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A Licensed Certified Professional Midwife (LCPM) is a healthcare professional licensed and certified to care for women and families throughout pregnancy, childbirth, and the postpartum period in the state of Kentucky. Other states may license CPMs but have a different creditionaling title for them. For example, in Tennessee, the correct creditial is CPM-TN. This article will primarily deal with Kentucky's LCPMs, who practice independently and provide care outside of hospital settings.  LCPMs practice withing the Midwifery Model of Care which focuses on supporting women through the natural process of childbirth in a holistic and personalized way. Midwives help care for both the mother and baby during pregnancy, birth, and afterward, while encouraging minimal medical intervention when possible. They build strong relationships with mothers, respecting their choices and involving them in decision-making. Midwives provide education to help mothers make informed choices and promote healthy lifestyles. While they focus on low-tech, natural childbirth, midwives also work with doctors to ensure proper care if complications arise. Scope of Practice in Kentucky The Midwifery Model of Care is the base for LCPMs, however, the state further defines the "scope of pracitice." Scope of practice is the set of rules that explains what a professional, like a nurse, doctor, or midwife, is allowed to do in their job. It’s based on their training and what they’re qualified to do safely. These rules help make sure that professionals don’t do things they aren’t trained for, keeping everyone safe and making sure people get the right kind of care. Certified professional midwives (CPMs) offer care throughout low-risk pregnancies, childbirth, and the postpartum period, as well as immediate care for newborns after birth. Their responsibilities include collaborating with, consulting, or referring to other licensed healthcare providers when necessary, ensuring appropriate care is provided based on the situation. Every state where CPMs are licensed will have laws and regulations defining the CPMs scope within that state. Education & Training Requirements To be an LCPM in Kentucky, the midwife must meet specific education and traning criteria. One of the following must be completed:
Certification & Continuing Education An LCPM must also maintain their NARM awarded CPM credential. Therefore they must complete, at minimum, enough Continuing Education Units (CEUs) to maintain a NARM CPM certification. Those minimum contact hours are as follows:
There are specific mandatory areas that are required for recertification of the CPM credential, such as having a current CPR and Neonatal Resusitation Program (NRP) certification, both of which are required to have a hands-on component (cannot be online only). Additionally, the CPM must have updated and current use of Practice Guidelines, Emergency Care Forms, Informed Disclosure, and Informed Consent documents. You can read more about the CPM requirements on the NARM website. Basic Practice Guidelines Licensed Certified Professional Midwives (LCPMs) are responsible for keeping accurate medical records for each mother, which include details like the client’s history, physical exams, lab results, medications, and information about labor, delivery, and postpartum visits. They must follow state and federal laws, such as HIPAA, to protect the client’s privacy. LCPMs offer full prenatal care for low-risk pregnancies, which includes reviewing medical histories, doing physical exams, providing educational support, and conducting necessary screenings. Clients can choose to refuse any recommended care, and the midwife must document those decisions and get written consent. During labor and delivery, LCPMs check the health of both the mother and the baby, monitor vital signs, and help with the birth process based on the mother’s preferences. After birth, they provide at least two postpartum visits (though usually more) to check on the well-being of the mother and baby, provide education, and screen for postpartum depression. LCPMs often conduct at least 5 postpartum visits, as they also care for the newborn in the first 6 weeks. They also help parents with newborn care and make sure the baby gets the required health screenings, like metabolic testing, at the right times. Parents can refuse certain tests for religious reasons but must provide a written objection. Collaboration, Consultation, and Referral with Appropriate Health Care Providers In Kentucky, certain conditions must legally result in a transfer of care. The mother has the right to refuse this transfer after being fully informed, but the midwife must carefully document the refusal and should try to connect the client with the right care provider. If the condition happens during labor or birth, or if the client is in immediate danger but refuses the transfer, the law requires the midwife to call 911 and continue giving care until another qualified health care provider takes over. Those conditions are as follows:
Kentucky also requires the following information to be documented for an emergency care plan for each client, should the need for transfer become necessary. Emergency care plans must include:
Conditions which require consultation with a physician: A consultation is a discussion between the midwife and the right health care provider. This can happen by phone, electronic messages, or video calls. Sometimes, the provider may need to evaluate the mother in person, through telehealth, or by reviewing her medical records. The midwife is responsible for starting consultations when needed and clearly sharing information with the provider. The consulting provider may give advice, information, care to the client or baby, or prescribe medicine or treatment to the client or newborn. The midwife must send all important client records to the consulting provider, along with a written summary of the mother's health history and current concerns. The midwife must fully document the consultation in the client’s records, including the following:
Referral or working together with another provider can only happen after the midwife talks with the client and the consultant, and everyone agrees. The midwife is responsible for making sure the mother understands each provider’s role and who is in charge of different parts of her care. The midwife should document the collaboration in the client’s record, including the name of the collaborating provider and the symptoms or conditions they are managing. The midwife stays in contact with the collaborating provider as much as needed to coordinate the client’s care. If the condition or symptom improves and both the midwife and the collaborator agree, the midwife takes over full care again, and this must be documented in the client’s record. If all care needs to be transferred, the midwife must talk with the mother as soon as possible, preferably in person. The midwife gives all important client records to the right providers or facilities, along with a written summary of the mother’s health history and current problems. If the condition or symptom that required the referral gets better, and both the midwife and the other providers agree, the midwife may take over full care again or work with the other provider in collaboration. All of this must be recorded in the client’s file. Certain conditions require consultation or referral, but the client has the right to refuse a medically recommended consultation, collaboration, or referral. The midwife must document the refusal in writing and advise the mother to talk about the condition and risks with a doctor or another licensed care provider. If the client still refuses, the midwife writes in the client’s record that the mother was informed of the condition, the need for consultation, collaboration, or referral, and the possible risks. The proper Informed Refusal Form must be signed. The midwife may continue providing care unless the client later agrees to the recommended collaborative care or referral. These conditions are all follows:
If any of the following conditions are found during the first or later assessments, the midwife must recommend consultation, collaboration, or referral. The mother can refuse, and this must be written down in the client’s record. The midwife may then continue to provide primary care.
I hope this article has helped you better understand what an LCPM is and does, whether you're looking for a midwife to support you through your own birth or are thinking of becoming an LCPM yourself!
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