shutterstock 200278673Are you a nurse who dreams about doing more? Are you a student in medical school who isn’t sure a decade of school is for you? Do you love babies and women’s health and want a career path that is sure to guarantee you get to work with that patient population?

There are a variety of reasons one may choose to become a midwife. These advance practice registered nurses (APRN) are of high demand in today’s healthcare environment and will likely continue to be so as the healthcare environment, reimbursement, and models of care continue to change.

What Is a Midwife?

Midwives are specially trained medical professionals traditionally involved in the care of mothers and infants, working to maintain healthy pregnancies and optimal births and recoveries. Midwives are also often trained in other gynecological cares. Midwifery focuses on holistic individualized care, assessing not only the physical needs of a woman, but also her emotional, spiritual, mental, and cultural needs. Midwifery care is common in countries across the globe and is associated with some of the best maternal and fetal outcomes.

Typically, midwives are part of a collaborative care approach. They often work as part of a team of providers, underneath the supervision of an MD when necessary or appropriate. Instead of existing as opposing forces, midwives and obstetricians care for mothers with their unique and complementary skills, working for optimal outcomes for mother and baby.

In June 2018, the American College of Nurse-Midwives (ACNM) and the American College of Obstetricians and Gynecologists (ACOG) released a joint statement related to their respectful collaborative relationship. Here is an excerpt: “ACOG and ACNM believe health care is most effective when it occurs in a system that facilitates communication across care settings and among clinicians. Ob-gyns and CNMs/CMs are experts in their respective fields of practice and are educated, trained, and licensed independent clinicians who collaborate depending on the needs of their patients.”

You can visit here to read the full statement.

How Do I Become a Midwife?

In the past, one could become a certified nurse midwife (CNM) with an RN degree and a BSN degree. In 2010, the ACNM changed the qualifications for entry into clinical practice as a CNM. Now, all CNMs must possess an MSN from an accredited institution and be certified by the American Midwifery Certification Board (AMCB).

Here is a “typical” educational path to a CNM career:

  • Graduate high school
  • Enroll in an accredited associate’s or bachelor’s degree nursing program

*If you choose an ADN program, you will likely need to complete an RN-BSN bridge before being able to pursue your MSN

  • Work as an RN for 1+ year(s)
  • Apply for and complete a program accredited by the Accreditation Commission for Midwifery Education (ACME)
  • Sit for and pass your national certification exam offered by the AMCB
  • Maintain your certification every 5 years

Types of Midwives

The information found in this article is largely focused on CNM education and practice, as that is the track accredited and championed by the ACME. However, there are five types of midwives you may encounter.

Certified Nurse Midwife (CNM): These professionals are trained and licensed in nursing and midwifery. They have a BSN and a MSN in midwifery from accredited universities. They are also certified by the ACNM.

Certified Midwife (CM): These individuals are trained and certified in midwifery. They will have at least a bachelor’s degree from an accredited university. They are also certified by the ACNM.

Certified Professional Midwife (CPM): These professionals are trained in midwifery and meet standards set by the North American Registry of Midwives. There are a variety of educational tracks and backgrounds that can lead you to CPM.

Direct-Entry Midwife: These are independent professionals who have studied for midwifery via apprenticeship, self-study, a midwifery school or a university program. They have no accreditations or specific educational track.

Lay Midwife: These individuals are not certified or licensed. They have received informal training through apprenticeship or self-study.

 What Does a Midwife Do?

The midwifery philosophy of care extensively focuses on individualized care for each woman and her reproductive choices. Typically, midwives offer a variety of options for their care and services and they work extremely hard to minimize interventions. Though they work collaboratively with physicians, their care models are very different. The specifics and nuances of The Midwives Model of Care can be further explored here.

CNM Services

A certified CNM often offers nearly every service that an OBGYN does. Those services are likely to include:

  • Gynecology: Annual exams, counseling
  • Reproduction: Family planning, preconception care, prenatal care, labor and delivery, newborn care, menopause management
  • Education: Fertility, exercise, pregnancy health, breastfeeding, contraception, newborn care, nutrition, postpartum health, gynecological choices
  • Prescriptive authority
  • Surgery: Some CNMs are certified to assist in surgeries (cesarean sections, gynecological procedures)

As with most medical practitioners, a CNMs full scope of practice will be dependent on state restrictions and the credentials and licenses that have been achieved. Of note is that a CNM is trained in nursing as well as midwifery. This duality of training often results in a well-rounded professional who has a broad spectrum of both technical and intrapersonal skills.

Midwives routinely consult with obstetricians, perinatologists, pediatricians, and neonatal nurse practitioners. High-risk women, pregnancies, and infants are referred to the appropriate professionals when they present problems and complications outside of a CNMs’ scope of practice.

CNM Care Settings

You will find midwives working in a variety of settings, largely dependent on their certifications, licensing, and personal preferences. Midwives offer at-home services, birth center services, work in physician offices and work as a part of labor and delivery teams in hospitals.

If women’s health and reproduction is an area you are passionate about, then a midwifery career may be an excellent choice for you. At times, your days will be chaotic, long, and hard. But you will also be privileged to spend time with women in some of their biggest, hardest, and most beautiful seasons.

Laura Mansfield

Master of Healthcare Administration (MHA) | Sacred Heart University

Associate’s Degree of Nursing (ADN) | North Seattle Community College

Bachelor of Business Administration (B.B.A.), Marketing, Sales | University of Washington (Seattle)

November  2019

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