The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

About Midwives as Primary Care Providers

It has been my impression that, in theory, a "primary care case manager" should be able to care for normal cases independently and recognize/refer high risk to the appropriate specialist. Under that definition, CNMs would make excellent case managers for OB/Gyn clients.

I'm afraid, though, the reality would be that the HMO's would object to nearly every referral to a more highly trained (read more expensive) specialist and the CNM-case manager would be faced with the choice of continuing care for high risk cases without referral or consultation or jeopardizing her/his livelihood.

We already ARE primary care case managers in WA state, and practice independently. We do primary care women's health care. I think/hope the AMA is a dollar short on implementing this, as the mechanisms are already in place in some states, and ARNPs aren't about to lose ground. I provide lots of primary care type things. I also know when to refer, either back to a PCP, or to a specialist. In our area, we refer to specialists. Remember, they like the business too, and if you refer them clients because you like their care, they'll accept your referrals. Its the inappropriate referrals that gets one into trouble. I think the important thing is knowing your limits and not overstepping your bounds. Some plans call for the PCP to make the referral. It's touchy, however, under some contracts.