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Since the unofficial inception of the modern-day nurse-midwife in the 1920s, nurse-midwifery in the U.S. has come a long way to become the highly regulated and widely respected profession that it is today.
Certified nurse-midwives now total more than 13,000 (as of 2014). These highly educated and trained nurses—identified as advanced practice registered nurses (APRNs) throughout much of the country—provide women with an alternative to the rigid medical model of antepartum, intrapartum and postpartum care. Nurse-midwifery instead offers women and their families a more holistic approach to care, focusing on birth as a normal, physiologic state, and one that does not require medical intervention in most cases.
The scope of the nurse-midwifery profession includes (among others):
- Performing physical exams
- Prescribing medications, including contraceptives
- Ordering and interpreting laboratory tests
- Providing gynecological care
- Providing prenatal, labor and birth, and postnatal care
- Providing care for the healthy newborn during the first 28 days of life
- Providing health education and counseling to women and their families
Nurse-midwives practice in a healthcare systems that allows for ample opportunities for consultation and collaboration.
The nurse-midwifery profession is exciting, rewarding, and challenging, reserved only for those individuals who possess a commitment to education, training, and the highest level of woman-centered care. In most states, Boards of Nursing regulate the practice of certified nurse-midwives. In other states, Departments of Health and Medical Boards regulate their practice. Regardless of the state in which they practice or the regulatory body that licenses them, certified nurse-midwives must successfully complete a number of steps to qualify for state licensure:
Step 1. Complete an Accredited MSN Nurse-Midwifery Program
Nurses interested in advancing their careers by entering a nurse-midwifery program are expected to have the following:
- A current and unencumbered registered nurse (RN) license
- A Bachelor of Science in Nursing (BSN) from an accredited college or university (some programs are designed to accommodate ADN-prepared RNs and bachelor’s-educated non-nursing professionals; see Alternative MSN Nurse-Midwifery Programs below)
All nurse-midwifery programs in the U.S. are offered at the graduate level, with a master’s degree in nurse-midwifery recognized as the minimum requirement for earning the CNM credential and becoming state licensed.
Programs must hold accreditation through the Accreditation Commission for Midwifery Education (ACME) to ensure graduates are eligible to earn the CNM credential and state licensure. As of March 2016, there were 40 ACME-accredited programs, most of which were designed as Master of Science in Nursing (MSN) programs. ACME also accredits post-master’s certificate programs and doctoral programs in nurse-midwifery for master’s prepared RNs.
MSN Nurse-Midwifery Curriculum
Universities base their MSN programs on a combination of health sciences theory and clinical sequences designed to prepare students to serve as primary healthcare providers for women and newborns. MSN Nurse-Midwifery programs also stress the integration of research with nurse-midwifery practice to ensure graduates deliver high-quality, patient-centered care based on the most current knowledge available in the field.
The core program content of an MSN Nurse-Midwifery degree program includes courses in pathophysiology, health assessment, pharmacology, research, and leadership, while nurse-midwifery-specific content includes courses such as:
- Antepartum care of normal women
- Advanced primary care nursing
- Intrapartum, postpartum, and newborn care
- Nurse-midwifery and the childbearing cycle
- Professional issues in nurse-midwifery
MSN Nurse-Midwifery Clinical Rotations
The clinical requirements of an MSN Nurse-Midwifery program often total more than 500 hours of practice, which provides students with experience in all aspects of the nurse-midwifery process and in a wide range of ambulatory and community settings, such as:
- Women’s health clinics
- Midwifery practices
- OB/GYN practices
- Hospitals
- Birth centers
- Home-based settings
The American College of Nurse-Midwives (ACNM) requires nurse-midwifery educational programs to meet the Competences for Master’s Level Midwifery Education. Specifically, clinical experiences should prepare nurse-midwife students to:
- Evaluate and apply clinical knowledge into best practice models to achieve the best outcomes
- Utilize research to provide evidence-based, quality healthcare and to improve the practice of midwifery
- Identify gaps that exist between evidence and practice and find solutions for bridging those gaps
- Utilize information systems to improve the safety of patients and the quality of care
- Serve as an effective team member and promote positive change in the practice
- Analyze health policy development, including the impact of policy on the nurse-midwifery practice
- Identify theories that relate to midwifery practice or scholarship
- Evaluate healthcare finance and identify ways to manage a healthcare practice
- Explore areas of interest within midwifery scholarship
According to the ACNM, clinical experiences must take place under the supervision of a certified nurse-midwife (CNM) who possesses the clinical expertise and didactic knowledge commensurate with the content they are teaching.
Clinical rotations must encompass the management of primary care for women throughout the lifespan, including:
- Reproductive healthcare
- Pregnancy and birth
- Care of the normal newborn
- Sexually transmitted infections in male partners
Alternative MSN Nurse-Midwifery Programs
Institutions offering nurse-midwifery MSN degree programs may offer specialized programs designed to accommodate nontraditional graduate students with different educational backgrounds. Program options include:
- RN-to-MSN Programs allow RNs with an Associate Degree in Nursing to earn both the BSN and the MSN in one accelerated program.
- Direct-Entry MSN Programs allow professionals with bachelor’s degrees in a major other than nursing to earn their RN and then complete their MSN, all in one accelerated program.
While traditional MSN programs (often called BSN-to-MSN programs) take between 18 and 24 months to complete, alternative MSN programs in nurse-midwifery may take longer, depending on the coursework the student has already completed.
Online Options for MSN Nurse-Midwifery Programs
In an effort to attract more students to the nurse-midwife profession, many institutions now offer their MSN Nurse-Midwifery degree programs in a partially or fully online format. Online MSN programs allow students to complete some or all of the required coursework through web-based study and then complete the clinical requirements of the program at partner sites close to home.
Online MSN Nurse-Midwifery degree programs provide students with a versatile solution to traditional, campus-based programs. Many RNs choose distance-based programs because these programs allow them to continue working while advancing their education. Online programs offer students the same rigorous curriculum and access to resources and experts as their campus-based counterparts.
Step 2. Take and Pass the National Certification Examination
All graduates of Nurse-Midwife MSN programs must take and pass the national certification examination offered through the American Midwifery Certification Board (AMCB) to become a certified nurse-midwife (CNM). To qualify to take the CNM examination, candidates must:
- Graduate from an ACME-accredited nurse-midwifery program
- Possess an active RN license
The purpose of CNM certification is to set the national standard for the profession of midwifery and protect the public by ensuring that CNMs possess the knowledge and skills required to safely practice nurse-midwifery. The CNM examination assesses the candidate’s entry-level nurse-midwifery knowledge in:
- Normal and abnormal conditions and circumstances
- Lab values
- Physical examination findings
- Physiology
- Pharmacology
- Clinical decision-making
The CNM examination consists of 175 multiple-choice questions. Test takers have four hours to complete the exam. The cost to take the CNM exam is $500.
Once candidates submit a complete and valid examination application to AMCB and receive approval to test, they may schedule the examination through AMP (913-895-4600). Test-takers must take the CNM examination in a computer-based format at one of the many Applied Measurement Professionals (AMP) testing centers throughout the U.S.
Step 3. Apply for State Licensure as an Advanced Practice RN-Certified Nurse Midwife
Once candidates have passed the CNM exam, they are eligible for state licensure as a nurse-midwife. In most states, certified nurse-midwives are recognized and licensed as advanced practice registered nurses (APRNs). In all cases, candidates for state licensure would be expected to provide proof of graduating from an accredited MSN Nurse-Midwifery program and CNM certification.
All U.S. states, as well as the District of Columbia, license CNMs. Although all states recognize nurse-midwives as independent healthcare providers, some states still require nurse-midwives to practice and/or prescribe under physician supervision or collaboration. These states require applicants to complete additional applications or forms related to physician supervision/collaboration for nurse-midwifery practice, for prescriptive authority, or for both.
Further, applicants who want to prescribe controlled substances as a CNM must also apply for DEA Registration.
As of February 2016, 26 states allow CNMs to practice independently, without the need for physician supervision, collaboration, or other formal oversight:
- Alaska
- Arizona
- Colorado
- Connecticut
- Delaware
- Hawaii
- Idaho
- Iowa
- Kentucky
- Maine
- Maryland
- Massachusetts
- Minnesota
- Montana
- Nevada
- New Hampshire
- New Mexico
- North Dakota
- Oklahoma
- Oregon
- Rhode Island
- Utah
- Vermont
- Washington
- Washington D.C.
- Wyoming
Though all states confer prescriptive authority to CNMs, just 22 states allow CNMs independent prescribing authority as of February 2016:
- Alaska
- Arizona
- Colorado
- Connecticut
- Hawaii
- Idaho
- Iowa
- Maine
- Massachusetts
- Minnesota
- Montana
- Nevada
- New Hampshire
- New Mexico
- North Dakota
- Oregon
- Rhode Island
- Utah
- Vermont
- Washington
- Washington D.C.
- Wyoming
Step 4. Maintain CNM Certification and Advanced Practice RN-Certified Nurse Midwife Licensure
CNMs must maintain their RN license and CNM national certification while licensed as a CNM. They must also complete any required continuing education credits during their CNM license renewal cycle.
While some states recognize maintaining national certification as a CNM as meeting the requirements for renewal, other states require the completion of additional continuing education requirements, particularly in pharmacology and pharmacotherapeutics.
To maintain national certification as a CNM, the AMCB requires CNMs to participate in the Certificate Maintenance Program. The maintenance program allows CNMs to meet the requirements for renewal in one of two ways:
Option 1: AMCB Certificate Maintenance Module Method
CNMs must:
- Complete at least three AMCB Certificate Maintenance Modules during their five-year certification renewal cycle
- Obtain at least 20 contact hours of Category I approved continuing education units
- Pay the annual fee of $55
- Complete a Recertification Application
Option 2: Re-examination Method
CNMs must take the current CNM examination within their five-year certification renewal cycle and pay the National Certification Examination fee of $500, in lieu of annual fees.