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Quick Facts :
What Is a Nurse Midwife?
Midwifery encompasses the work of certified midwives as well as certified nurse midwives. Both of these positions offer a comprehensive range of health services for women, from their first menstrual period until menopause. Some of the specific services included under the umbrella term “midwifery” include:
- Admit and discharge women from a hospital or birthing center
- Disease prevention and management
- Family planning
- Gynecological and other types of exams
- Labor and delivery coaching
- Newborn care during the first four weeks of life
- Postpartum care
- Preconception care
- Pregnancy care
- Prescribe medication, including oral contraception and controlled substances
- Primary care
- Prevention counseling and treatment of sexually transmitted diseases for women and their male partners
- Wellness counseling and education
Women often seek midwives for their initial in-depth assessment as well as for diagnosis and treatment of a variety of conditions. A certified nurse midwife works with female patients and their families in many different types of settings, the most common of which are hospitals, birthing centers, private practice offices, patient homes, and public health systems. Midwives differ from traditional obstetricians in that they usually include the entire family in pregnancy care, the birth plan, delivery, and aftercare.
The CNM and CM Credential
Certified Nurse Midwife (CNM)
A certified nurse midwife (CNM) has obtained advanced educational credentials in both midwifery and nursing. In addition, midwives have successfully completed the certification program required by the American Midwifery Certification Board (AMCB). Each state sets its specific requirements to which a midwife must adhere to become certified, including the training that qualifies as an acceptable post-secondary degree. A certified nurse midwife is a registered nurse (RN) who has completed coursework approved by the Accreditation Commission for Midwifery Education (ACME).
Before working as a certified nurse midwife, RNs must pass a national board exam administered by the ACMB, which also requires licensed midwives to complete and pass a recertification exam once every five years.
Certified Midwife (CM)
The “certified midwife” credential indicates that the individual graduated from college with a non-nursing degree. However, he or she must meet the requirements established by the AMCB in addition to state-of-residency requirements. The certified midwife also must complete a degree program accredited by the ACME and pass the nationwide AMCB board exam. Typically, a certified midwife holds a bachelor’s degree in a health-related field, but he or she is not a registered nurse. Individuals with either the certified midwife or certified nurse midwife title have the same basic responsibilities, although some patients may prefer to work with a certified nurse midwife because of the RN credential.
Midwifery Licensure Requirements
A benefit of earning the certified nurse midwife credential is that these professionals not only can offer a wider range of services, but they are also capable of performing more complex treatments. Additionally, they may be more qualified from a legal standpoint. Since it’s in the patient’s best interest to work with a highly educated and certified nurse midwife, many states now require midwives to have a graduate degree in nursing to become eligible for licensure. In 2012, the ACME required every program it certifies to offer either a Master of Science in a general health care field, a Master of Science in Nursing, or a Doctor of Nursing Practice degree.
A certified nurse midwife can practice in all 50 states as well as in the District of Columbia. The role of a nurse midwife is legally recognized in Delaware, Missouri, New Jersey, and New York. Missouri is one of the few states that does not require licensure for certified midwives. Since state laws and guidelines vary greatly, students must understand and fulfill their state requirements when obtaining licensure and establishing a practice.
Steps to Become a Midwife
A midwife is a healthcare professional trained to help women throughout pregnancy and after the birth. In addition, midwives are trained to administer care throughout labor and delivery, as well as during the prenatal and postpartum stages. Midwives perform a variety of services to meet a mother’s physical, emotional, and psychological needs throughout pregnancy and after delivery. Midwives primarily provide natural and individualized support and typically only use technological interventions when needed. Women who seek the services of a midwife often have a specific interest in natural childbirth and individualized care.
Midwives can perform examinations, prescribe contraceptives and medications, administer gynecological treatment, educate women about health, and provide counseling. Often, midwives help women give birth at home or in the environment of their choice, or they may work in a hospital setting to help those women who choose a more modern-day form of childbirth. To become properly certified, a prospective midwife must first complete a midwifery education program.
Midwives provide essential support to women during a very important time in their lives. If you would like to become a midwife, you must possess a number of qualities: good communication skills, healthcare training, and a compassionate nature. Women seek the services of the midwife at a vulnerable time in their lives when they need comfort and unwavering support. The midwife must be able to fulfill all these needs – and more.
1. Earn a Nursing Diploma, Associate of Science in Nursing, or Bachelor of Science in Nursing (BSN)
Individuals begin their career as a certified nurse midwife by first earning a Bachelor of Science in Nursing (BSN), a nursing diploma, or an Associate of Science in nursing (ADN). While studying for these programs, nurses gain real-world practical skills and theoretical knowledge. Whether you’re studying for a BSN, an ADN, or a nursing degree, you will acquire hands-on instruction that will assist you during your career in the nursing profession.
While earning their degree, students are expected to develop a mastery of a variety of topics, including ethics, anatomy, fundamentals of nursing, pathophysiology, microbiology, human behavior, health assessment, and nutrition. This wide range of topics helps nurses develop an understanding of the fundamental principles of nursing.
While pursuing their degree, nurses typically complete clinical hours during which they observe nurses in real-world clinical settings. For students, observation provides a realistic glimpse into the everyday duties of the nursing profession and the types of situations they will encounter in their future careers. During the training, students are taught leadership skills and the importance of continuing education. Nurses must become lifelong learners who are always looking for an opportunity to better themselves.
2. Pass the National Council Licensure Examination (NCLEX-RN)
Once a nurse graduates from a degree program, the next step is to pass the NCLEX-RN exam. Also known as the “National Council Licensure Examination,” this test measures a potential nurse’s understanding of the fundamentals of nursing. Successfully passing this exam is required of every nurse in the United States.
A national computerized exam, the NCLEX-RN test is scored by the National Council of State Boards of Nursing (NCSBN), a non-profit organization that regulates healthcare standards in the U.S. The test is designed to ensure that all nurses begin their careers with the same basic knowledge and skill set. Standardization in expectations means that all patients across the U.S. can expect to receive an established standard of care wherever they are.
Before the student can take the test, he or she must first apply for a nursing license. The student submits the application for a license to receive an examination candidate bulletin, which qualifies him or to sit for the test.
The NCLEX-RN includes multiple sections that measure a nurse’s competency, such as:
- Basic Care
- Management of Care
- Health Promotion and Maintenance
- Safe and Effective Care Environment
- Reduction of Risk Potential
- Physiological Adaptation
- Psychosocial and Psychological Integrity
- Pharmacological Therapies and Parenteral Therapies
The questions on the computerized exam measure how well the nurse will be able to meet the needs of patients suffering from a range of health problems as well as injuries and illnesses. The computer bases each subsequent question on the way that the student answered previous questions, with the goal of revealing the full scope of the nurse’s knowledge and ability to think through problems.
To prepare for the test, the student must study a range of topics, including infection control, basic care, pharmacology, disease prevention, management of care, and safety. Find additional information about the test on the NCBSN website.
After the nurse passes the NCLEX-RN exam, he or she can begin work as a registered nurse. To become a midwife, the nurse must obtain an additional two to four years of experience in a midwife-related field. Working as an RN allows individuals the opportunity to acquire a bedside manner and expertise in patient care, both of which help prepare them for their future careers as midwives.
Most graduate-level nurse midwife education programs require their applicants have at least two years of experience working as an RN. Before applying to a midwife program, the applicant may want to work in women’s health, labor and delivery, neonatal nursing, or an ICU or pediatric care program.
3. Pursue Professional Development Opportunities
While working as a registered nurse, prospective midwives should pursue professional development opportunities at local hospitals, outpatient facilities, or doctors’ offices to gain insight into working as a midwife.
Volunteer-abroad opportunities also exist. As health care professionals, these volunteers provide important services to international communities. This volunteer work enables the aspiring midwife to gain valuable insight and experience, while also providing the opportunity to develop connections with healthcare professionals around the world.
Prospective midwives also can get experience by connecting with nursing organizations. Nationally recognized organizations provide information about conferences and events, produce publications, and give nurses networking opportunities.
4. Earn a Graduate Degree (Master’s Degree or Higher) from a Program Accredited by the Accreditation Commission for Midwifery Education (ACME)
Once an RN has obtained the required experience, the next step to becoming a certified nurse midwife is to earn a graduate degree from a program accredited by the Accreditation Commission for Midwifery Education (ACME). Acquiring a master’s degree helps certified nurse midwives progress to advanced levels of practice where they can provide a higher level of patient care. While many nurses obtain a master’s degree to become a certified nurse midwife, some go on to pursue a doctorate.
Typical program goals for a master’s program in midwife nursing include learning how to manage conditions within the scope of practice and how to treat patients in an ethical manner. Certified nurse midwives learn how to encourage patient autonomy and how to analyze, interpret, and apply recent research to daily practice. During their time in school, CNMs are taught the communication skills necessary to work with patients, their doctors, and other health care professionals.
Essential Skills & Knowledge
Master’s programs teach many of the skills essential to help students assume an advanced practice role. A CNM must be able to integrate theory and research into their practice when working with women and children. Additionally, they must utilize leadership skills in the workplace to effect change and advocate for their patients. They must be able to design and implement health care strategies for expectant or new mothers and have the ability to adapt to a constantly changing environment to deliver the best possible care to their patients.
A typical master’s program for certified nurse midwives requires students to complete clinical coursework on subjects such as pathophysiology, pharmacology, health assessment, leadership, research, advanced primary care nursing, antepartum care, intrapartum care, newborn care, and postpartum care.
Students are also required to complete clinical rotations to gain experience in a range of facilities with patients who have a variety of needs. Clinical rotations prepare certified nurse midwives to work within a team, evaluate patients, and apply theories and research to real-life situations. During clinical rotations, students must obtain experience in treating women in all cycles of prenatal, labor and delivery, and postpartum care.
5. Get Certified by the American Midwifery Certification Board (AMCB)
The American Midwifery Certification Board (AMCB) certifies nurse midwives (CNMs) and certified midwives (CMs). Certification is important to ensure quality and consistency in the midwifery profession.
Certification sets the national standard for the midwifery profession to ensure that practicing midwives possess the skills and training necessary to deliver quality care to women and their babies. Regulation of the profession helps to enforce patient confidence in midwife services and to ensure that using midwives as an alternative method of delivering children remains relevant to patients. The certification process also instills confidence in beginning midwives, who can begin their professional careers knowing they have the skills that employers desire and are fully equipped to perform successfully on the job.
Topics on the test include physical exams, physiology, pharmacology, and clinical decision-making. AMCB examinations are computer-based, and official results are provided at the site, on the day of testing. The test consists of 175 multiple-choice questions.
6. Search for Jobs / Enter the Workforce
Certified nurse midwives (CNM) typically work in facilities such as hospitals, doctors’ offices, clinics, university medical centers, and private practices, while certified midwives (CM) often work in their patients’ homes. After completing a graduate-level program and obtaining certification, the nurse midwife is prepared to seek a position.
Many midwives start their job search before graduation. Researching the types of positions available in the area, their salaries, and the locations of the best positions will help certified nurse midwives determine the focus of their job search after graduation. Find this information on job boards and facility websites. And don’t underestimate your professional contacts: Nurses who maintain their acquaintanceships with fellow students, medical staff, faculty, and administrative personnel throughout their years in school often find that their contacts lead to a position after graduation.
Before beginning the job search, the midwife candidate must create a resume and cover letter. Again, having the names, email addresses, and phone numbers of professional references helps nurses prepare for their job search since this information is usually required on a resume.
For many nurses, one of the hardest parts of finding a job is the interview process. Many job candidates become nervous and experience difficulty in answering questions clearly and accurately. To help make this process easier, participate in mock interviews. Practicing interviews with other nurses, teachers, and HR professionals often help CNMs increase their confidence and become more experienced prior to interview situations.
During interviews, CNM candidates should communicate coherently and knowledgeably with the interviewer. Doing so demonstrates to the interviewer that the CNM has good communication skills, a useful talent when communicating with clients. CNMs who role-play interviews, edit their resumes thoroughly and perform research prior to the interview typically experience little to no difficulty in obtaining a position fairly quickly.
For the right person, a job as a certified nurse midwife is highly rewarding. Although the education and certification process can take many years, many midwives find the process is worthwhile, and the resulting career very satisfying.
Nurse Midwife Salary and Job Outlook
In May 2015, the U.S. Bureau of Labor Statistics (BLS) released a report indicating that the typical registered nurse midwife with a graduate degree earned a salary of $93,610 per year. This is the equivalent of $45.01 per hour in a full-time annual position. A median salary means that half of all nurse midwives earn more than this figure, while half make less. The BLS also reports the following salaries and percentile rankings:
- 10th: $50,310
- 25th: $73,460
- 75th: $112,340
- 90th: $132,270
The BLS predicts an annual growth rate of 4.4 percent for nurse midwives across the United States. In 2015, California, New York, Massachusetts, Georgia, and Florida had more individuals working as a certified nurse midwife or a nurse midwife than the other states. The median wage in these five states ranged from $88,350 to $137,040 in 2015.
Furthermore, the BLS research reveals the type of industry that employs the most individuals in this medical specialty: Physicians in private practice. In fact, in 2015, they employed several times the number of midwives than did outpatient care centers, offices of other healthcare practitioners, colleges, universities, professional schools, and specialty hospitals. Certified nurse midwives or nurse midwives also report the highest median salary when working for a physician in private practice, adds the BLS.