Certified nurse midwives (CNMs) are educated in the two distinct disciplines of midwifery and nursing. They are licensed, independent healthcare providers who possess prescriptive authority in every state in the U.S., as well as American Samoa, Guam, Puerto Rico, and Washington D.C.
According to the American College of Nurse-Midwives (ACNM), the professional association representing CNMs in the United States, the work that midwives perform consists of providing initial and ongoing comprehensive assessment, diagnoses, and treatment of women before during and after pregnancy.
Under federal law, nurse midwives are identified as full primary care providers. Although commonly known for pregnancy-related care, the practice of midwifery actually embodies a full range of primary care for women throughout the lifespan, from adolescence to well beyond menopause.
The Practice of Midwifery in the U.S.
In 2012, CNMs attended nearly 314,000 births. Since 1991, the number of midwife-attended births in the U.S. has more than doubled.
Although midwives are best known for providing pregnancy care and attending births, about 54 percent of CNMs identify reproductive care as their main area of focus, while 33 percent identify primary care as their main job responsibility.
In 2012, almost 95 percent of CNMs attended births in hospitals, while just 2.6 percent attended births in freestanding birth centers and 2.5 percent attended births in private homes. Further, more than 60 percent of midwives named a physician practice or hospital/medical center as their principal employer.
The ACNM reported that after decades of research and a recent review of midwifery studies, researchers found that women that receive care from midwives (compared to physician care) had:
- Lower rates of labor induction/augmentation
- Lower use of regional anesthesia
- Lower rates of primary cesarean births (9.9 percent compared to 32 percent)
- Lower rate of episiotomies (3.6 percent compared to 25 percent)
- Higher rates of breastfeeding initiation (78.6 percent compared to 51 percent)
Nurse Midwife Job Duties and Responsibilities
Nurse midwives are educated, trained, and certified to provide the following services:
- Primary care
- Preconception care
- Family planning services
- Pregnancy care
- Childbirth
- Gynecological care
- Postpartum care
- Newborn care (first 28 days of life)
- Treatment of male partners for sexually transmitted disease
Midwifery care may be provided in any number of settings, including:
- Private practice
- Community and public health systems
- Ambulatory care clinics
- Birth centers
- Hospitals
- Private homes
The job duties and responsibilities of nurse midwives often include:
- Conducting annual examinations
- Writing prescriptions
- Admitting, managing, and discharging patients
- Ordering and analyzing laboratory and diagnostic tests
- Providing basic nutrition counseling
- Providing parenting and patient education
- Conducting reproductive health visits
The work of nurse midwives encompasses health promotion, disease prevention, and individualized wellness education and counseling.
CNM vs. CM: What’s the Difference?
The ACNM reported that as of March 2014, there were more than 11,000 certified nurse midwives (CNMs), while there were just 81 certified midwives (CMs) practicing in the U.S.
CMs, the newest designation in midwifery, are authorized to practice in just 5 states—Delaware, Missouri, New Jersey, New York, and Rhode Island—and possess prescriptive authority only in New York.
The single, distinguishing difference between a CNM and a CM is the pre-licensure graduate education required for national certification:
Certified Nurse Midwives, who are educated in both nursing and midwifery, possess graduate degrees and RN licenses, complete CNM programs accredited by the Accreditation Commission for Midwifery Education (ACME), and achieve national certification through the American Midwifery Certification Board (AMCB). CNMs have been practicing midwifery in the U.S. since the 1920s.
Certified Midwives, on the other hand, are educated solely in the practice of midwifery. These professionals possess graduate degrees in a health-related field other than nursing, complete ACME-accredited midwifery programs, meet specific health and science educational requirements, and achieve national certification through the AMCB.
Although both CNMs and CMs must both pass a national certification examination through the AMCB, they receive different professional designations due to their educational background.
How to Become a Nurse Midwife: Education and Certification Requirements
Becoming a nurse midwife follows a similar path in all jurisdictions, requiring a specific course of education, state licensure and national certification.
Education Requirements for Nurse Midwifery Programs
There are currently 39 ACME-accredited CNM midwifery programs in the U.S.; just 2 of these programs are designed for CM students. To be eligible for admission into an ACME-accredited CNM midwifery program, students must typically possess a bachelor’s degree from an accredited college or university. Programs typically require an RN license either upon admission into the program or prior to the start of graduate study.
Many of today’s CNM programs are bridge programs, designed specifically for currently licensed RNs seeking to earn not only their graduate degree, but their baccalaureate degree, as well. These programs, many of which are offered through online coursework, are often referred to as RN to MSN programs or RN to CNM programs, as they consist of all necessary coursework and clinical experiences to achieve both a Bachelor of Science in Nursing (BSN) and a Master of Science in Nursing (MSN).
Six of the 39 CNM programs (many of which offer the RN to MSN/RN to CNM option), offer primarily distance-based education, with the majority of their didactic material presented through online curricula. Clinical education, in both campus-based and distance-based educational models, is completed through local midwifery clinical preceptors.
The growth of distance-based education has enhanced the capacity of midwifery programs to accept more students, and has changed the way students of midwifery programs obtain their clinical learning experiences.
Typical graduate coursework in a CNM program includes:
- Advanced pathophysiology
- Assessment for advanced practice
- Well woman healthcare
- The childbearing family
- Primary care for women
- Labor and birth
- Integrated assessment of the neonate
- Health promotion
- Advanced nurse midwifery
Other CNM educational options include a Doctor of Nursing Practice (DNP), which may be accomplished through the completion of a post-MSN degree or a BS to DNP degree, and a post-graduate certificate option for graduate-prepared APRNs who want to add the practice of midwifery to their scope of practice.
Clinical Requirements for Nurse Midwifery Programs
Clinical requirements in a CNM program must meet the core competencies for basic midwifery education, as outlined by ACNM. Specifically, clinical experiences must occur under the supervision of an AMCB-certified CNM or APRN who holds a graduate degree and has clinical expertise and didactic knowledge of the content being taught.
Clinical experiences must include the management of primary care for women throughout the lifespan, including:
- Reproductive healthcare
- Pregnancy
- Birth
- Care of the normal newborn
- Management of sexually transmitted infections in male partners
Certification Requirements for Nurse Midwifery Programs
Upon the completion of an ACME-accredited CNM or CM program, graduates must take and pass the certification examination through the American Midwifery Certification Board (AMCB) to become eligible for state certification as a CNM or CM.
Applicants have 24 months from the date of their graduation to sit and pass the CNM/CM examination. Applicants are permitted to sit for the examination up to 4 times. To register and schedule the examination, applicants must complete the online application and pay the $500 examination fee. Applicants who have completed the CNM application must submit a copy of their RN license to the AMCB.
AMCB notifies all applicants, usually within a week, of their eligibility to sit for the examination. Applicants, upon notification from AMCB, may schedule their examination with AMP, the testing facility that handles all CMN/CM examinations.
Applicants who have passed the CNM/CM examination can then apply for state certification and begin practicing as a CNM or CM. The CNM/CM designee must be recertified every 5 years through AMCB upon the completion of specific continuing education requirements.
Salary Statistics for Nurse Midwives
According to the ACNM, the median salary for nurse midwives has grown about $10,000 between 2007 and 2010.
According to a 2010 ACNM salary survey, nurse midwives earned an average, annual salary of $114,152 and a median, annual salary of $88,000. About one-quarter of all midwives earned productivity bonuses in addition to their annual salary.
The largest employers of midwives, as of 2010, were hospitals and medical centers (35 percent), followed by physician practices (29.9 percent). The survey also found that the majority of midwives worked in urban areas.
Resources for Nurse Midwives
- American College of Nurse-Midwives (ACNM)
- National Association of Certified Professional Midwives
- Midwives Alliance of North America
- American Pregnancy Association