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Nurse Midwife

Nurse Midwife

Overview

Certified Nurse-Midwives (CNMs) are Advanced Practice Nurses who provide counseling and care during preconception, pregnancy, childbirth, and the post-partum period. CNMs and their colleagues certified midwives (CMs) also provide family-centered primary healthcare to women throughout their reproductive lives.

Skilled midwifery can reduce the need for high-tech interventions for most women in labor, but midwives also are trained in the latest scientific procedures to assist in normal deliveries.  CNM-attended births account for 10% of all spontaneous vaginal births in the US, and 7% of all US births in total.  Of these deliveries, 97% occur in hospitals, 1.8% in freestanding birth centers, and 1% at home.

Many people mistakenly think that midwives do nothing but assist with births. In fact, although attending births is an integral and rewarding part of the job, this is only a fraction of what midwives actually do. On average, CNMs/CMs spend 10% of their time in the direct care of birthing women and their newborns.

In addition to the care they give patients before, during, and after pregnancy and childbirth, CNMs/CMs provide routine gynecological services – including reproductive health visits, regular gynecologic care (i.e., annual exams), and peri-/post-menopausal care. In fact, 90% of all their patient visits are for primary, preventive care. CNMs/CMs are skilled health professionals who practice in a wide variety of clinical settings, diagnosing and treating patients as well as referging them to a specialist, if required.

CNMs/CMs are a vital part of the healthcare team and collaborate closely with physicians. When CNMs/CMs and physicians work together as a team, women receive an optimal combination of primary and preventive care, with specialized services as needed.

Today’s midwives come from all walks of life.  Some earned their midwifery degree immediately after graduating from college, but others are former teachers, writers, missionaries, general practice nurses, etc. CNMs/CMs mirror our modern world: rich in diversity.  However, all of them share a deep commitment to bettering maternal and child health, not only in this country but throughout the world.

Working Conditions

CNMs and CMs work in a variety of settings, including private practices, hospitals, birth centers, health clinics, and home birth services. There are many different opportunities and environments, but as with virtually all the other health professions, there is an especially acute need for CNMs/CMs in underserved areas.

There are many different career options for CNMs/CMs – from clinical practice, education, administration and research, to domestic and global health policy and legislative affairs. They practice in public, private, university, and military hospitals. They work in HMOs, private practices, and birth centers. Many midwives work in public health clinics, while others choose to provide in-home birth services. CNMs/CMs are also active in international health programs, working worldwide to improve the health of women and children.

According to a recent survey by the American College of Nurse-Midwives (ACNM), the median salary for CNMs/CMs is $70,000. However, individual salaries may vary widely, depending upon practice setting, geographic region, location (urban or rural), benefits packages, hours worked per week, and type of care provided (full-scope of women’s health services, pre-natal care, gynecologic care, etc.). Certified nurse midwives must have master’s degrees in the science of nursing and be registered nurses licensed by the state in which they practice. They can attend births in hospitals as well as attending homebirths and births in birthing centers. According to Scrubs Magazine, the average annual starting salary for certified nurse midwives in December 2010 was $84,000. Nurse midwifery was ranked one of the top ten highest paying nursing specialties at that time.

Academic Requirements

The CNM/CM degree is earned by completing a nationally accredited program and then passing the national certification exam. There are currently 42 ACNM-accredited programs in the US.  Four of these are post-baccalaureate certificate programs and 39 are graduate programs.NOTE: Beginning in 2010, completion of a graduate degree will be required for entry into clinical practice.

Almost all programs require applicants to hold a bachelor’s degree. The majority also require that applicants be a registered nurse (RN), although there are a growing number of programs geared toward students who hold a non-nursing bachelor’s degree.  Some, but not all, require that entering RNs hold a bachelor’s degree in nursing (BSN).

If your degree is not in nursing (BA/BS), you will become a certified midwife.  If your degree is in nursing (BSN), you will become a certified nurse-midwife.  In most cases, non-bachelor’s-level RNs are required to complete a bachelor’s degree before attending a CNM program.  Some programs offer a flexible option that enables associate degree-level nurses to complete their bachelor’s studies in the course of the CNM program.

Because of the intensive faculty-to-student ratio needed to graduate quality midwives, most CNM/CM programs have a limited number of spaces to admit new students each year. It is not unheard of for a prospective student not to be accepted the first time s/he applies to a program; do not hesitate to re-apply. Check ACNM’s list of midwifery education programs, and contact the program you are interested in regarding specific program prerequisites.

CNMs are licensed in all 50 states and the District of Columbia. CMs must meet the same rigorous standards of practice as CNMs, but because this is a relatively new option for preparation, CMs are only licensed to practice in New York, New Jersey and Rhode Island.

In terms of the clinical services they provide, there is virtually no difference between a CNM and a CM. There also is no significant difference between a certificate- and master’s-prepared CNM.  However, a growing number of states and employers are requiring midwives to be master’s-prepared, and by 2010 graduate-level training will be required for clinical practice throughout the United States.

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