82 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
for the entry- level nurse- midwife, learning materials in self- contained packages, inde-
pendent and self- paced learning, and self- assessment measures by which students could
decide if they were ready for testing. By 1979, the ACNM established core competen-
cies in nurse- midwifery, which specified the body of knowledge, skills, and behaviors
expected of nurse- midwife graduates (Avery, 2005). The core competencies served as a
guide for formulating curricula, accrediting nurse- midwifery programs, and setting the
standards for the national certification exam.
As the three branches of military service in the United States had difficulty recruit-
ing and retaining obstetricians, the Air Force started its own nurse- midwifery program
at Andrews Air Force Base in Maryland in 1973 (Rooks, 1997). The ACNM, however,
would not accredit its program. The Air Force affiliated with Georgetown University
in 1975 and offered its base as a clinical site. The Army formed its own graduate nurse-
midwife program in 1974 in affiliation with the University of Kentucky and offered Fort
Knox as the clinical site. The Navy chose to send its personnel to already- established
nurse- midwifery programs (Rooks, 1997).
By the 1980s there were 21 accredited nurse- midwife educational programs rang-
ing from 9- to 18- month certificate programs to two to three master’s- level programs
(Burst & Thompson, 2003). In 1980, the Education Program Association opened the first
distance learning program for family NPs and physician assistants desiring to practice
midwifery in publicly funded clinics in California. This innovation allowed students to
continue to live in their own communities, while rapidly completing the requirements
for graduation. By 1989, the FNS had established its own distance learning by establish-
ing the Community- Based Nurse Midwifery Program (CNEP) in order to increase rural
access to nurse- midwifery education. CNEP affiliated with Francis Payne Bolton School
of Nursing at Case Western Reserve University in order to offer a master’s degree in
nursing (Burst & Thompson, 2003).
Although the number of midwifery programs increased to 28 by 1984, enrollment
dropped between 1984 and 1986, largely as a result of the malpractice crisis (Burst &
Thompson, 2003; Rooks, 1997). By 1988, however, the Robert Wood Johnson Foundation
provided a grant for scholarships to educate and recruit nurse- midwifery students
to work in West Virginia after graduation (Burst & Thompson, 2003). The program
increased the number of nurse- midwives in West Virginia from four in 1989 to 20 in
- Between 1991 and 1993, federal financial support provided nurse- midwifery edu-
cation in exchange for working in underserved areas. In 1991, the ACNM task force
also identified barriers for nurse- midwives and established the goal of 10,000 practic-
ing nurse- midwives by 2001. In response to a 50% decrease in practicing obstetricians
and 20% increase in births, the Florida Midwifery Resource Center established a call
to action in 1993 to educate 600 additional nurse- midwives by the year 2000. By 1993,
67% to 70% of nurse- midwives were master’s prepared and 4% to 5% were doctorally
prepared (Burst & Thompson, 2003; Rooks,1997).
Between 1982 and 1997, ACNM Division of Accreditation (now the Accreditation
Commission for Midwifery Education [ACME]) only provided accreditation for nurse-
midwifery programs (2010). In 1997, however, the ACNM Division of Accreditation rec-
ognized the certified (direct entry) midwife credential. There are only two direct- entry
midwifery programs recognized by the ACNM, including the Midwifery Institute at
Philadelphia University in Philadelphia, Pennsylvania, and State University of New York
(SUNY) Downstate Medical Center Midwifery Education Program in Brooklyn, New
York. Graduates of this program must meet the core competencies and may sit for the
national certification exam. The ACNM issued a position statement (Mandatory Degree
Requirements for Entry Into Midwifery Practice) in 2010 that a graduate degree (mini-
mum master’s degree) is required for entry into clinical practice for both nurse- midwife