A certified nurse midwife is a registered nurse who has completed special training in the care of normal pregnancy, childbirth, family planning and general women's health care. To become certified, the nurse-midwife must complete a course of study in an accredited educational program and pass a rigorous examination administered by the American College of Nurse-Midwives. The certified nurse-midwife provides safe, low tech, personal care for women and their families. The CNM is considered by many to be an expert in normal childbirth, but is trained to care for moderately complicated pregnancies in consultation with the physician. In uncomplicated pregnancies and births, the patient and her baby receives all their care from the midwife. Most nurse midwives deliver babies in the hospital, although some do home births as well. Midwives currently deliver about 9 per cent of the babies in the United States, and this number is rising every year. There are currently over 7500 midwives working in the USA, most in populated areas. Nurse-midwives are frequently employed in large hospitals that serve a mainly low-income population, because they have been found to reduce maternal and infant morbidity and mortality (illness and death) in these populations very effectively. Before and after pregnancy, the CNM assists clients in maintaining reproductive health, providing well women gynecological care, treatment of common gynecological problems, pre-conception counseling, birth control information and prescription, including birth control pills, IUD, Ortho Evra (the patch), Nuva Ring(a vaginal ring placed once a month), natural family planning and barrier methods. The CNM also provides postmenopausal women with routine gynecological services, including prescription of estrogen replacement therapy. During pregnancy, she monitors the mother and baby's health with frequent prenatal visits. These visits may take 30 to 60 minutes each visit. Besides monitoring the pregnancy, education on nutrition, exercise, childbirth methods, infant health, and what to expect as parent is taught. During labor, the CNM evaluates the progress of labor, and provides ongoing emotional and physical support. Most CNM's feel their main role is to facilitate the natural process of labor, so that the mother can deliver her baby as naturally and with as few interventions as possible. The CNM assists the mother to give birth, examines the newborn, repair any damage to the birth canal, and facilitates family bonding. Nurse-midwives offer personalized care Nurse-midwives recognize that every client is different and therefore requires individualized attention to discuss their specific needs. Nurse-midwife care improves birth outcomes Care provided by nurse-midwives is characterized by distinctly low rates of induced labor, episiotomies, cesarean sections, or forceps births. Their safe, personal care helps women to have the healthiest babies possible. Nurse-midwives emphasize patient choice A considerable amount of freedom is offered to nurse-midwives clients who are encouraged to find the most comfortable position or activity to help ease the pain of labor and expedite delivery. Nurse-midwives provide high quality care equal to that of physicians The Department of Health and Human Services' Office of Inspector General says that nurse-midwives provide better care than doctors in service areas that depend on communication with patients. Nurse-midwives treat birth as normal Nurse-midwives understand that most births are normal and not a high-risk situation waiting to happen. Kenneth Bell, M.D., an obstetrician and area associate medical director of the Orange County, CA branch of Kaiser Permanente HMO said, "Nurse-midwives focus on the normal, they celebrate the normal, and their incentive is to keep the normal, normal." Patients are satisfied with nurse-midwife care Studies have shown that women are satisfied with nurse-midwife care and can expect obstetric outcomes similar to those associated with traditional physician care. Nurse-midwives care for women throughout their lives Nurse-midwives include postpartum, newborn care, gynecology, family planning and many other facets of preventive health care in their scope of practice. Nurse-midwives have a long history of providing care to women Nurse-midwives have a rich history of helping women from all walks of life give birth and stay healthy.