how to become a midwife

Certified Nurse-Midwife (CNM)

Certified Nurse Midwife

While many are familiar with the role of a Certified Nurse-Midwife (CNM) in providing pre-natal and obstetrical care, few understand the full scope and responsibilities of a CNM. A CNM is a registered nurse with advanced training and specialization in pregnancy, labor, delivery, and postpartum care. They play a vital role in expanding women's access to healthcare and reducing maternal morbidity and mortality rates.

For those interested in becoming a certified nurse-midwife, this article will provide an overview of the broad spectrum of services offered by a CNM as well as the key differences between a CNM and other midwifery care providers.

What Is a Certified Nurse-Midwife?

A Certified Nurse-Midwife (CNM) is an advanced practice registered nurse (APRN) who is qualified to provide obstetrical, gynecological, and nursing care for women of all ages, from adolescence through menopause.

CNMs focus their work on women's health and a woman's reproductive health care needs, including managing chronic diseases, such as diabetes and heart disease; assisting with gynecological and menopausal issues, such as abnormal bleeding and depression; and educating and counseling patients about issues relating to sexual health. CNMs also provide prenatal care during pregnancy and labor, postpartum care, and newborn care.

Important Facts About Certified Nurse-Midwives

CNMs have a Master's or Doctoral degree in nurse-midwifery.
CNMs take part in 9% of all births in the United States.
Approximately 95% of births attended by CNMs occur in hospitals.
53% of CNMs identify reproductive care and 33% identify primary care as their main job responsibilities.
Nurse-midwives have been found to have lower complication rates for mothers and babies than physician-attended births.
According to the American College of Nurse-Midwives, women who use the services of a CNM are less likely to have medical interventions such as C-sections, induced labor, and anesthesia.

What Does a Nurse-Midwife Do?

Nurse-midwives are a type of midwife who has been trained in both obstetric and gynecological care. In the U.S., nurse-midwives provide prenatal care, labor and delivery services, educate pregnant women, and provide gynecological wellness services.

The most common misconception of a nurse-midwife is that they only deliver babies. Although a nurse midwife does have a focus on prenatal care and labor and delivery, the role of a nurse-midwife is much more extensive than that of traditional midwives. For example, a certified nurse-midwife is able to offer services such as family planning, management of menopause and menstrual disorders, diagnosis and treatment of infertility, gynecological exams, breastfeeding education and support, and screening for breast cancer and ovarian cancer. CNMs can even write prescriptions for certain conditions.

The services offered by a CNM also include the following:

Primary care for women and expecting mothers
Measuring and monitoring fetal development
Postnatal examinations
Disease prevention and management
Lifestyle and nutritional assessments
Pap smear screenings
Screening for sexually transmitted diseases
Breast examination and cancer screening
Counseling and support for general wellness goals

What Is the Difference Between a CMN, CM, CPM, and Doula?

It is easy to get confused when seeing terms like CMN, CM, CPM, and Doula. What are they? How do they differ from one another and what do they mean? The answers are actually pretty simple, but many people have no idea what these terms are. Below, you will find a short explanation of each credential and the differences between them.

Certified Nurse Midwife (CNM)
Certified Midwife (CM)
Certified Professional Midwife (CPM)
Doula

Certified Nurse-Midwife (CNM)

Certified nurse-midwives are registered nurses who have earned additional certification as a midwife. Holding double licensure as a midwife and registered nurse allows a CNM to provide routine primary care, obstetrical, and gynecological services. CNMs are best known for working with pregnant patients, but they also have much to offer in the areas of the postpartum period, childbirth, pregnancy planning, family planning, prenatal visits, childbirth education, and research.

Certified Midwife (CM)

The primary difference between a Certified Midwife (CM) and a Certified Nurse Midwife (CMN) is that a CM is not a licensed nurse. CMs and CNMs possess the same core competencies, have identical certifications, and have identical scopes of practice, including authorization to prescribe medication.

Certified Professional Midwife (CPM)

Certified Professional Midwives (CPMs) are independent practitioners who are educated in the discipline of midwifery through various education and apprenticeship programs distinct from the discipline of nursing. Certification requirements are less rigorous than that of a CNM/CM and do not require previous nursing or medical training. A high school education or equivalent along with CPR training is sufficient to meet CPM eligibility standards. The CPM credential is the only credential in the U.S. that requires knowledge and experience in out-of-hospital settings.

Doula

A doula is a person who provides emotional support to the woman during pregnancy and prior to, during, and after delivery. Doulas are also known as birth companions, labor assistants, and pregnancy coaches.

Unlike a CNM, becoming a Doula does not carry the requirement for a nursing or midwifery education and there aren't any direct legal requirements regarding their practice. Doulas do not provide medical care or treatment. A doula's most important role is to help the mother feel calm and comfortable before, during, and after the birth of her baby.

Nurse Midwife Salary

Nurse-Midwives earn a competitive base salary and have the potential to increase their earning power with continued education and experience. According to data published by the U.S. Bureau of Labor Statistics (BLS), nurse-midwives earned an average annual salary of $115,540 as of May 2020, which is the equivalent of $55.55 per hour.

The annual wage earned by nurse-midwives has grown substantially in the past five years. The average nurse-midwife salary in 2015 was $93,610, or $45.01 per hour. This represents an increase of $21,930 over five years. This rate of growth (23%) is much higher than the average for all occupations.

Highest Paying States for Nurse-Midwives

The salary earned by a Nurse-Midwife can vary significantly by location, with some CNMs earning substantially more than others with the same job description in a different state. For example, Nurse-Midwives in California earn $159,590 annually on average, whereas CNMs in Florida earn just $67,530 per year. The states listed below represent the five highest-paying states for Nurse-Midwives in 2020.

STATE	HOURLY MEAN WAGE *	ANNUAL MEAN WAGE *
California	$76.72	$159,590
Utah	$64.27	$133,680
Mississippi	$61.52	$127,960
New York	$60.47	$125,780
Minnesota	$59.42	$123,600
* Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, May 2020

Helpful Organizations for CNMs

American College of Nurse-Midwives (ACNM)
International Confederation of Midwives
Midwives Alliance of North America
Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)
National Association of Certified Professional Midwives (NACPM)

Certified Nurse-Midwife FAQ

CNMs specialize in maternal and newborn care. They provide prenatal care, labor and delivery services, and postnatal care. This includes delivering babies and providing medical care for the new mother. CNMs are similar to doctors in this way, but CNMs are not qualified to provide all of the services that a doctor can.

Obstetricians are emergency physicians who treat complications of pregnancy and childbirth as well as perform C-sections. Although nurse-midwives are qualified to perform many labor and delivery procedures, they are not trained to perform C-sections.

Being a midwife does not mean you are a nurse-midwife and becoming an RN does not make you the equivalent of a midwife. To be clear, certified nurse-midwives are registered nurses who have earned a degree from a graduate-level nurse-midwife program and have been certified by the American Midwifery Certification Board (AMCB). Midwives are non-nurses who have completed a graduate-level nurse-midwife program and have been certified by the American Midwifery Certification Board. Midwives are holders of the title Certified Midwife (CM).