of North AmericaVolume VI, Issue 1, Winter 2004Providing certification standards for

Certified Professional Midwives

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� �Inside This IssueFrom Calling to Courtroom A Survival Guide for Midwives . . . 1

Notices & Announcements:

Madrona Bourdeau Retires fromNARM Board . . . . . . . . . . . . . . . . . 4

Results of First National Survey ofWomen�s Childbearing Experiences 4

FDA Warns Against�Keepsake� Ultrasounds . . . . . . . . 4

Resources for Midwives . . . . . . . . . . 5

NARM Workshops . . . . . . . . . . . . . 5

What�s On the Web Site? . . . . . . . . . 5

NARM Policy

Accountability Policies Expanded . . 6

Importance of Confidentiality . . . . . 6

Books Donated to the NARM TestDepartment Library . . . . . . . . . . . . 7

Related Organizations:

FAM has successful Annual Appeal 8

CfM announces new brochure . . . . 8

MEAC works for midwives in 2003 . 9

Looking for opportunitiesto earn CEU�s? . . . . . . . . . . . . . . . 10

NARM needs your ideas fortest questions . . . . . . . . . . . . . . . . 10

Who is the NARM Board? . . . . . . . 11

Upcoming Conferences . . . . . . . . . 11

What�s on the Website? . . . . . . . . . 11

Committee Reports:

NARM Accountability Committee . 11

Test Department Report for 2003 . 12

Treasurer�s Report . . . . . . . . . . . . . 13

Policies Year-End Report � 2003 . . 13

NARM Applications DepartmentReport � Year End 2003 . . . . . . . 14

NARM Preceptor Survey . . . . . . . . 14

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news

S U P P O R T E R

Registry of MidwivesMidwivesNorth American

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�� �From Calling To Courtroom:A Survival Guide forMidwives

A free internet book available late Spring of2004!

Over the past few years, US midwives have been per-secuted/prosecuted in increasing numbers. The vastmajority of us find ourselves wondering, �What do I donext?? Do I find a lawyer? How? Should I talk to the investi-gator/sheriff/police? How do I raise defense funds? How do I write a press release? Howdo I mobilize client support? WHAT DO I DO NEXT??�

A group of us on the internet have pondered those questions, and have deter-mined to answer them. From Calling to Courtroom is an amazing project, pro-duced by some of the most knowledgeable, experienced people in the US. In-cluded are chapters on:

�Why You Aren�t Safe!�Preparing Ahead of TimeProsecuted Midwives Speak Out: �What I wish I had known�Organizing and Mobilizing Client SupportUnderstanding the Legal SystemAfter the Dust Settlesan extensive Resources section and much MUCH more!

Perhaps one of most astounding parts about this project is that the book will beabsolutely free! It will be posted online, and you can access it and print it out atno cost.

Please join us in midwifing this book into birth! For more information or tovolunteer your help, contact Valerie Vickerman Runes at (847) 368-0899 orfilerook@aol.com

The following is an excerpt from the new book coming out entitled From Call-ing to Courtroom.

The Myth of the �Alegal� Midwifeby Ida Darragh

There is a myth about the legality of the practice of midwifery that continues toconfound most midwives. That myth is that the practice of midwifery is legal,illegal, or alegal, depending on the state laws. To better understand the legal is-sues affecting midwives in every state, we need to have a clear understandingabout what these terms mean or don�t mean. The word �legal� is defined byWebster�s as �authorized by law.� � Illegal� means �forbidden by law�. There isno definition of �alegal,� though it has been used for many years to describe thepractice of midwifery in states that do not have a law authorizing or forbiddingthe practice.

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�� From Calling to Courtroom�

CPM News is a newsletter of theNorth American Registry of Mid-wives (NARM) published twice ayear, Winter and Summer. We wel-come submissions of questions, an-swers, news tips, tidbits, birth art,photographs, letters to the editor, etc.

Deadlines for submissions are De-cember 1 and June 1. Send all news-letter material to: Joanne Gottschall,200 N. Jasper Avenue, Margate, NJ08402 or cpmnews@narm.org

The views and opinions expressedby individual writers do not necessar-ily represent the views and opinionsof NARM.

� �Contact Information

NARM General Information(or to order How to Become a CPM)888-842-4784Fax: 404-521-4052

Applications & Recertification:NARM Applications Department:P.O. Box 420Summertown, TN 38483

NARM BoardDebbie Pulley, CPM5257 Rosestone DriveLilburn, GA 30047888-842-4784info@narm.org

Test Department information:Ida Darragh, CPMPO Box 7703Little Rock, AR 72217-7703888-353-7089testing@narm.org

CPM News Editor:Abby J. Kinne, CPM58 South Center StreetWest Jefferson, OH 43162614-879-9835editor@narm.org

CPM News�

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In nineteen states, direct entry mid-wives can receive a license to practicemidwifery, in two other states they canbe licensed if they have attended anurse-midwife program, and in sevenstates direct-entry midwifery is prohib-ited by law. That leaves twenty-twostates where the legal status is vagueand where midwives have consideredtheir profession to be unregulated butalso alegal.

If there is no state law either autho-rizing or forbidding the practice ofmidwifery, then why should we notconsider it �alegal� or at least definedin a similar context as not needing au-thorization. Why does any activitywhich is not expressly forbidden evenneed a defined legal status? The answerlies in the Medical Practices Act. Everystate has a Medical Practices Act whichsays that it is illegal to participate inactivities that the medical professionconsiders its own. Words vary slightlyfrom state to state, but all contain ref-erences to treating, diagnosing, or pre-scribing for any disease, injury, pain,or condition. These activities are pro-hibited by anyone not authorized bythe state through licensure or not ex-empted from the Medical Practices Act.Exemptions are often listed for personsacting as a good Samaritan or in anemergency, or for parents treating theirown children, or for religious reasons.Some allow exemptions if no fee orother consideration of value are ex-changed. Many midwives feel that theMedical Practices Act does not applyto midwifery because the midwife isnot treating a disease; she is nurturingor supporting a natural process. Somego so far as to not charge a fee butonly accept donations, or to charge forchildbirth classes or labor supportrather than midwifery services. Whileany of these defenses may seem to bereasonable to the midwife, they arerarely successful in the courtroom.

There is no clearly defined legal sta-tus for midwives except licensure orspecific exemption from the MedicalPractices Act. In the few cases wherean exemption has been successful, it

has either been revoked at a later dateor it significantly restricts the midwifeto �catching� the baby, almost if byaccident, without the extended exemp-tion for providing prenatal care, whichis considered by most midwives to beessential to midwifery. For all practi-cal purposes, for midwifery to be legalit must be licensed by the state. Infact, all states do have some avenue forlicensure as a midwife, but many ofthese routes apply only to the CertifiedNurse Midwife who is licensed by theBoard of Nursing and must practiceaccording to the licensure requirementsfor nurse-midwives. Direct-Entry Mid-wives (DEMs) are licensed in only 21states, and in two of those states (NewYork and Rhode Island as of January,2004) the only direct-entry route is theCertified Midwife, a credential issuedto non-nurse midwives who have com-pleted their education in a nurse-mid-wifery program. DEMs who have re-ceived their training and educationoutside of the medical/institutionaleducational systems are licensed onlyin nineteen states. In all of the otherstates, the legal exemption to the prac-tice of medicine applies only to Certi-fied Nurse Midwives. Unlicensed mid-wives can be charged with the practiceof medicine OR the practice of nurse-midwifery.

Another myth regarding the practiceof midwifery is that even without licen-sure, there are precedents in state lawthat protect the midwife. These prece-dents may help in the midwife�s defenseif she is charged, but they don�t preventcharges from being filed. For example,there is a chart on the Citizens forMidwifery web site(www.cfmidwifery.com) that lists sevenstates as �legal by statute, but licensureunavailable.� That usually means thatthere has been something in an olderlaw that referenced midwifery, or a pre-vious system for licensure that is ex-tinct, but there is no current processfor licensing midwives. In one ofthose states (Alabama), a midwife whohad been practicing for twenty yearssuddenly found herself arrested. After

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being threatened with an expensive trialand potential charges of manslaughterin the death of a baby after transport-ing with a prolapsed cord, she pledguilty to practicing nurse-midwiferywithout a license and received a sus-pended sentence and fines. There wasno �legal by statute� protection for her.Another �legal by statute� state wheremidwives had considered their profes-sion �alegal� for years is Georgia. TheMedical Board has recently begun aninvestigation, stating they have a list ofmidwives. To date, only one midwifehas been contacted though no chargeshave been filed. Another category onthe CfM chart is �not legally definedbut not prohibited.� There are anotherseven states where midwives have con-sidered their practice as alegal only tofind the wolf at the door unexpectedly.These states are Connecticut, wherefour midwives were arrested in 2002and charged with practicing medicineor nurse-midwifery without a license(and this happened even after the statewas unsuccessful in prosecuting an-other midwife on these charges a fewyears earlier); Illinois, where two mid-wives have faced charges ranging frommanslaughter to practicing without alicense and several other midwives wereissued Cease and Desist orders; Neb-raska, where one midwife was arrestedfor practicing nurse-midwifery withouta license in July and two midwiveswere issued C&D orders in August of2003; Ohio, where one midwife is un-der investigation currently; and SouthDakota, where one midwife has beentried twice on charges of practicingmedicine or nurse-midwifery. She wasacquitted one time and sentenced tojail the second time. A third categoryof legal status is �legal by judicial inter-pretation or statutory inference.�Eleven states are listed in that category.Of those states, Idaho has had a mid-wife arrested and charged with practic-ing medicine (charges were laterdropped but legal fees were high), Penn-sylvania has had periodic investiga-tions and arrests in years past andthere is one active arrest and one recent

Cease and Desist order, and Utah hadan arrest in 2000. Many of these ar-rests lead to charges that are laterdropped or are settled with a plea bar-gain before trial. But the expense andthe emotional stress are very high forthe midwife and her family, and for theother midwives in the state.

Five years from now many of thesecases will have been settled, and manymore may have been filed. Some willhave gained legal status through licen-sure. The point worth noting is that inall of the previously mentioned states,the midwives thought that the practiceof midwifery was �alegal� in theirstates and many had practiced openlyfor years before being harassed. Someinvestigations were the result of a trans-port or a bad outcome, but many werejust for attending births. Each year,midwives in the alegal or illegal statesface prosecution just for attendingbirths, and almost sure manslaughtercharges if a baby dies while in theircare. Most of the currently active in-vestigations and prosecutions are oc-curring in the alegal states; only a feware in illegal states, possibly becausethe midwives are less likely to practicein an open, publicly identifiable man-ner. Interestingly, there are no currentprosecutions of unlicensed midwivesin the states that license midwives.Their focus seems to be on regulatingthe licensed midwives rather than fer-reting out the unlicensed ones. Cer-tainly, in those states an unlicensedmidwife could be charged with practic-ing midwifery without a license, butanecdotally there seems to be less ten-dency to do so. I know of one unli-censed midwife who has practiced in alicensed state for over twenty years. Re-cently, she transported a client to a lo-cal hospital where the OB casuallyasked her what she thought of the pro-posed midwifery regulation changesthat had been written about in the statenewspaper. She replied that she hadn�tthought anything about them becauseshe was not licensed. �Oh,� he replied.He�d always assumed she was licensed,but at that point it didn�t really matterthat she wasn�t.

Many midwives prefer the freedom topractice according to their own proto-cols rather than by government regula-tion. However, the annoyance of regu-lation is nothing compared to thestress of arrest and prosecution. Somemidwives have fought diligently andpersistently for licensure laws, andsome have fought just as diligently andpersistently against them. Regardlessof our own personal feelings aboutregulation, licensure is the only waymidwifery will survive into the nextgeneration. Outlaw midwives are a dy-ing breed. Women coming into theprofession do not want to face jail timefor serving the women in their commu-nities. At the very least, they deserve toknow the risks they face. Midwives inlicensed states work to create accept-able regulations. Midwives in illegalstates accept the necessity of practicingunderground until they eventually re-tire, leave the state, get arrested, orchange the laws. Midwives in the otherstates are living with the most uncer-tainty because of the fallacy of �alegal�status. They spend years in training,invest in setting up a practice, some-times work for years establishing areputation, and then one day whenleast expected comes �the knock on thedoor.� Life changes at that moment.Her clients have to find someone else;all her time and money go toward herdefense; her family tries to understandbut nothing seems fair; and she ques-tions her own sanity. �But wait,� shecries, �I�m legal by judicial interpreta-tion or statutory inference!� This isnot a career path we can offer ourdaughters. This was not an issue facedby the midwives in the bus in the park-ing lot of Northwestern University in1971, but even the Farm midwives arelicensed now. Alegal is a concept of thepast, and we are going to have to moveforward. Licensure is not somethingthat should be forced on recalcitrantmidwives by a paternalistic govern-ment. It is something that should becreated by midwives; it is the next stepin self-actualization.

Midwives have created a certificationprocess which upholds the integrity of

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the autonomous midwife for out-of-hospital birthing. This credential, theCertified Professional Midwife (CPM)is issued by the North American Regis-try of Midwives (NARM). NARM is aprime example of how midwives cancreate a credential that reflects the Mid-wifery Model of Care. All of the statesthat license direct-entry midwives toattend births out of the hospital do usethe NARM exam or the CPM certifica-tion as the basis for licensure. If we asmidwives can take an active role in cre-ating licensure programs in the sameway that we created the credentialingprogram, there is great hope for the fu-ture of midwifery. If we turn awayfrom regulation and leave our arrestedsisters to fight the battle alone, then wewill be picked off one by one untilthere is no one left. Our strength isnot in our few numbers, but in ourcombined will, the intensity of our be-liefs, and our unflagging determina-tion. There is no alegal status; our le-gal status will be what we make it.

� �Madrona Bourdeauretires from NARMBoard

The NARM Board would like tothank Madrona Bourdeau for the timeand contributions she gave us duringher term on the Board.  Madrona hasbeen involved with the birthing com-munity for over twenty years.  Wewish her well in her future endeavors.

� �Results of FirstNational U.S. Survey ofWomen�s ChildbearingExperiences

The Listening to Mothers survey ex-plored women�s attitudes, feelings, andknowledge about many aspects of theirmaternity experiences. It also docu-mented for the first time at the na-tional level the frequency of many as-pects of childbearing that have beenrecorded only at the clinical level, if atall, in the past. Entirely new data in-clude various practices (e.g., eating,drinking and walking in labor; use ofdrug-free methods of labor pain relief;birth position), information about ma-ternity preparation and personnel (e.g.,attendance at childbirth educationclasses, specialty of physiciancaregivers, and providers of supportivecare in labor), and outcomes (postpar-tum health concerns, including depres-sion). And the survey documentedmany data items that are collected inthe federal vital and health statisticssystem, including some that have beenshown in validation studies to be un-der enumerated on birth certificatesand in hospital discharge data. Resultsof the Listening to Mothers survey thusoffer a new and more complete level ofunderstanding about many aspects ofchildbearing in the United States.

The Listening to Mothers survey wasconducted for the Maternity CenterAssociation by Harris Interactive. Amulti-disciplinary National AdvisoryCouncil provided guidance.

To view the survey go towww.maternitywise.org and click on Lis-tening to Mothers.

� �FDA warns against�keepsake� ultrasounds

The Food and Drug Administrationhas issued a warning about getting fetalultrasound videos for non-medical rea-sons, in view of the growth of commer-cial enterprises offering fetal videos askeepsakes. The FDA acknowledges thatthe long-term effects of repeated ultra-sound exposures on the fetus are notfully known, and therefore ultrasoundshould not be used except for diagnos-tic medical purposes (when the riskspresumably are outweighed by the ben-efits).

The warning does not address thecommon practice of obstetricians hav-ing women get multiple ultrasoundscans during pregnancy, the assump-tion apparently being that if the OBordered the ultrasound, it must be forbona fide medical reasons. However, itis also true that doctor office ultra-sounds are more likely to be lower in-tensity than the latest 3D and 4D ultra-sounds that are being marketed.

To read more about the new warn-ing, go to: http://www.fda.gov/fdac/fea-tures/2004/104_images.html

For a list of articles on ultrasoundsafety (many with links to full text) goto: http://www.ob-ultrasound.net/joewoo3x.html

A useful article: �Ultrasound Scans -Cause for Concern� by Sarah Buckley,MD. First published in Nexus maga-zine, vol 9, no 6, Oct-Nov 2002, nowon BirthLove at:http://www.birthlove.com/free/ultrasound.html

Susan HodgesGrassroots Network Message 402006

Notices & Announcements�

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� �Resources for Midwives

Midwifery andHomeopathy Training

ACNM and MECA creditsApril 16-18, 2004Marriott, Downtown Portland, ORNational Center for Homeopathy

Visit www.homeopathic.org or call tollfree (888) 624-0613

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Fetal and Women�s Imaging:OB/GYN Ultrasound Update

September 12-14, 2004The Westin SeattleSeattle, WA

Additional information is availablefrom our website, e-mail, or phone infobelow.

Thank you,JoAnn Cooke

20 East Poplar, Suite 202Walla Walla, WA 99362

Tel.  (509) 529-9202        (888) 207-9105

Fax  (509) 529-9650E-mail: office@worldclasscme.com

www.worldclasscme.com

***Laboratory Services

My laboratory (Midwest CancerScreening) has provided pap smear

NARM does not endorse or rec-ommend the following advertisers,they are provided for your informa-tion only. NARM is not respon-sible for, nor do they guarantee theinformation or services provided.

services for midwives around the coun-try for many years now. Occasionallyour midwife clients have asked us tolook into pricing for OB panels.Charges reported to us range from $75to $95 for the panel.

We are offering an OB panel for $46.We were able to negotiate an excellentprice by combining our client�s patientbases (close to 200,000 patients alltold). Because only the serum portionof blood is stable enough for shippingvia express mail, a CBC is not in-cluded in the panel. It does include:ABO/Rh + Ab screen, RPR, Hep BSAg, and Rubella.

Beta Strep (Swab) $12Herpes (Swab) $24CMP (Serum) $18HIV (Serum) $14GC/CT (Gen-Probe) $13.50

Our pap prices are:Conventional $12Thin Prep $18HPV Test (High risk) $42(From swab or thin prep vial)

My hope is that small practice mid-wives who are charged unreasonableprices by local labs will be able to pro-vide better care for their patients withthis testing. My lab is committed toproviding reasonable health care forEVERYONE.

If you could help me by offeringguidance into how to disseminate thisnews for your organization, I would bemost appreciative.

Thank you!

Chris BradleyOperations Manager

Midwest Cancer Screening1-888-299-1937cbmcs@msn.com

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� �NARM Workshops

If a region will host an Item WritingWorkshop (test writing) with at least 6CPM participants, NARM will alsooffer QE training with no minimumnumber of participants. Item Writingparticipants must be CPMs. QEs mustbe CPMs with at least three years expe-rience and 50 births beyond the num-ber required for certification. There is acost of $100 for the QE Workshop, butthis fee includes a copy of the PracticalSkills Guide for Midwives (a $60value). QEs are also paid by NARMfor administering the Skills Assessment($75 per candidate).

The QE workshop is a full day work-shop and can be held the day after theItem Writing workshop. The QE work-shop fee will be waived for anyone whohosts the Item Writing workshop. Thereis no participant fee for the Item Writ-ing Workshop. Other workshops canbe offered in conjunction with the ItemWriting workshop. CEUs are offeredfor all workshops.

Please contact NARM at 1-888-353-7089 if you are interested in hosting aworkshop event.

� �What�s on the Website:

Site Sections� Contact NARM� About NARM� How to Become a CPM� Candidate Information

Bulletin� CPM Recertification� Policy and Procedures� Peer Review� CPM State Information� OSU Testimony� NARM Job Analysis� Application Deadlines� CPM Stat Forms� CPM News Online

www.narm.org

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�� NARM Policy�

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� �Accountability PoliciesExpanded 4/03

A CPM who has been named in acomplaint is required to participate inNARM�s Peer Review for Handling aComplaint.  Failure to participate inthe accountability processes will resultin revocation of the credential.

Added to existing policy:NARM must receive complaints

within 18 months of occurrence. However, NARM will not begin theprocess of Peer Review/GrievanceMechanism with a CPM who is alsofacing civil or criminal litigation.NARM will proceed with these pro-cesses after the court case is closed.

Added to existing policy:A CPM with inactive or expired sta-

tus is bound by all policies regardingNARM Peer Review/Grievance Mecha-nism.  Failure to respond to a com-plaint will result in revocation of thecredential.

Added to existing policy:Complaints must be received within

18 months of occurrence. The status ofthe CPM at the time of occurrence isirrelevant. Notice of complaints re-ceived regarding a midwife whose CPM

credential has been revoked will beplaced in this person�s file in Applica-tions; the original complaint will bekept in Accountability.  Should thisperson apply for a CPM credential inthe future, all fees must be paid prior toNARM continuing the process appro-priate to the complaint.  Applicationswill notify Accountability. The com-plainant will be notified and given theopportunity to pursue the originalcomplaint.  If the complainant cannotbe located at that time with the infor-mation on file, the applicant may pro-ceed with the application. The com-plaint may be reactivated by the com-plainant within one year of the CPM�snew certification period.

Complainant must respond withintwo weeks of being notified by NARMPeer Review Chairperson with attemptsto establish a date for the Peer ReviewProcess session.  If the complainantdoes not continue participation in theprocess, the complaint will be droppedand will not reflect on the CPM inquestion.

9/03 addition: If a complainant laterwishes to continue complaint, a newcomplaint must be filed and it will beviewed as the first complaint regardingthat case. Complaints must be receivedwithin 18 months of occurrence.

NARM is exploring the possibility of bringingthis newsletter to you via the internet to savefinancial and environmental resources. If youwould like to try this out, go towww.narm.org/cpmnews.html and open the pdffile. You can print it or save it. If you wouldlike to receive an email notifying you that anew issue of the CPM News is now availableonline in lieu of a paper copy, send youremail address to cpmnews@narm.org.

� �Importance ofConfidentiality

Confidentiality is an integral part ofPeer Review and the Grievance Mecha-nism.  In the case of NARM�s Peer Re-view for Handling a Complaint andthe Grievance Mechanism, participantssign confidentiality agreements at theonset of these proceedings.

If a CPM breaks the confidentialityof the NARM Accountability process,a formal review will consist of the fol-lowing:

1. Written statements from at leasttwo individuals who have firsthand knowledge of the break ofconfidentiality.  Statementsmust include the details whichwere revealed, the setting anddate of the conversation.

2. NARM Director of Accountabilitywill contact the peer reviewchairperson (or if the accusationis about that person, anotherparticipant in the session) anddiscuss the details that were re-vealed in the break of confidenti-ality.  If the details are con-firmed as part of the confidentialproceedings, this will confirmthe accusation.

3. NARM Director of Accountabilitywill contact the person accusedand inform her/him that this hasbeen documented and that if an-other documentation is made inthe future, the CPM in questionwill be put on probation for theperiod of one year during whichtime she/he must meet require-ments assigned by the Account-ability Committee

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� �Books Donated to the NARM Test DevelopmentLibrary

It is an on-going function of theNARM Test Department to developquestions for the NARM Written Ex-amination. Questions are written byCPMs who take a workshop in writingtest questions. The questions are re-viewed by several teams of CPMs, andthe answers are referenced to at leasttwo of the books on the NARM refer-ence list. It is the job of the Test De-partment to confirm that all new ques-tions are referenced to current editionsof the reference texts, and to re-refer-ence older questions which are still inuse.

In June of 2003, NARM wrote toseveral publishing companies andasked for review copies of newer edi-tions of our favorite texts and also re-view copies of some newer books. Toour surprise and pleasure, several com-panies sent not only the texts we hadrequested, but many other midwifery-related books. We looked through thesebooks with an eye for which were mostuseful in referencing the questions thatare being used on the current forms ofthe exam, and then updated our recom-mended reading list for exam prepara-tion. Not all of the donated bookswere chosen for our updated referencelist, but all are useful sources of mid-wifery knowledge. We are grateful tothe publishers below for the books thatwere donated to the NARM test devel-opment library. The 2004 NARM ref-erence list can be found on this page,as well as in the Candidate Informa-tion Bulletin and on the NARM webpage.

Thanks to these publishers fortheir contributions:

Jones and Bartlett PublishersVarney�s Midwifery, fourth editionImpact of Birthing Practices on

Breastfeeding, Kroeger and Smith

Case Studies in Breastfeeding: Prob-lem Solving Skills and Strategies,Cadwell and Turner

Celestial Arts Publishing Com-pany

Breastfeeding, Renfrew, Fisher, andArms

Heart and Hands, DavisNatural Pregnancy Book, Romm

Elsevier Publishing CompanyAnatomy and Physiology for Mid-

wives, Coad and DunstallEthics and Midwifery, FrithMidwifery, Mind and Spirit: Emerging

Issues of Care, HallEssential Midwifery, Henderson and

JonesSkills in Midwifery Practice, Johnson

and TaylorEthics in Midwifery, JonesThe New Midwifery: Science and

Sensitivity in Practice, PageMaye�s Midwifery: A Textbook for

Midwives, SweetMidwifery: Community Based Care,

WalshMidwifery: Best Practice, WickhamProfessional Studies for Midwifery

Practice, FraserHealth Promotion in Midwifery,

DunkleyPrinciples and Practice of Research in

Midwifery, Cluett & BluffLinking Research and practice in Mid-

wifery, Proctor & Renfrew

Following is the new referencelist for the NARM exam:

Primary Reference List:Davis, Elizabeth. Heart and Hands: A

Midwife�s Guide to Pregnancy andBirth, 3rd edition, Celestial Arts,1997.

Frye, Anne. Holistic Midwifery: AComprehensive Textbook for Mid-wives and Home Birth Practice,Vol. 1, Care During Pregnancy,Labrys Press, revised 1995.

Frye, Anne. Understanding Labworkin the Childbearing Year, 6th edi-tion, Labrys Press, 1997.

Gaskin, Ina May. Spiritual Midwifery,4rd edition, The Book PublishingCompany, 2002.

Myles, Margaret. Textbook for Mid-wives, 14th edition 2003, Elsevier

Page, Lesley Ann, The New Midwifery,Churchill Livingstone, 2000

Simpkin & Ancheta, Labor ProgressHandbook, Blackwell, 2000

Sinclair, Constance, A Midwife�sHandbook, Saunders, 2004

Thureen, Assessment & Care of theWell Newborn, Saunders, 1998

Varney, Helen, Midwifery, 4th edition2003, Jones and Bartlett.

Walsh. Linda, Midwifery: CommunityBased Childbirth, Saunders, 2001

Secondary Reference List:Coad, Jane, Anatomy & Physiology for

Midwives, Mosby, 2001Frye, Anne. Healing Passage, 5th edi-

tion. Labrys Press, 1995Goer, Henci, The Thinking Woman�s

Guide to Birth, Penguin Putnam,1999

Hall, Jennifer, Midwifery Mind andSpirit, Elsevier, 2001

Johnson &Taylor, Skills for MidwiferyPractice, Churchill & Livingston,2001

La Leche League, International. TheBreastfeeding Answer Book.Mohrbacker and Stock, 1997.

Oxhorn and Foote. Human Laborand Birth, 5th edition. McGrawHill, 1986.

Pritchard and McDonald. William�sObstetrics, 21th edition. PrentissHall, 2001

Renfrew, Fisher, Arms. Bestfeeding:Getting Breastfeeding Right. 2nd

edition, 2000 Celestial ArtsWickham, Sarah, Midwifery, Best

Practice, Elsevier, 2003

8 NORTH AMERICAN REGISTRY OF MIDWIVES, W INTER 2004��

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� �The Foundation forAdvancement ofMidwifery (FAM) hassuccessful AnnualAppeal

Ashley Kraft, President

The Foundation for the Advance-ment of Midwifery (FAM) received awonderfully warm response to our2003 Annual Appeal.  We receivedmany generous donations, and are stillreceiving funds.  Thank you to all ofyou who have donated and recom-mended others for us to contact as webroaden our base of support!  The en-ergy your contributions represent sup-ports efforts to get the information�out there� to the public and to policymakers that midwifery is the solution,not the problem!

Last year, our funding efforts focusedon one project, the CPM 2000 Statis-tics Project. This year, we are seeking tofund the development of a collabora-tive effort of several organizations toget the word out about midwiferycare.  Many organizations are seekingto bring more positive attention tomidwifery care and its benefits, andFAM intends to support this.  We havereceived several grant proposals, andare in the process of considering theseapplications. Notifications should besent out in March.

Several people have volunteered timeand skills, as well as money, to FAM. One of this year�s top goals for FAM isto further develop our committees, espe-cially our Grant Writing Committee. If you, or someone you know, is inter-ested in helping us in this area, pleasecontact us.

As always, we�d love to receive morecontributions. You or your supporterscan make tax-deductible contributionsby mailing a check, by charging toVisa or Master Card, by pledging anamount to be paid over a certain num-

ber of months or by transferring stockto us.:

Foundation for the Advancement ofMidwifery, Inc. 1779 Wells Branch Pkwy, #110B-284Austin, Texas  78728 877-594-9996 (toll free)info@formidwifery.orgwww.formidwifery.org

� �Citizens for Midwiferyannounces newBrochure

Susan Hodges, President

New CfM BrochureCitizens for Midwifery has rede-

signed and simplified the brochureabout CfM, and the new printing isnow available. The new colors (sagegreen and a soft blue-violet) look beau-tiful with the Midwives Model of Carebrochure as well as with other CfM lit-erature. As before, these brochures areavailable at no charge, although a do-nation to cover costs is always appreci-ated. 

Membership Rates IncreaseAfter considering all the facts, the

Citizens for Midwifery Board has de-cided to increase the basic membershiprates for the first time since the organi-zation was founded in 1996. It wasclear that with increases in postage andin paper/printing costs, the $15 ofeach membership for the newsletterdoes not cover the costs of the newslet-ter.

As of January 1, 2004, the studentrate (also the special �joint member-ship� rate) will increase from $15 to

$20, and the basic �suggested� member-ship rate will increase from $25 to$30.

CfM�s goal is to be self-supportingwith memberships, which must includemany other expenses in addition to thenewsletter.  Donations are an impor-tant part of our income.  Ten dollarsof each �Suggested� membership (bothold rates and new rates) is considered adonation. Anything above the student/joint rate (which just covers the cost ofthe newsletter) is counted as a dona-tion. A significant number of membersjoin or renew as �Supporters� or �BestFriends� ($50 or $100, respectively). The donations that come in with mem-berships made up nearly one third ofour annual revenues for 2003.  With-out these donations, Citizens for Mid-wifery would not have adequate fundsfor operating expenses (phone, admin-istrative costs, etc.) or for outreach ef-forts (website costs, travel to confer-ences and meetings, etc.). Sales of bro-chures and videos add a very smallamount of revenue, and this year a gen-erous individual contributed $5000 toCitizens for Midwifery.  Thank you toour many generous members!

Do you already have a supply of Citi-zens for Midwifery brochures or othermaterials with the old rates? You arewelcome to simply change the amountsfor the student and suggested rates, orreplace them with the new brochures.

Midwives: Sign up your clients!Citizens for Midwifery would like to

encourage you to have your clients joinCitizens for Midwifery, so we are offer-ing you a price break. If your practicehas your clients join (you are signingthem up and you are paying for theirfirst year of membership), you can doso at the �special� rate of $20 insteadof the suggested rate of $30.  Please letus know, and just check off the studentrate on the membership forms. We re-ally appreciate your work and your ef-forts to inform your clients and intro-duce them to Citizens for Midwifery!

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� �MEAC works formidwives in 2003

Mary Ann Baul, President

MEAC works for midwives in2003:

�  Eleven schools are now accred-ited or pre-accredited.

�  One school is in the accredita-tion process.

�  We have received one new pre-application.

�  We are beginning 8 re-accredita-tions, 4 of which will be com-pleted in the next year and theremainder in the next year and ahalf.

�  In 2002, there were 405 stu-dents in MEAC accreditedschools and 60 graduates ofMEAC accredited programs.

�  We have produced a new hand-book, trimming the Standardsdown from 13 to 10 and stream-lined the accreditation process. We are also developing new ARCand Site Visitor tools as well asmoving towards a paperless ac-creditation process.

�  We have achieved and main-tained full five-year continuingrecognition with the UnitedStates Department of Education� a rare accomplishment for sucha young accrediting agency. This recognition allows eligibleMEAC accredited schools to ap-ply for federal financial aid pro-grams, opening midwifery educa-tion to aspiring midwives whomay not have had the financialmeans necessary to pursue theirdreams.

tion by encouraging credentialed mid-wives to submit distance education pro-grams for continuing education ap-proval for CEU�s. If you have designeda continuing education program thatcould be offered at a distance, such ascorrespondence, audiotape, videotape,CD-ROM, or on-line computer course,you are invited to submit this programfor CEU approval by MEAC. The pro-gram, if approved, could then be of-fered to midwives who need to fulfilltheir ongoing continuing educationrequirements for re-certification or li-cense renewal.

MEAC plans to create a list of ap-proved continuing education programsand post it to their website.

Contact MEAC at www.meacschools.orgor info@meacschools.org for applications.

MEAC is also looking for a mid-wifery educator to review continuingeducation programs for approval. Ifyou would like to volunteer to help us,we would love to hear from you. It is awonderful way to find out what�s goingon at midwifery conferences and giveseducators great ideas for topics!

Teaching and MentorshipCPMs who are interested in teaching

or taking on an apprentice may wantto contact one of the accreditedschools (especially those that providedistance education) to see about whatrequirements they must meet and tolink up with aspiring midwifery stu-dents.

Here is a list of accredited schools:Midwifery Education AccreditationCouncil Accredited and Pre-AccreditedMidwifery Institutions and Programs:

PROGRAMS:Miami Dade College1

Midwifery Sciences Department950 NW 20th StreetMiami, FL 33127-4693(305)237-4234www.mdc.edu/northacademic_programs.aspjclegg@mdcc.eduJustine Clegg, Midwifery Program DirectorAccreditation Period: 4/00 - 4/04

�  We have responded to over 600requests for information fromaspiring midwives as well as re-quests for continuing educationinformation, requests from otheragencies, and midwifery advo-cates.

�  We have established stronger,ongoing ties with our sister or-ganizations.  We participate inmonthly joint board conferencecalls and have been fortunate tomeet with the joint boards twicethis year during our board meet-ings.

Continuing EducationCommittee

MEAC is currently looking for mem-bers for our continuing educationcommittee. This volunteer job entailsreviewing CEU applications for classesand conferences. This can be a greatway for educators to get ideas and seewhat is currently on the continuingeducation circuit: keep up to date onreferences and studies, see what the�hot� topics are, get class ideas, andbecome familiar with the speakers inmidwifery. The time commitment for aCEU committee member varies depend-ing on how many applications are re-ceived in a particular month, but theaverage time is estimated at three hoursa month. Please circulate this informa-tion to people you think would be in-terested in becoming a CEU committeemember for MEAC. We require the fol-lowing qualifications: someone who isa credentialed midwife and/or a mid-wifery educator. We provide guidelinesand assistance to the volunteer. Thankyou for helping us get the word out topeople and for helping us provide con-tinuing education approval for practic-ing midwives and childbirth profes-sionals!

At-A-Distance CEUsMEAC would like to improve mid-

wives� options for continuing educa-

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��Related Organizations

� �Looking forOpportunities toObtain CEU�s?

Don�t miss a great opportunity toearn CEU�s and have a great time do-ing it! Plan on attending MANA 2004in Portland, OR October 15-17.

Last year @ MANA 2003 in Austin,TX, there was opportunity to earn 10contact hours during the regular con-ference and 7-8 more hours if you at-tended a pre-conference workshop.

� �NARM Needs YourIdeas for Test Questions

While NARM Test questions mustbe written by those trained in ItemWriting, ideas for the questions cancome from any midwife. The purposeof the exam is to differentiate betweenthose midwives who are competent topractice independent midwifery andthose who are not quite ready for inde-pendent practice. We are looking forsituations that are common to mid-wifery practice as identified by thosewho are currently in practice. NARMwelcomes submissions of ideas for testquestions from all CPMs. Please sendus a problem or scenario in 3-5 sen-tences. These situations can come fromprenatal care, birth, or postpartum. In-clude, if you will, your idea for the cor-rect answer and any ideas for incorrect

INSTITUTIONS:Arkansas Midwives School and Ser-

vices4528 E Huntsville RoadFayetteville, AR 72701(479) 571-2229www.midwifearmss.orginfo@midwifearmss.orgTeresa Elder, Executive DirectorAccreditation Period: 10/27/03 - 10/

27/06

Birthingway College of Midwifery12113 SE Foster RoadPortland, OR 97266(503) 760-3131www.birthingway.orgbirthing@teleport.comHolly Scholles, PresidentAccreditation Period: 10/22/02 - 10/

22/06

Birthwise Midwifery School66 S. High St.Bridgton, ME 04009(207) 647-5968www.birthwisemidwifery.orgbirthwise@ime.netHeidi Fillmore-Patrick, DirectorAccreditation Period: 4/02 - 4/06

Florida School of Traditional Mid-wifery1

PO Box 5505Gainesville, FL 32627-5505(352)338-0766www.midwiferyschool.orginfo@midwiferyschool.orgJana Borino, DirectorAccreditation Period: 4/00 - 4/04

Manna School of Midwifery &Health Sciences1

PO Drawer 2248Bonita Springs, FL 34133(239) 992-1211Fax: (239) 992-8149Marilyn Quinn, DirectorPre-accreditation period: 11/00-11/03

Maternidad La Luz1

1308 Magoffin St.El Paso, TX 79901(915) 532-5895

Fax: (915) 532-7127www.maternidadlaluz.comDeborah Kaley, DirectorAccreditation Period: 3/99 - 3/04

Midwives College of Utah1, 2

(Formerly Utah College of Midwifery)560 S. State St., Ste. B2Orem, UT 84058(888) 489-1238 or (801) 764-9068Fax: (801) 434-8704www.midwifery.eduoffice@midwifery.eduJodie Fisher, PresidentAccreditation Period: 3/01 - 3/04

National College of Midwifery1, 2

#209 State Road 240Taos, NM 87571(505) 758-1216www.midwiferycollege.orgelizabet@taosnet.comElizabeth Gilmore, DirectorAccreditation Period: 3/01 - 3/04

National Midwifery Institute1, 2

P. O. Box 128Bristol, VT 05443-0128(802) 453-3332www.nationalmidwiferyinstitute.comsanton@nationalmidwiferyinstitute.comShannon Anton, Administrator and

Co-DirectorElizabeth Davis, Co-DirectorAccreditation Period: 10/02 - 10/05

Seattle Midwifery School1, 2

2524 16th Ave. South #300Seattle, WA 98144-51041-800-747-9433 or (206) 322-8834Fax: (206)328-2840www.seattlemidwifery.orginfo@seattlemidwifery.orgLynn Hughes, Midwifery Program Di-

rectorAccreditation Period: 10/99 - 10/04

Footnotes:1 Institutions/programs renewing

accreditation or pre-accredita-tion status in 2004. According toMEAC policies and procedures, aprogram or institution maintainsits accreditation status until a

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final decision is made regardingthe Re-accreditation of the pro-gram.

2 Have distance education pro-grams.� Pre-accredited programs/institu-

tions did not have graduates fromtheir basic midwifery educationtrack prior to applying for ac-creditation.

� Program Accreditation is for thoseprograms whose parent institu-tion is accredited by a USDOE rec-ognized accrediting agency.

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� �Upcoming Conferences

Following are upcoming conferencesthat members of the NARM Board willbe attending:

Midwifery Conferences:

Midwifery TodayPhiladelphia, PAMarch 18-20, 2004

Midwives Alliance of NorthAmerica (MANA)

Portland, OROctober 15-17, 2004

NARM Also Attends:

National Conference of StateLegislators

Salt Lake City, UTJuly 19-23, 2004

Council on Licensure, Enforce-ment and Regulation (CLEAR)

Kansas City, MOSeptember 29-Oct 2, 2004 

American Public Health Associa-tion (APHA)

Washington, DCNovember 7-11, 2004

National Organization for Com-petency Assurance (NOCA)

Miami, FLNovember 17- 20, 2004

Who is the NARM Board of Directors?

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answers. Incorrect answers should beplausible to an inexperienced appren-tice, but lacking some understanding ofthe situation. NARM seeks LOTS ofideas. The Item Writers will likely revisethe scenario and answers, but IDEASare what we need to start with. TestSpecifications for the Written Examcan be found in the Candidate Infor-mation Bulletin, or on the web atwww.narm.org. Send any ideas by emailto testing@narm.org, or to the NARMTest Dept, P.O. Box 7703, Little Rock,AR 72217-7703.

� �NARM Accountability CommitteeYear End 2003 Reportsubmitted by Shannon Anton, CPM Director of Accountability

Committee Report s

NARM Accountability Committeefollows Peer Review and GrievanceMechanism policies and addressescomplaints against CPMs. Legal adviceis sought when appropriate. NARMBoard receives regular updates regard-ing the activities of AccountabilityCommittee.

In 2003 NARM received one com-plaint, which was addressed in localpeer review. Three recommendationswere made to the midwife for improv-ing her practice. Two complaints origi-nating in 2002 were resolved in 2003.One was addressed by local peer reviewand the other complaint was with-drawn. NARM revoked one CPM cre-dential due to noncompliance withGrievance Mechanism requirements.

Since the beginning of the CPM cre-dential in 1995, this committee has re-ceived sixteen formal (written) com-plaints. These complaints involvedseven CPMs, with two CPMs each fac-ing three separate complaints.

Two complaints: Must be cleared be-fore midwives may apply for recertifi-cation may be made after two years.)

Ten complaints: Heard in local PeerReview. One proceeded to the Griev-ance Mechanism.

Five complaints: Initiated implementa-tion of NARM�s Grievaevance Mecha-nism following Peer Review.

The outcome of two complaints heardin Peer Review found no fault with theCPM; in one of these instances theconsumer was dissatisfied with thatoutcome and filed a second complaintto initiate the Grievance Mechanism.The outcome of the Grievance Mecha-nism proceedings reached the sameconclusion.

NARM has revoked two CPM creden-tials, one in 2000 and one in 2003.Both revocations were due to noncom-pliance with Grievance Mechanism re-quirements.

Sharon K. Evans, CPM, LMPolicy Management

Shannon Anton, CPMVice-ChairpersonAccountability

Joanne Gottschall, CPMSpecial Projects

Robbie Davis-Floyd, Ph.D.Anthropologist/Writer/EditorPublic Member

Ida Darragh, CPM, LMBoard ChairpersonTesting Department

Carol Nelson, CPM, LMTreasurer

Debbie Pulley, CPMPublic Education & AdvocacySecretary1-888-84BIRTH

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Committee Report s� �Test Department Report for 2003

5. Recertifying NARM�s QualifiedEvaluators, who administer theNARM Skills Assessment to thePEP candidates. One hundredand five QEs have been trainedby NARM to administer the SkillsAssessment since 1996. NARMrequires recertification of theQEs every five years, a policy thatwas implemented in 2003.Twenty-four QEs recertified bydocumenting inter-rater reliabil-ity on the Skills Assessment,bringing our current total of ac-tive QEs to fifty-one.

6. Administering the NARM SkillsAssessment to fifteen PEP candi-dates, and the NARM Written Ex-amination to 125 candidates.

7. Attending the annual NOCA andCLEAR conferences, and partici-pating on the NOCA ProgramCommittee and the CLEAR Pro-gram Committee andCredentialing and Exam Re-sources Committee.

8. Revising the NARM WrittenExam reference list; NARM re-viewed many new books on mid-wifery and chose ten new mid-wifery texts to add to the recom-mended reading list for theNARM Written Exam.

NARM TestingThe NARM Skills Assessment was

administered to 15 PEP candidates in2003. The assessment was taken bycandidates in 12 states and Mexico.NARM began to require recertificationof Qualified Evaluators with a two-yeargrace period which ended in Decemberof 2003. QEs must maintain certifica-tion as CPMs and must recertify asQEs every five years. Of the 105 CPMswho have trained as QEs since 1996,54 have been removed from the active

list due to inactivity, retirement, or per-sonal choice. Ten CPMs were trainedas QEs in 2003, bringing the activetotal to 51 QEs in 28 states andCanada.

The NARM Written Examinationwas given to 125 candidates in 2003.Seven took form E and 118 took formG. Sixty candidates were taking theexam to complete the CPM certifica-tion process. Sixty-five candidates weretaking the exam for state licensure.Eleven states currently administer theNARM Written Exam as a state licen-sure exam. These states are Alaska, Ar-kansas, Arizona, California, Colorado,Louisiana, Montana, New Mexico,South Carolina, Texas, and Washing-ton. An additional eight states requirethe CPM or the Exam portion of theCPM for licensure: Delaware, Florida,Minnesota, New Hampshire, New Jer-sey, Oregon, Tennessee, and Vermont.NARM currently offers the Written Ex-amination at the eleven state agenciesand at nine University Testing Centersin Florida, Iowa, Massachusetts, Mary-land, Ohio, Oregon, Tennessee, Utah,and Vermont.

Test DevelopmentThree item writing workshops were

given in preparation for developmentof Form H of the exam: Boston, Mass(Oct 2002), Lakeland, Fl, (June 2003),and Nashville, TN (June 2003).Twenty-seven people took the work-shops, writing 95 items either duringthe workshops or afterwards. These 27CPMs represented 12 states: Alabama,Arkansas, California, Florida, Georgia,Kansas, Maryland, New Hampshire,New Jersey, Tennessee, Texas, and Ver-mont.

Items from the workshops were writ-ten by teams and reviewed by the largergroup. Items written outside of theworkshop were added to the NARMExam database.

All items were reviewed again onconference calls by teams of five CPMsin September 2003, and again by theNARM Board in October. Telephonereview teams discussed groups of 17-27

Ida Darragh, Director of Testing

Major Tasks of the Test Depart-ment in 2003 included:

1. Maintaining yearly renewal ofNARM�s accreditation by the Na-tional Commission ofCredentialing Agencies (NCCA),the accrediting arm of the Na-tional Organization for Compe-tency Assurance (NOCA).

2. Presenting Item Writing Work-shops in June in Florida andTennessee. Twenty sevenpeople were trained to write testquestions for the NARM itembank, writing test questions ei-ther during the workshops orafterwards. These 27 CPMs rep-resented 12 states: Alabama,Arkansas, California, Florida,Georgia, Kansas, Maryland, NewHampshire, New Jersey, Tennes-see, Texas, and Vermont.

3. Developing Form H of the NARMexam, using both new and oldquestions from the item bank.Form H was cut-scored in Octo-ber at the MANA conference, andwill be administered in Februaryof 2004.

4. Presenting the CPM in statesconsidering licensure. Represen-tatives from the NARM Board,along with our testing consult-ant, Dr. Jerry Rosen from Person-nel Measurement Center, spoketo the New York Board of Mid-wifery about the NARM Examand the CPM credential, in a pre-sentation developed to promotethe acceptance of the exam andcredential in states that do notcurrently license direct-entrymidwives using the CPM creden-tial.

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� �Policies Year EndReport � 2003Sharon K. Evans, CPM, CDMPolicies Management

It became apparent that NARMneeded a way to categorize, cross-refer-ence and easily locate various docu-ments. In 2003 a computer databasewas developed to organize NARM�svolumes of documentation. As of Feb-ruary 6, 2004, 106 entries have beenmade into the new database. The goalfor 2004 is to input as much data aspossible as well as fine-tune the data-base and explore ways to merge docu-ments with it.

questions. The reviewers discarded sixitems, and revised many. The NARMBoard discarded one other item andrevised several more. Two pairs wereconsidered similar enough that theywill not be used on the same version ofthe exam, leaving 85 new items to beused on Form H.

Eighty-five questions were removedfrom Form G and replaced with newitems to make form H. Some ques-tions that were kept on the exam wererevised slightly. For example, if adistracter was not chosen by anyonethen it might be replaced after re-refer-encing.

The questions for Form H were cutscored using the modified-Angoffmethod on October 30, 2003 at theMANA conference in Austin, Texas.Both old and new questions were cut-scored.

NARM Participation in NOCAand CLEAR

The NARM Test Department andBoard of Directors participates in thenational conferences of both the Na-tional Organization for CompetencyAssurance and the Council for Licen-sure, Enforcement, and Regulation. In2002, Director of Testing, Ida Darraghattended the NOCA conference in Or-lando, FL, in November and theCLEAR conference in Toronto,Canada, in September and businessmeeting in New Orleans, LA, in Janu-ary. In addition, Ida served on theNOCA program committee, and onCLEAR�s Exam Resources and Advi-sory Committee and Credentialing andExamination Issues committee.

Goals for 2004Test Department goals for 2004 in-

clude:� Training and working with more

Item Writers to create a largerdatabank of test questions.

� Continue working with NOCA andCLEAR, and maintaining our certi-fication with NOCA.

� Revision of the Qualified Evalua-tors training manual and the ItemWriter�s training manual. Presen-tation of Item writer workshopsand Qualified Evaluator work-shops.

� Participation on the weekly NARMBoard phone calls and annualmeetings.

� Scheduling of NARM Skills Assess-ments as needed, and of theNARM Written Examination on thethird Wednesdays of Februaryand August at regional sites andagain at the annual MANA confer-ence.

� �Treasurers ReportCarol Nelson, CPM

Income and Expenses 2003The year 2003 was a good year for

NARM from a fiscal standpoint. Weended the year with money in thebank and all expenses paid. The certi-fication process has taken a lot of fi-nancial resources. NARM was incor-porated in 1992 and to date we havespent over 1 million dollars on theCertified Professional Midwife pro-cess.

NARM�s main sources of incomeare from Test Sales and Applications.Applications include requests for ap-plications, certifications, and recerti-fications. Test Sales are from thestates that use the NARM exam intheir Licensures/Certification process.Occasionally we will get a grant for aspecific project such as the 2001 JobAnalysis. A Job Analysis every fiveyears or so is necessary to remain stateof the art in testing.

As the Treasurer for NARM, I be-lieve a balanced budget is the only fis-cally responsible way to run our orga-nization. Our challenge is to main-tain our resolve and momentum tofurther improve our financial posi-tion without knowing how many ap-plicants or test sales we will have forthe year. We need to not only maintain

a balanced budget, but we must thinkahead to projects of the future and besaving money for those projects. An-other Job Analysis in three years isone such project. To remain state ofthe art in testing this is a must. Otherprojects include continued work onour test such as Item Writing work-shops; work with the Qualified Evalu-ators and the Skills Assessment andcontinued promotion of the CertifiedProfessional Midwife (CPM) creden-tial, for a few examples.

We are looking forward to NARM�scontinued growth and a balanced bud-get in 2004.

With the growth of our certificationprocess and more Certified Profes-sional Midwives each year, we feelhonored to be doing our part to movemidwifery forward and to promote theMidwives Model of Care.

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� �NARM Applications Department Report2003 Year End

Committee Report stus must be established within 90 daysof the CPM expiration, and is main-tained annually for up to six years. In-active status is renewed each year byfiling an intent to be inactive and a feeof $35.00. During this period, inactiveCPMs will receive the CPM News andall NARM mailings, but may not usethe CPM designation or refer to them-selves publicly as a CPM or as certifiedby NARM. During the six-year period,an inactive midwife may renew the cer-tification by submitting the recertifica-tion form and fees ($150.00, 25 con-tinuing education hours, five hours ofpeer review, plus the recertificationform documentation.).

Expired CPMsCPMs whose certification has been

expired for more than 90 days, or whohave not declared inactive status, willbe given expired status and will be re-quired to follow the new policy on re-activation in order to be recertified.All of NARM�s policies regarding re-certification, certification status, orreactivation are available on the web atwww.narm.org

FinancesThe Applications Department re-

ceives fees for application packets,CPM applications, and recertifica-tions. In 2003 a total of $87,534.00was processed through the applicationsdepartment.

AuditsThe Applications Department gener-

ates random audits from applicantsand CPM�s recertifying. Items requiredare Practice Guidelines, an InformedConsent document, forms and hand-outs relating to midwifery practice andan Emergency Care Plan.

PreceptorsIn the 2003 Summer Issue of the

CPM News, notice was given that pre-ceptors in the NARM Preceptor Tablewere sent a survey letter requesting in-formation such as address confirma-

transcript or diploma etc), but so farhave not received the CPM application.

CPM�s88 New CPM certificates were issued

in 2003.

Table of Comparison:

Total number of CPM�s

2003 8932002 8042001 7242000 624

RecertificationThe Applications Department now

has a new Recert Table to keep track ofincoming and outgoing recertifica-tions. It became necessary to create theadditional database table for the Certi-fication and Applications Departmentsto check recertification informationsent and received between the two de-partments. Additionally, Debbie Pul-ley, Public Education and AdvocacyDepartment, can look in the recertifi-cation Table, should a CPM want toknow their status, or if the recertifica-tion information has been sent to theCertification Department for process-ing.

Table of Comparison

Number of Recertifications

2003 1262002 1432001 1482000 72

Inactive StatusAs of January 1, 2004 we had seven

people take advantage of the new inac-tive status.

Inactive CPMs will continue to re-ceive the CPM News and may recertifywithin a six-year period. Inactive sta-

Carol NelsonSummertown, TN

NARM Applications DepartmentP.O. Box 420Summertown, TN 38483888-842-4784applications@narm.org

The big change in the North Ameri-can Registry of Midwives (NARM) Ap-plications Department in 2003 wasmoving the department from Alaska toSummertown, TN. The ApplicationsDepartment had been housed in Alaskafor most of the Certified ProfessionalMidwife (CPM) history, which beganwith the first application in 1994.Carol Nelson, Board member, is nowoverseeing the Applications Depart-ment. The move took place in Septem-ber and all correspondence should goto the new address (see above) Pleaseinclude your Social Security numberand CPM number in any correspon-dence.

Our thanks go out to Sharon Evans,NARM Board member, Anna Sippey,Dianne Osborne and Natalie Olsonfor the work they have done throughthe years to keep the applications officestate of the art and running smoothly.We thank them also for making themove a very smooth one.

In the year 2003 the NARM Applica-tions Department received a total of 72applications.

�There were 204 applications sentout to people requesting applicationpackets.

�There are 23 candidates waiting totake the February written exam, andtwo candidates waiting to take theirskills exam.

�There are 30 application files wait-ing for some piece of information, i.e.,reference letters, current CPR cards,transcript or diploma etc. to completetheir CPM application.

�There are 102 files where we havereceived information (reference letters,

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tion, numbers of births attended, etc.In an effort to update the vital infor-mation in this table, NARM is request-ing that all CPMs who are or who an-ticipate becoming a preceptor in thenext year please fill out the enclosedsurvey questionnaire. If you know of anon-CPM midwife who is a preceptor,please encourage that midwife to par-ticipate by volunteering, the informa-tion. The letter and survey is as fol-lows:

Dear Midwife Preceptor:Your name is in our database be-

cause you are listed as a preceptor forat least one NARM CPM applicant.We are contacting you to obtain neces-sary additional information for ourdatabase of midwifery preceptors.

NARM is dedicated to the preserva-tion of apprenticeship and the Mid-wives Model of Care. With that goalin mind, a Preceptor Database has beendeveloped for the purpose of research toprove the validity of competency-basededucation.

The purpose of this letter is twofold:1) To inform you of the require-

ments for preceptors of NARMPEP applicants.

2)To obtain general information toupdate the database.

A preceptor for a NARM PEP appli-cant is required to affirm they are aprimary midwife, that the applicantacted as a primary under supervision,and they were physically present in thesame room in a supervisory capacityduring that care in which the applicantacted as primary under supervision.

On Verification of Birth ExperienceForm (114), preceptors also affirm thefollowing number of procedures withthe applicant:

· Number of births· Number of initial prenatal exams· Number of prenatal exams· Number of newborn exams

Preceptors must affirm they are:· A nationally certified midwife

(CPM, CNM, or CM); or· Legally recognized in a jurisdic-

tion, province, or state as a practi-tioner who specializes in mater-nity care, or

· A midwife practicing as a primaryattendant without supervision fora minimum of three (3) years andfifty (50) out-of-hospital.

NARM Preceptor Survey

Name: ________________________________________________ Date _______________________________________

Address: _______________________________________________ Phone: (W) __________________________________

City: _____________________ State: ____ Zip: ___________ (H) _________________________________

I am/am not a credentialed midwife (circle one).(If applicable) my title is:_____ (Please spell out if different from the list of titles below) ___________________________Are you interested in becoming a CPM at this time? _______ If not please share your reasons for this decision. ___________________________________________________________________________________________________________

I am: q A nationally certified midwife (CPM, CNM, or CM); orq Legally recognized in a jurisdiction, province, or state as a practitioner who specializes in maternity care, orq A midwife practicing as a primary attendant without supervision for a minimum of three (3) years and fifty (50)

out-of-hospital births.I have been a primary midwife since (fill in date):____________________________________I have been preceptor for (fill in number)_______________ of NARM CPM applicants.I have attended (fill in number)_________________births as a primary midwife.

NARM greatly appreciates your time in this matter. Please either send the information to the Applications Department viaemail (applications@narm.org) or mail it to NARM Applications Department.___________________________________________________________________________________________________

In addition preceptors are asked toaffirm the length of time (fill in thedate) they have been a primary midwifeand the number of births they have at-tended as a primary midwife.

NARM may request additional infor-mation from preceptors, such as clientcharts.

Preceptors may also be audited forPractice Guidelines, Informed ConsentDocumentation, forms and handoutsrelating to midwifery practice andemergency care plan. Refusal to pro-vide additional information may de-tain the application process or may begrounds for denial of application ap-proval.

NARM greatly appreciates your co-operation in this matter.

By being a midwifery preceptor, youare part of a growing movement witheach one of you making a difference inmidwifery and access to midwivesacross the nation, regardless of theroute of entry you have chosen into theprofession. Together we can make adifference in midwifery availability forout grandchildren and for their chil-dren.

CPM NewsP.O. Box 420Summertown, TN 38483

ADDRESS SERVICEREQUESTED

PRESORTED STANDARDU.S. POSTAGE

P A I DSummertown, TN 38483

PERMIT NO. 9

� �Can NARM Give Your Name to Those Who Request Information?

NARM often receives requests from people who want to find a CPM in their area. Because of the volatile legal situa-tions in some states, NARM has a policy of not releasing names of CPMs unless permission has been received from themidwife. If you wish to give permission for the release of your name, you must notify NARM�s public education office.You may do this by sending the statement below to info@narm.org, or by mailing it to Debbie Pulley, CPM, NARM PublicEducation, 5257 Rosestone Drive, Lilburn, GA 30047.

� �Release Form

I, (print/type name)____________________________________ give permission for NARM to release my name as a

CPM. This becomes effective on (date)___________________. I understand that to revoke this permission, I must

send notice in writing to the same address.

Current address:_______________________________________________________________

Current city, state, zip:__________________________________________________________

Current phone:_______________Current e-mail (if available):_____________________________

Current status: ___ legally recognized (licensed, registered) by state, or___ no legal recognition by state

� �Information Request s