with life, including

addressing the psychosocial needs of a grieving parent.

g. Health education specific to the needs of the neonate and family

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REFERENCES

1. Donaldson MS, Yordy KD, Lohr KN, Vanselow NA, eds. Primary Care:

America's Health Care in a New Era. Washington, DC: National Academy Press;

1996.

2. American College of Nurse-Midwives. Our philosophy of care.

http://www.midwife.org/Child-Page-3. Accessed December 17, 2012.

3. American College of Nurse-Midwives. Midwives are primary care providers and

leaders of maternity care homes. Position statement.

http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/

000000

000273/Primary%20Care%20Position%20Statement%20June%202012.pdf.

Published June 2012. Accessed December 17, 2012.

4. American College of Nurse-Midwives. Joint statement of practice relations

between obstetrician gynecologists and certified nurse midwives/certified

midwives. Position statement.

http://midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/00000

0000224/ACNM-College-Policy-Statement-(June-2018).pdf Accessed June,13,

2018.

5. American College of Nurse-Midwives. Transgender/Transsexual/Gender Variant

Health Care. Position statement

http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/

0000000000278/Transgender%20Gener%20Variant%20Position%20Statement%

20December%202012.pdf Accessed May 3, 2018.

6. American College of Nurse-Midwives. Forging our future: ACNM 2015-2020

strategic plan.

http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000005401/2015

-20-StrategicPlanExecSummary-FINAL-061715.pdf. Accessed March 27, 2018.

Source: Basic Competency Section, Division of Advancement of Midwifery

Approved by the ACNM Board of Directors: October 27, 2019