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Are you interested in a career in labor and delivery, but you want a more hands-on approach? Does the excitement of caring for an expecting mom and being up close and personal during delivery excite you? Are you interested in gynecology as much as you are nursing? Nurse midwifery may be the right career for you. 

What is a certified nurse-midwife?

A certified nurse-midwife (CNM) is an Advanced Practice Registered Nurse with training, education, and certification in:

  • Women’s health
  • Pregnancy
  • Labor and delivery
  • Prenatal and postnatal care

CNMs are educated in graduate-level nurse-midwifery programs. Besides delivering babies, CNMs provide a variety of health and wellness care to women. CNMs offer health screenings, and according to Nurse.org, CNMs also provide family planning and gynecological checkups.

Job outlook for CNMs

As of February 2019, there were 12,218 CNMs in the United States. Certified Nurse-Midwives Care for women holistically and fill an increasing need for providers. More parents are choosing to use nurse-midwives instead of or in addition to OB-GYNs. According to the American College of Nurse-Midwives, a certified nurse-midwife attended more than 85% of all U.S. births in 2017. CNMs practice in all 50 states. They also have prescriptive authority and, under U.S. federal law, are considered primary care providers. 

You will find CNMs in

  • Hospitals
  • Birthing centers
  • Private residences
  • Health departments
  • OB-GYN offices
  • Clinics
  • Private Practice

The Bureau of Labor Statistics (BLS) expects the demand for CNMs — along with nurse anesthetists and nurse practitioners— to grow 26 percent through 2028. The BLS shows that the national median annual salary for CNMs is $105,030.

Education and certification requirements to become a certified nurse-midwife.

To become a CNM, a nurse must first: 

  1. Earn a bachelor’s of science in nursing 
  2. Pass the National Council Licensure Examination (NCLEX)
  3. Apply to a Certified Nurse-Midwife program, accredited through the Accreditation Commission for Midwifery Education (ACME) 

There are currently 37 accredited CNMs programs

After completing the education requirements, candidates must apply for the national certification exam administered by the American Midwifery Certification Board (AMCB). To be eligible for certifications, candidates must:

  1. Show proof of an active and current U.S. license as a Registered Nurse.
  2. Have satisfactory completion of a graduate degree or have met the institutional requirements for a graduate degree from a program accredited by or with pre-accreditation status from the ACME.
  3. Have verification by the nurse-midwifery program director confirming the candidate has met the institutional requirements for a graduate degree and the date completed.
  4. Have an attestation by the director of the nurse-midwifery program that the candidate performs at a safe, beginning practitioner level.

Candidates who pass the certification examination are awarded the CNM credential.

Certified Nurse-Midwives vs. Certified Midwives vs. Doulas vs. Nurse Practitioners

There are some key differences in nurse-midwives and other maternal professionals:

  • Certified Nurse-Midwife: Certified nurse-midwives are graduate-prepared registered nurses trained in the disciplines of nursing and midwifery. CNMs legally practice in all 50 states, including the District of Columbia. 
  • Certified Midwife: Certified midwives are masters-prepared healthcare professionals trained in the discipline of midwifery. They do not hold a nursing degree. Certified Midwives only practice Delaware, Maine, Hawaii, New Jersey, New York, and Rhode Island.
  • Doulas: Doulas meet the requirements of a certification program. They provide support to mothers during childbirth, and many give support to mother and baby in the weeks following childbirth. Doulas are trained in the birthing process and postnatal care, but they are not maternity care providers. They do not provide clinical or medical care. Doulas primarily focus on the emotional and physical needs during labor. 
  • Nurse Practitioners: While Women’s Health Nurse Practitioners (WHNP) and some Family Nurse Practitioners (FNP) treat women with both chronic and acute illnesses, the nurse-midwife’s primary focus is on well-woman. WHNPs and FNPs do not deliver babies.

 

Dedra Sally MSN, CNM, WHNP-BC, a CNM of five years, spoke with Aspen about her journey.

PW: Why did you choose CNM vs. FNP or CRNA?

D.S.: I chose a CNM because I knew I wanted to provide Women’s Health care, including deliveries. An FNP does not incorporate the inpatient/delivery aspect of Maternal Health — one of my favorite parts of the job. I never had an interest in CRNA. I enjoy working with CRNAs in the L&D operating room.

PW: What is a typical day like for you?

D.S.: Busy! There are plenty of responsibilities whether I’m seeing patients in the office or the hospital for 24 hours. Both environments require constant attention to detail and changing responsibilities. Flexibility is imperative.

Share a day in the office as a CNM

  1. Check triage messages. 
  2. Check colleague communications.
  3. Start reviewing labs.
  4. Review charts for the day. 
  5. Pre-chart. 
  6. Communicate with M.A. regarding plans for the day.
  7. There are an array of patients to see: 
    • New pregnancy appointments with ultrasounds
    • Gynecology (GYN) physicals
    • Contraception visits
    • STD visits
    • GYN problem visits
    • Long-acting reversible contraception (LARC) placement/removals
    • Postpartum visits. 
  8. And of course, CHARTING. 

I place orders for labs and review lab results between patients —sending messages to patients regarding their results.

Share a day in the hospital as a CNM

  1. Receive a report from the previous provider (OBGYN or CNM).
  2. Visit any patients on L&D. 
  3. Complete postpartum rounds. 
  4. Perform circumcisions. 
  5. Return pages from patients. 
  6. Receive calls for L&D, postpartum and antepartum nurses. 
  7. Appropriately update and consult the attending physician. 
  8. Consult OB-GYN patients in the E.D. 
  9. Perform vaginal deliveries. 
  10. Provide Surgical First Assist for unscheduled C-sections with physician colleagues.   

In my downtime, I may review office charts and labs in my electronic in-basket.

What was your program like? Was it difficult to get into a program?

D.S.: My program was challenging. It required plenty of time studying and in clinicals. I had a very accommodating employer and colleagues. I worked (L&D RN) plenty of holidays and weekends so I could go to class and clinical during the week. No, I didn’t find it difficult to get into a program. It’s important to be able to show that you understand what the role entails and explain what you can bring to the field of Midwifery.

Certified Nurse-Midwives work intimately and holistically with mothers and babies and get to experience the joy of helping mothers bring a new life into the world. If you are considering an advanced practice in labor and delivery, consider CNM. 

 

Portia Wofford is an award-winning nurse, writer, and digital marketer. After dedicating her nursing career to creating content and solutions for employers that affected patient outcomes, these days, Portia empowers health practices to grow their communities through engaging content that connects and converts. Follow her on Instagram and Twitter for her latest.


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