How to Become a Nurse Midwife (CNM)

Overview

By Sarah Maurer
Nurse holding a newborn

The birth of a child is one of the most exciting events in life, and the presence of a nurse midwife can make the experience especially meaningful. Nurse midwives (also called certified nurse midwives, or CNMs) are registered nurses with advanced training in women's health.

While they're best known for delivering babies, they also provide a full range of care services for women of childbearing age, including:

  • Pregnancy care
  • Family planning
  • Women's primary and preventative care
  • Newborn care
  • Treatment of male partners for sexually transmitted infections.

CNMs are recognized health practitioners in all 50 states. The profession is governed by state-level scope-of-practice laws, which spell out the specific functions a CNM may perform independently as well as the functions that must be supervised by a physician. In most places, CNMs can independently care for women who are at low risk for pregnancy complications. When the risk is higher, the CNM may treat the patient as part of her healthcare team.

CNMs offer an alternative childbearing experience focused on the needs and desires of the patient and family. Midwifery practice emphasizes natural, intervention-free care when possible. CNMs encourage women and family members to be active participants in the pregnancy and birth. Many women feel that using a midwife provides a more fulfilling birth experience.

Most midwives choose the field out of genuine compassion for families and children. CNMs often develop long-term relationships with patients as they care for them through multiple pregnancies and births. Another fulfilling aspect of the job is its freedom; unlike registered nurses (RNs), CNMs have considerable autonomy to make care decisions and manage their own practices.

Work Environment

The two largest employers of CNMs are physician offices (47 percent) and hospitals (28 percent). CNMs also work in birthing centers, government organizations, and colleges and universities. Some states allow CNMs to run their own private practices.

Overtime is the norm for CNMs; 89 percent report working more than 40 hours a week. In office-based practices, they generally work daytime hours with some evenings on-call. Hospital-based CNMs work irregular shifts, including evenings, weekends, and holidays.

Contrary to popular belief, CNMs usually deliver babies in hospitals (although they may occasional travel to patient's homes for a low-risk delivery).

Work as a CNM can be very physical and may involve long periods of standing. These professionals must also have the strength to lift patients.

Midwifery can be a high-stress profession due to the potential for complications. CNMs must be emotionally stable; able to make high-stakes decisions quickly; and comfortable working with people who are in physical or emotional pain.

Like other health care professionals, CNMs are exposed to occupational hazards like dangerous drugs and contagious disease. These risks can be minimized by following safety procedures and using protective clothing and equipment.

Requirements

Education and Training

To become certified as a nurse midwife, candidates must:

  • Earn a master's degree (or higher) from a program recognized by the Accreditation Commission for Midwifery Education
  • Hold an active registered nurse (RN) certification
  • Be nationally certified, usually by the American Midwifery Certification Board
  • Be licensed and registered in their state of practice.

High school students interested in a career in nurse midwifery should take a rigorous college preparatory curriculum, including math, science, English, and foreign language courses.

College students can prepare by completing the prerequisite courses for graduate midwifery programs, including biology, microbiology, chemistry, human anatomy, and physiology. A bachelor's degree in nursing is very helpful (though not always essential) to gain admission to midwifery graduate programs.

Graduate nurse midwifery training typically lasts three years and includes both classroom and clinical components. Topics covered include anatomy, physiology, pharmacology and practical skills like patient assessment and medical procedures.

RN certification is a prerequisite for admission to most graduate nurse midwifery programs. Programs also typically require a bachelor's degree in nursing (BSN). However, there are also bridging programs for students who hold an associate degree, a diploma in nursing or a bachelor's degree in a related field.

Many nurse midwifery graduate programs require candidates to have two to four years of experience working as an RN in a women's health-related field.

CNMs are legally recognized to practice in every state and in the District of Columbia. For detailed licensure requirements in your state, contact your state board of nursing.

Certification

Several organizations certify nurse midwifes, but the American Midwifery Certification Board is the most widely recognized and respected. AMCB certification is a prerequisite for licensure in many states and is also required by many employers. To become CNM-certified through AMCB, candidates must:

  • Hold an active RN license
  • Demonstrate completion of an ACME-approved training program
  • Pass a computer-based knowledge exam
  • Recertify every 5 years.

Necessary Skills and Qualities

  • Interpersonal skills. Nurse midwives often care for patients who are in pain or emotional distress. They must be able to develop trusting, long-term relationships with patients.
  • Flexibility. Midwives respond to calls at all hours. During a delivery, they must be patient, but also ready to act if problems arise.
  • Communication. CNMs must be careful, perceptive listeners when taking patient histories. They must also be capable of explaining procedures to patients and conveying complicated medical information to team members and consultants.
  • Critical thinking. It's crucial that CNMs continuously assess changes in their patient's health. When a problem arises, they need to sort quickly through the various options and take the most appropriate action.
  • Compassion. Midwifery, like all health careers, involves caring for patients who are in pain and emotional distress. To be effective in their roles, CNMs should be motivated by a genuine desire to help others.
  • Attention to detail. CNMs should have excellent powers of observation. Even small changes in a patient's condition could indicate a problem that requires action.

Opportunities for Advancement

It's quite a long road to become a CNM, and for many people, achieving this level of practice is a goal in itself. A significant number of nurse midwives eventually earn doctorates in nursing, which qualifies them to teach at the university level and conduct research in the field.

Earning a CNM credential also opens up opportunities in consulting, healthcare management and public policy development.

Where permitted by law, many CNMs move in to private practices, giving them considerable autonomy over their practice affairs.

If you would like to gain the necessary education to become a nurse midwife, we highly recommend that you check out our free School Finder Tool located HERE.

Salary and Job Outlook

According to the US Bureau of Labor Statistics, the median annual salary for nurse midwives is $92,510. The lowest-paid 10 percent earn less than $50,310, and the highest-paid 10 percent earn more than $132,270.

Salaries vary with work setting and geographic location. Hospital-based nurse midwives generally earn more than those in outpatient settings and academia. In addition, CNM salaries tend to be higher on the West Coast, in the upper Midwest, and in the Northeast.

In a word, job prospects for nurse midwives are excellent. According to the Bureau of Labor Statistics, employment of CNMs is expected to grow by 31 percent between 2014and 2024, which is much faster than the rate for all occupations.

Growth of the midwifery profession is largely driven by increasing demand for health care services. Recently enacted federal health reform laws expanded insurance coverage to millions of Americans. Growth has also been spurred by new scope of practice regulations that allow nurse midwives to take on roles traditionally performed by physicians. Finally, the growing shortage of primary care physicians means CNMs are in demand to provide well-woman care.

Job prospects should be especially good in areas with physician shortages, particularly inner city and rural areas.

Further Reading

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