Expectant mothers now have more options at ECU Health when it is time to have their baby. That includes Certified Nurse Midwives, or CNMs, whose expertise lies in supporting those moms-to-be throughout their pregnancies, all the way to the delivery table. At ECU Health, qualified, experienced CNMs are now empowered to work within the full scope of their practice authority, a change that aims to improve health care outcomes for mothers and babies while better distributing provider workloads across maternal care teams.
As of April, independent CNMs at ECU Health with at least two years and 4,000 hours of clinical experience are now able to admit patients to the hospital, discharge patients from the hospital and write all notes and orders without the need for a physician’s co-signature or supervision.
CNMs deliver babies from “standard risk” pregnancies while consulting with physicians to identify cases that come with higher risks of complication or need procedures like C-sections. They continue to work in tandem with other members of the maternal care team like OB-GYN physicians.
“This was an incredibly important step forward to ensure that we are using our providers to their full scope of practice in order to improve access to care and broaden our services,” said Elaine Cudnik, executive director for Women’s and Children’s advanced clinical practice at James and Connie Maynard Children’s Hospital at ECU Health Medical Center. “There is a nationwide shortage of OB-GYN providers and ECU Health is not immune to the challenges in recruiting that specialty. We continue to augment our services with advanced practice providers and independent certified nurse midwives who can support that critical maternal service here at ECU Health.
Added Cudnik, “I think allowing independent CNMs to work to the top of their license brings an incredible value to the community that we serve and will only expand the access that we’re able to provide.”
On the day the change went into effect two CNMs — Sarah Sears and Margi Reither — were granted independent CNM privileges at ECU Health. Reither called it a monumental step and the result of decades of advocacy. She is grateful that ECU Health now grants qualified CNMs more freedom in scope of practice.
“It is great, professionally, to be able to take care of our own patients,” Reither said. “That’s what we are truly grateful for. We have had wonderful support from our OB-GYN team who agree this is a good, professional decision. This was truly a team effort between midwives, physicians and administrators.”
Sears said the change is empowering, and that it shines a light on how midwives are crucial parts of an OB-GYN team.
“It makes us feel seen,” Sears said. “There is certainly a feeling of respect not just in being able to work with my patients in a new way, but from the health system recognizing what we do and making our roles more visible.”
More importantly, the change is good for patient outcomes. Sears said midwifery care is shown to improve maternal and neonatal outcomes. When physicians and midwives collaborate, it allows providers to play to their own strengths. For midwives, that is recognizing and managing standard risk labor and delivery.
“Physicians really are needed for the high-risk things, the abnormal circumstances that can arise during a delivery,” Sears said. “As midwives, we are focused on the normal. It comes down to working together to make sure our approach fits each individual patient on a case-by-case basis.”
Dr. James Whiteside, department chair, Obstetrics and Gynecology, ECU Health and the Brody School of Medicine, played a critical role in helping expand the scope of midwifery practice at ECU Health when he arrived at the health system in 2022. He said further expanding midwives’ scope of practice to include independent care is an important step toward addressing clinician shortages that continue to strain maternal care nationwide.
“We saw an opportunity to expand the role of midwifery across our region and leverage independent scope of practice for these integral members of our care teams,” Dr. Whiteside said. “More midwives will help us address the real challenges facing rural delivery, specifically when it comes to resources and the number of clinicians we have available to provide high-quality care and reduce risk associated with delivery.”
Dr. Dan Dwyer, chief medical officer, ECU Health Community Hospitals and an obstetrician, said he is excited for the positive impact the change will have on maternal services in some of eastern North Carolina’s most rural communities. CNMs will have reliable teams they can work with and the ability to transfer care to another clinician, or to another facility, as needed, in the most efficient way possible.
“Looking ahead, we are excited to introduce independent Certified Nurse Midwives (CNMs) into care teams throughout ECU Health’s rural community hospitals,” Dr. Dwyer said. “Teamwork is a cornerstone of our culture, and we are committed to recruiting and nurturing skilled CNMs whose dedication and values align with our mission. These professionals are essential to delivering the highest quality care in rural settings.”
Serving 29 counties and operating eight rural birthing locations, Dr. Dwyer said ECU Health faces a range of challenges — not least of which are recruiting and retaining talented healthcare professionals.
“To address these needs, it is imperative that every member of our health care team — including independent CNMs — practice at the top of their license. Creating an environment where everyone feels valued and welcomed is central to our approach,” he said. “The collaborative efforts of CNMs, family practitioners and obstetricians, supported by advanced digital technology and a robust network of sub-specialists, are critical to ensuring patients receive timely, appropriate care wherever they are. We take great pride in the strength of our teamwork and remain confident that, together, we can overcome future challenges and continue to provide exceptional care for our communities.”
ECU Health has maintained labor and delivery services at its rural hospitals. Midwives’ knowledge and skills play a prominent role in ensuring that quality care is available to even more patients in eastern North Carolina, Cudnik said.
“We strongly believe in midwives’ practice and their ability,” Cudnik added. “We strive to create a place where that expertise is valued and leveraged in a way that supports our unique rural academic mission. Not only will expanded access to care benefit community hospitals and rural communities, these midwives will also have a chance to teach students and residents at our ECU Health Medical Center. We’re excited to see the independent CNM program grow.”