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How To Become a Nurse Midwife

April 8, 2021 | Staff Writers

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Nurse-midwives are one of the fastest-growing nursing careers. These professionals are highly skilled medical professionals who specialize in women’s health services, including family planning and childbirth. They primarily work with women who seek natural childbirth and family planning techniques.

The use of midwives in the delivery room has steadily increased over the last several years and is expected to continue to rise in the upcoming years. In fact, according to the Bureau of Labor Statistics (BLS), the demand for nurse midwives is expected to increase by 12% over the next decade, which is substantially higher than the job growth demand for all occupations (4%). While specific salaries vary greatly depending on education level, location, and job position, the median salary for nurse midwives, according to the BLS, is $105,030 annually.

If you have a desire to become a nurse-midwife and help women through the family planning and childbirth process, then this guide is for you. It will explain exactly what a midwife does, what you can expect your workday to look like, what qualities are necessary to become a good midwife, and what steps to take to start your career as a nurse-midwife.

What a nurse midwife does

While the popularity of nurse midwifery care has increased significantly in recent years, there’s still an immense misconception as to the role these professionals play. Some people erroneously think a nurse midwife is the same thing as a doula (birthing coach). However, certified nurse midwives (CNM) are not simply birthing coaches. Rather, they are professional health care workers who often serve as the primary care provider for women’s health issues, such as maternity and family planning.

Certified nurse midwives are recognized in all 50 states, however, the exact services they are able to provide varies from state to state. In most states, however, nurse midwives can handle many of the same services as an OB/GYN, including overseeing the labor and delivery of babies in a hospital, home, or birthing center setting. These nurse practitioners monitor both fetal and maternal health before, during, and after birth. They are also skilled to handle many minor birthing issues, such as breech births and premature labor.

The primary difference between midwives and obstetricians is that nurse midwives focus on natural child birthing techniques. They are, however, still able to administer pain medication when necessary. They also offer women more birthing options, such as the ability to have a home birth. This distinct difference is why some women choose midwifery services over those of an OB/GYN.

However, another misconception about midwifery is that they only perform home births. While midwives can oversee home deliveries and many are willing to do so, the vast majority assist with births at a hospital or birthing center. In fact, according to the American College of Nurse-Midwives (ACNM), 94% of all CNM-attended births are conducted in a hospital setting.

Certified nurse midwives are highly trained and experience. Many midwives begin their careers as a nurse after completing a bachelor’s degree program and earning their license as a registered nurse. They then continue on to earn a master’s degree or doctoral degree before taking the national midwifery certification exam to earn their certification and license as a nurse midwife.

Due to their extensive training and experience, most CNMs can provide a wide range of additional maternity care services, such as conducting a gynecological exam, providing prenatal and postpartum care, and offering direct patient education, including breastfeeding training and SIDS prevention resources. CNMs can also order lab tests, make diagnoses, and write prescriptions.

A CNM also handles other women’s health issues, including health screenings, vaccinations, family planning, STI diagnosis and treatment, and nutrition education. In addition, many certified nurse midwives can provide newborn care for the first 28 days. Midwives can also serve as the primary care provider for many women. In fact, nearly one-third of all CMNs rank primary care as the top service they provide.

In most cases, midwives are not allowed to conduct surgical procedures, such as Caesareans (C-sections). In these cases, the nurse midwife would collaborate with an OB/GYN or surgeon, who would then perform the necessary surgery. Nurse midwives can, however, assist during the surgery process. Additionally, nurse midwives are not able to administer epidurals or other anesthesia. Instead, a nurse anesthetist would conduct these services.

CNMs work in a variety of workplace settings, including hospitals, birthing centers, physician offices, healthcare clinics, military bases, and private practices. As a CNM you can expect to spend the majority of your day on your feet providing patient care and completing required paperwork. They may also attend meetings, complete continuing education classes, and oversee staff members.

Due to the nature of these positions, nurse midwives work all hours of the day and night. You can expect to be awake for extended periods of time and to be on-call 24/7 on certain days of the week.

Certifications required to become a nurse midwife

There are three types of certifications within the midwifery field, including a Certified Nurse-Midwife (CNM) and Certified Midwife (CM), both of which are regulated through the American Midwifery Certification Board (AMCB), and a Certified Professional Midwife (CPM), which is regulated through the North American Registry of Midwives (NARM).

When determining which certification to acquire, it’s important to understand the specific regulations in your state. For example, only a handful of states recognize CM certifications and just over 30 states recognize CPM certifications. Even with these approvals both CMs and CPMs are severely limited in the types of services, they can provide.

Only certified nurse-midwives (CNMs) are recognized in all 50 states and are qualified to perform a wide range of services. Therefore, most midwives move forward to earn their CNM certification. Due to its wide scope and popularity, this guide will discuss the steps needed to earn a certification as a CNM.

Certification for nurse-midwives is handled by the American Midwifery Certification Board. While specific requirements vary from state to state, there are four basic requirements, including holding a current RN license, earning a graduate degree in midwifery, completing the required clinical practice experience, and passing the national midwifery examination. Additionally, CNMs must recertify every five years.

Here’s a more detailed look at each of these requirements for certification as a nurse-midwife.

RN license

The fastest way to earn a license as a registered nurse (RN) is to earn a Bachelor of Science in Nursing (BSN) degree. It typically takes about four years of full-time studies to complete an undergraduate degree program. You will find numerous BSN programs available both on-campus and online. While many classes can be taken completely online, you will likely have to complete clinical hours at an approved facility to earn your degree.

While there is no specialty degree in midwifery available at the undergraduate level, you can expect to take a wide range of health-related courses, including biology, anatomy, and physiology. You may be able to take elective courses related to the midwifery field, such as women’s health and childbirth courses. It’s advisable to talk to your advisor about your future career goals when selecting your courses.

Upon graduation of an approved BSN nursing program, you will be able to sit for the National Council Licensure Examination for RNs, otherwise known as the NCLEX-RN exam. This exam is administered by the National Council of State Boards of Nursing (NCSBN) and successful passage of the exam is required in all 50 states.

Graduate degree

Certified midwives must also complete a nurse-midwifery graduate degree program at the masters or doctoral level. A midwifery student wishing to complete a master’s level nursing program typically earns their MSN (Master of Science in Nursing) or MS (Master of Science) degree with a specialty in nurse-midwifery. These programs take an average of two to three years to complete and involve both classroom (either in-person or online) and clinical experience. Students who have an RN license but didn’t complete a BSN program might consider an RN-to-MSN program.

Students at the doctorate level earn a Doctor of Nursing Practices (DNP) degree with a concentration in nurse-midwifery. It can take anywhere from two to three years of additional studies to complete the doctorate level program.

Nurse-midwifery students at both the master’s and doctorate-level can expect to take advanced courses in anatomy, microbiology, statistics, and pharmacology as well as midwife-specific courses, such as childbirth techniques and maternity care.

Clinical hours

Nursing students are also required to complete a set number of clinical hours in adherence to state regulations and the Core Competencies for Basic Midwife Education. These clinical hours must be done under the supervision of a certified CNM or CM or an Advanced Practice Registered Nurse (APRN). Additionally, these hours must involve midwifery-services, such as pregnancy care, reproductive testing, newborn care, and STI treatment.

Some of these hours may be completed under an internship program or through the course of regular working hours. However, these hours must be well documented.

National nurse-midwifery certification examination

The first step to taking the nurse-midwifery certification exam is to complete the application and submit all necessary documentation proving RN license, graduate degree, and the completion of clinical hours. Once you have been approved you can schedule a time to take your exam.

The nurse-midwifery certification exam is administered by the American Midwifery Certification Board (AMCB) and consists of 175 multiple-choice questions. You have a maximum of four hours to complete the entire test. This exam covers a wide range of topics involving women’s and neonatal care, women’s health issues, and family planning as well as antepartum, intrapartum, and postpartum maternal and fetal care.

Since the successful passage of this exam is required to earn a certification in nurse-midwifery, it’s recommended to study uses prep books and resources or to take an exam prep course to help you study.

Recertification

CNMs are required to recertify their credentials every five years. There are two ways to complete this recertification process

  1. Complete the required application and submit any necessary document, complete at least 20 hours of approved continuing education courses, and pay the annual fee.
  2. Retake and pass the Nurse-Midwifery Certification Exam. This process is typically only used by those nurses who have let their CNM certification lapse for a significant amount of time.

Qualities of a good nurse midwife

People considering a career as a nurse-midwife should have a keen interest in women’s health issues and the child birthing process. It’s also important to maintain a high aptitude in medical-related subjects, such as biology, anatomy, and human development. Additionally, midwives must be available at all hours of the day or night, so the ability to maintain sporadic work hours and provide emergency services is a must.

If you’re considering a career as a nurse-midwife, you should possess or focus on acquiring these skills:

Communication

To be a great nurse midwife, you must have good communication skills. You will be working directly with patients as well as writing comprehensive treatment plans. It’s vital that you can clearly communicate as well as listen to your patients and understand their needs. You will likely continue to improve your communication skills during the course of your training and clinical experience.

Integrity

Nurse-patient confidentiality is crucial. Not only is it a nurse’s legal responsibility to keep medical records confidential but confidentiality also helps to build trust with patients. You must have a high level of integrity if you wish to be a successful licensed midwife. Through the course of your training, at both the undergraduate and graduate level, you will learn more about nursing ethics and what your exact responsibilities are.

Critical thinking

Critical thinking is one of the most important attributes for midwives to have. On a daily basis, you will be expected to monitor patients’ health, including mother and baby’s health, as well as diagnose and treat any potential issues. You will also assess symptoms and test results in order to provide the right treatment options. Additionally, you must be able to consult with other midwives, OB/GYNs, and surgeons as needed.

Decision making

Nurse midwives should be able to think quickly and clearly, despite working in a chaotic work environment. They must be able to assess the situation and make immediate decisions, which requires a high level of decision-making skills. Naturally, the longer you work in this field, the better equipped you’ll be to make these instant decisions. This factor is one of the main reasons nursing students are required to complete a vast number of clinical hours for both undergraduate and graduate programs.

Empathy

Everyone in the medical field, including nurse midwives, should have a high level of empathy. You will see patients with all different demographics, socioeconomic backgrounds, lifestyles, and mental health conditions. You must be able to show compassion and care to all patients despite their backgrounds. Additionally, the medical field comes with some tragic and traumatic events. You should be able to empathize with your patients while still providing professional medical care.

Detailed oriented

The work-life of a CNM can be quite chaotic. You will have days where you literally stand on your feet for 10 to 12 hours or more. Despite this chaotic work environment, you must be able to focus on the small details. Just one erroneously read lab test or missed symptom could have traumatic results. It’s vital that you train yourself to be a very detailed oriented person during your undergraduate and graduate studies to ensure you have this ability once you’re a CNM.

Leadership skills

As a certified nurse midwife, you are expected to control the delivery room whether at home, in a birthing center, or at a hospital. You must have strong leadership skills that allow you to supervise staff members, monitor the patient, and manage treatment.

Top nurse midwife certification programs

Nurse midwives must have a graduate degree in order to obtain certification as a CNM. This requires the completion of an MSN or DNP degree program.

Master of Science in Nursing Degree

Nursing students interested in becoming a CNM can obtain a Master of Science in Nursing (MSN) degree with a specialty in nurse-midwifery. These certified midwife programs take about two to three years to complete and will make you eligible for certification as a nurse-midwife. There are some RN-to-MSN programs available that may allow you to obtain your graduate degree without a bachelor’s degree. Some students choose to complete a dual specialty in both nurse midwifery and women’s health nurse practitioner.

Doctor of Nursing Practices Degree

Nursing students who prefer to earn their doctorate degree can earn a Doctor of Nursing Practices (DNP) degree with a specialty in nurse-midwifery. It typically takes an additional 1 to 3 years of full-time studies to complete a doctoral CNM program. There are some BSN-to-DNP programs available that may provide a faster route to earning your doctorate degree.

According to the BLS, there are currently about 6,930 nurse midwives working throughout the United States. Due to this small number of midwife professionals, there are limited nurse midwifery programs available. However, there are still over three dozen nurse midwifery programs in the United States for you to choose from. There are several things you should consider when selecting the right midwifery program for you, including:

Accreditation

It’s absolutely crucial that you select a nurse midwifery program that has been accredited by the Accreditation Commission of Midwifery Education (ACME). Schools should proudly state this accreditation, but it’s recommended to always check with the American Midwifery Certification Board just to be sure.

A certified nurse midwife program ensures that the program meets the stringent expectations set forth by the board. It also ensures that you will take all the courses needed to have a successful career as a nurse midwife. This accreditation is required to obtain a certification as a CNM and without it, you will not be allowed to sit for the national certification exam.

Specialty

It is not enough that you complete a standard MSN or DNP degree program. Instead, you must also take a specialty in nurse-midwifery. Without the completion of a nurse midwifery program, you will not qualify to become a CNM. When comparing schools, specifically ask each university if they offer a specialty MSN program in nurse-midwifery.

Not only should they be able to answer this question, but they should be able to show you the entire list of courses needed to complete this program. You should notice various midwifery-related courses on this list, such as childbirth, maternity care, and neonatal care.

Online vs in-person

There are both online and in-person MSN and DNP programs available. Keep in mind, however, that classroom work only makes up a percentage of the program requirements. You will also be required to complete a large number of clinical hours, which cannot be completed online, but must be done in-person.

Many universities and colleges partner with various medical facilities across the country to provide this clinical experience. This partnership may allow you to complete your clinical experience at a facility near your home. However, it’s important to discuss this process with any college or university you are considering.

Full or part-time studies

There are graduate-level programs available for both full-time and part-time students. It’s important for you to evaluate your future goals and available time to determine which option is right for you. If you are currently working full-time, you may want to consider part-time studies because graduate-level courses are quite demanding. However, be sure to keep in mind that once your clinical start, you may not be able to continue working (at least not full-time) and complete the clinical requirements.

On the other hand, if you are able to stop working or only work part-time, then full-time studies may be the right option for you. This pathway will speed up the time it takes to complete the graduate program and allow you to earn your CNM faster.

Clinical requirements

Each university and college has its own set of clinical requirements needed for graduation. Be sure to ask about this expectation prior to enrolling in any graduate program. It’s altogether possible that you will not be able to continue working while completing at least some portion of your graduate-level program.

It’s important to understand these requirements right from the start so you can financially plan for this timeframe. The last thing you want to do is get near the end of your program and realize that you don’t have the ability to complete it. Always obtain as much information about these clinical requirements prior to enrollment.

Additionally, no matter where your clinical work is done, you will need to have access to reliable transportation, either public or private. Missing clinical hours for any reason, including transportation issues, will prolong your graduation time or expel you from the program.

Specific coursework

Each midwifery program requires a series of specific classes that must be completed, such as advanced anatomy, women’s health issues, childbearing family care, and pharmacology. Take the time to read each program description and evaluate the courseload for each program.

Next, write down the special features and courses you like about each program. This step will help you better compare programs and help you determine which option best matches your interests and future goals.

Tuition

Tuition is always a factor that needs to be considered no matter what educational pathway you’re considering. While tuition into some of these programs can be quite high, there are scholarships available. Additionally, your workplace may offer some type of education reimbursement program that may allow you to recoup some of the money spent on tuition.

Another factor that should be considered is in-state versus out-of-state tuition. Not all universities charge more for out-of-state students, especially at the graduate level, but it’s important to check prior to enrollment. Take the time to explore all your financial options when considering which midwifery program to select.

Local housing

With only a couple of dozens of programs available, it’s possible that you may have to move closer to the university in order to complete the program. If this is necessary, be sure to check out local housing costs and availability before choosing a school. This additional cost may play an important role in the overall costs of the program. Check with any school you are considering and ask them for more information about housing options near the university.

Exam success rates

Once you’ve narrowed your graduate program options down to just a few, ask each school to provide you with the number of graduates who go on to pass the national certification examination for CNMs. A high percentage value shows that the school provides a comprehensive program that includes all the training and experience necessary to become a great CNM. A lower exam success rate may be cause for concern. In fact, this could be a sign that the program fails to prepare students for a career as a nurse midwife.

The combination of these tips can help you compare and contrast the different programs as well as enable you to determine which midwifery graduate program is best for you.

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