How to Become a Certified Nurse Midwife

A certified nurse midwife, sometimes referred to as a CNM or simply a nurse midwife, is an advanced-practice registered nurse (post-baccalaureate) who specializes in women’s reproductive health and childbirth. Not only do they attend to women during pregnancy, childbirth, and post-partum, they also are responsible for preventive women’s health maintenance.

Why Are Certified Nurse Midwives So Important?

Nurse midwives differ from physicians primarily because they are first and foremost nurses. They approach patient care with a holistic view – not only focusing on the physical needs of the patient, but the mental and psychosocial needs as well.

According to the American College of Nurse-Midwives (ACNM), the benefits of Certified Nurse Midwife (CNM) assisted births include:

• Lower rates of cesarean births
• Lower rates of labor induction/augmentation
• Significant reduction of third and fourth-degree perineal tears
• Less use of regional anesthesia
• Higher rates of breastfeeding

Additionally, women cared for by CNMs were more likely to receive:

• Prenatal education
• A more hands-on approach and closer relationship with their provider
• Fewer technological and invasive interventions

From a financial standpoint, the use of CNMs in obstetric and gynecological care can reduce health care costs. This is due to:

• An increase in access to care
• Less invasive medical interventions required
• Reduced number of cesarean births
• Reduced use of pharmacological pain management interventions

Using a midwife also opens the possibility of home births—an option which helps lessen the mother’s anxiety and reduce the possibility of feeling “rushed,” which may result in labor-inducing drugs or cesarean delivery.

Those interested in the field of midwifery should enjoy working with women from various backgrounds, enjoy educating patients and promoting preventive and holistic health. They should be skilled in building trusting relationships and should be able to remain unbiased, work well under pressure, and be able to provide support during emotionally charged events.

Certified Nurse Midwife Education Requirements and Training

Nurse midwives are advanced-practice registered nurses who have completed a minimum of a Master’s of Science in Nursing (MSN) degree. A Doctor of Nursing Practice (DNP) is a post-graduate degree and is another option, but is not required for entry-level nurse midwifery.

To advance to an MSN, a student must first complete an accredited nursing program and obtain a Bachelor’s of Science in Nursing (BSN) degree. After that, the successful completion of the NCLEX-RN is needed for licensure. The length of time it takes to complete an MSN program depends on the nurse’s starting point:

• Nursing students enrolled in a BSN program complete in about four years
• RN to BSN takes about two years
• BSN to MSN takes about two years

Both online programs and classroom programs are available to accommodate students. Both types have pros and cons depending on students’ needs, therefore researching individual schools is encouraged.

The training needed to become a nurse midwife is incorporated in the advanced degree program. General advanced-practice courses are completed in the first part of the program. Once the general courses are completed, students can choose a midwifery specialty track. Additionally, since there can be a lot of overlap between Women’s Health Nurse Practitioner (WHNP) curriculum and midwifery, many programs offer dual certification for each.

Educational Prerequisites

Requirements for midwifery programs vary from institution to institution. The American College of Nurse-Midwives lists the forty schools that are accredited by the Accreditation Commission for Midwifery Education and describes which degrees are available (MSN, DNP, etc.).

They also have a reference list in which prospective students can review the various requirements for the different midwifery programs and explore available options. For example, some institutions:

• Allow non-nurses into the curriculum
• Do not require experience in nursing or labor and delivery before admission
• Offer an ADN to MSN bridge program
• Require a BSN before admission
• Offer an accelerated entry to the nurse midwifery program

Due to the considerable variability in program requirements, students are encouraged to visit the website to see which institution would best fit their needs.

The curriculum for nurse midwifery can vary depending on the student’s starting point and educational institution, but should include courses and clinical practice rotations focusing on:

• Health promotion and maintenance
• Advanced pathophysiology
• Advanced health assessment
• Pharmacology for advanced practice nurses
• Primary care of women
• Role of the nurse midwife
• Care during pregnancy, labor, birth, and postpartum, to include newborn care
• Women’s health

Schools that offer DNP programs also include courses in education, leadership, and advocacy.

Certified Nurse Midwife Program Specialties

While there are no formal specialties for nurse midwives (it is a specialty in and of itself), they can choose which clinical focus area to work in, such as:

• Primary care/clinics
• Birth centers
• Hospitals
• Community health centers
• Education
• Research

Examination, Licensure, and Certification

After completing graduate or post-graduate education with a focus in midwifery, candidates can apply and test for certification. The American Midwifery Certification Board (AMCB) outlines the requirements for testing/certification such as:

• Submitting proof of licensure as an RN or NP
• Completion of a graduate program accredited by the Accreditation Commission for Midwifery Education (ACME)
• Verification by the director of the NM program confirming all program requirements were met, along with the date of completion
• Attestation by the director of the NM program that the applicant performs at a safe, competent beginner level

Applicants can attempt the exam four times, but all attempts must be within 24 months of program completion. Certification is valid for five years, and the AMCB offers re-certification options.

Certified nurse midwives also must register with their state’s Board of Nursing. Some states offer certification simply by applying, if the graduate program meets the state’s educational standards. Otherwise, nurses can submit certification obtained through the AMCB. Nurses are encouraged to check their state Board of Nursing to identify specific requirements.