How to Become a Nursing Midwife

by Timon Kaple
• 5 min read
reviewed by Brandy Gleason
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Nursing midwives are trained, board-certified professionals who specialize in caring for women, expecting mothers, and infants.

The certified nurse midwife (CNM) credential designates you as an advanced practice registered nurse (APRN) and does not require a doctor of medicine degree. As a CNM, you can provide valuable services to women, expecting mothers, and infants while earning a top midwife salary. Read on to learn the steps to becoming a CNM, which skills you need for success, and how you will help improve patients' lives with your specialized knowledge and clinical training.

What Do Certified Nurse Midwives (CNMs) Do?

CNMs work directly with patients in clinical settings and offer prenatal, gynecological, and post-pregnancy care. They may also assume primary care roles, help care for newborns during the first weeks of their life, and offer general women's health services.

In most cases, CNMs work in clinics, hospitals, health maintenance organizations, and private medical practices. CNMs can also work at free-standing birthing centers and deliver babies in patients' homes.

CNMs often work as part of a small team of healthcare providers, depending on their place of employment. They typically function as part of an integrative healthcare team to help provide the best possible quality of care for patients.

Primary responsibilities and daily tasks for CNMs include:

  • STI testing for expecting parents
  • Prenatal and postnatal exams
  • Prescribing medications
  • Delivering newborns
  • Educating and instructing new parents
  • Assisting physicians with cesarean sections or birthing complications
  • Referring patients to appropriate specialists as needed

Types of Midwives and Similar Professions

Not all midwives possess formal nursing training or a nursing degree. In fact, midwifery professionals serve different purposes, with their roles and responsibilities dependent upon education, credentials, and location.

CMs hold a graduate degree in midwifery and board certification through the American Midwifery Certification Board (AMCB). CMs differ from CNMs in that they do not possess licensure as a nurse. CMs deliver babies, provide patient guidance, and work as part of a healthcare team in various settings. CMs are only legally recognized to practice in Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, and Virginia. CNMs hold a BS and MS in nursing, possess licensure as a registered nurse, and may practice in all 50 states. They must earn their degrees from programs accredited by the American College of Nurse-Midwives and pass the national certificate exam offered by the AMCB. These primary care providers specialize in women's health, gynecological, post-pregnancy, and prenatal care. CPMs receive training in at-home or out-of-hospital births. They must complete this training in a program that holds certification from the American Registry of Midwives and pass the national certification exam. CPMs often work in birth centers or in private home birth settings. They usually provide women with continuous care throughout the childbearing cycle, including labor and birth. CPMs must follow laws and regulations established by their state. Doulas do not possess medical training and do not provide medical support of any kind. Expecting mothers or birthing centers may hire doulas to provide emotional and informative support during pregnancies, labor, delivery, and postpartum periods. No states require doulas to possess licensing or certification to offer these services. Many doulas, however, choose to seek out professional training to improve the quality of support they offer clients. Labor and delivery nurses must pass the NCLEX-RN and become a registered nurse in order to practice. While this may only take an associate degree or diploma, many employers today expect labor and delivery nurses to possess a bachelor's degree. They work in hospital settings and care for expecting mothers throughout the birthing process. Labor and delivery nurses monitor the mother's and baby's vital signs, induce labor, administer medications, and assist with cesarean deliveries. They also coach new mothers during labor, birth, and postpartum periods. An OB-GYN is a medical doctor with a specialty in obstetrics and women's health. After medical school, they complete several residency rotations in family planning, gynecologic surgery, ultrasonography, and reproductive endocrinology. They may work in hospitals and private practices. Many OB-GYNs serve as primary care physicians for mothers long after they give birth. An OB-GYN's primary responsibilities include diagnostic procedures and surgeries related to childbirth, reconstructive surgery, preventative care, infertility, and hysterectomies. RMs and LMs are types of direct-entry midwives. These midwives are independently educated and may learn through apprenticeships, college and university programs, self-study, or a midwifery school. They do not possess formal training as a nurse. Licensure requirements for RMs and LMs vary among states. They specialize in care for women, newborns, and pregnant individuals who receive care outside of the hospital.

Steps to Become a Certified Nurse Midwife

To become a CNM, you will need to earn an undergraduate degree and pass the NCLEX exam. After you gain work experience as an RN, you will need to complete a master's degree in nursing and earn the appropriate certification and licensure. Here is a closer look at the step-by-step process to become a CNM.

1. Earn an RN license.

The first step toward your career as a CNM is to obtain licensure as a registered nurse. To do this, you must complete an associate degree in nursing or a bachelor of science in nursing (BSN). Upon completion of the program, you must apply for your nursing credential through your state's board of licensure and registration.

Then, you must register for and pass the NCLEX exam administered by the National Council of State Boards of Nursing (NCSBN). If you pass, you will earn your registered nursing credential. Bear in mind that candidates must sit for the NCLEX exam within 12 months of registering.

Many nurses today pursue a multi-state license through the Nurse Licensure Compact. As of July 2021, 38 states participate in the compact. If you live in a compliant state and wish to pursue a multi-state license, especially if you plan to work as a traveling nurse, contact your state board of nursing for more information.

2. Work for 1+ years in a labor and delivery unit as an RN.

Most RNs who plan on pursuing careers as CNMs spend one or more years working in hospital settings. You can hone your skills in a labor and delivery unit and pursue additional certifications that help you prepare for future work as a CNM. By bolstering your skills in areas such as women's health and neonatal care, you improve the quality of care you can provide patients while preparing for graduate-level education.

3. Earn an MSN with a specialization in midwifery.

The next step toward a career as a CNM is earning a master of science in nursing with a specialization in midwifery. Learners can choose from two educational paths to make it to the master's level: the RN-to-MSN and the BSN-to-MSN. If you possess an associate degree but no bachelor's degree, you will follow the RN-to-MSN program. These programs typically take learners 2-4 years to complete. Those who already possess a BSN can complete a BSN-to-MSN path, which takes 2-3 years to complete.

Your master's program should hold programmatic accreditation from the Accreditation Commission for Midwifery Education. This accreditation indicates that your midwifery master's program offers a quality education that meets high industry standards.

4. Earn certification through the AMCB.

You need to pass the AMCB's certification exam in order to practice as a certified nurse midwife or certified midwife. The multiple-choice, computer-based exam assesses your cognitive knowledge in physiology, clinical decision-making, pharmacology, and physical examination findings. The exam only tests knowledge that the AMCB deems necessary for professionals in entry-level midwifery roles as beginning practitioners. The CNM credential remains valid for five years.

5. Apply for advanced practice state licensure.

Like nurse practitioners, CNMs are designated as APRNs who must follow guidelines enforced by their state's board of nursing. There is no multistate license for APRNs, unlike RN and LPN licensure. The NCSBN developed legislation for a multi-state APRN license in 2020. The APRN compact does not take effect until seven states meet the requirements and follow the model. Until then, you will need to reapply for licensure if you move to another state.

6. Maintain certification and licensure through continued education.

The CNM credential remains valid for five years. Within each five-year cycle, CNMs must complete at least three AMCB-approved modules and obtain at least 20 contact hours. You will need to keep track of your approved continuing education credits and contract hours using the AMCB online portal. Alternatively, you can retake the certification exam in lieu of acquiring the necessary continuing education credits.

Certified Nurse Midwife Skills

CNMs must possess a variety of hard and soft skills, sometimes referred to as technical and human skills. Since much of their nursing training takes place in hands-on scenarios and clinical settings, prospective CNMs develop many of these skills during their education. CNMs also get the chance to brush up on technical and human skills as they complete continuing education credits to maintain their certifications. Here are valued skills for today's nursing midwives.

Human Skills

  • Ability to work quickly under pressure
  • Active listening
  • Empathy
  • Communication
  • Problem-solving and critical thinking
  • Work as part of a team and independently

Hard Skills

  • Diagnose and treat women and expecting mothers
  • Guiding the labor and delivery process
  • Assist physicians during cesarean sections
  • Checking and interpreting patient vital signs and fetal monitoring
  • Understanding patient safety protocols
  • Technological skills with medical equipment
  • Prescribe medication
  • Ability to instruct and educate patients
  • Emergency care skills

Nurse Midwife Salary Overview

CNMs and other nursing professionals focused on women's health earn a healthy salary. According to the Bureau of Labor Statistics, the median annual nurse midwife salary is $111,130. Individuals with a medical doctorate can apply to more lucrative roles in women's health. For example, professionals who work as OB-GYNs earned a mean wage of $239,120 in 2020.

Salary Overview: Nurse Midwife and Similar Occupations
Career Median Salary (2020)
Nurse Anesthetists $183,580
Nurse Practitioners $111,680
Nurse Midwives $111,130
Registered Nurses $75,330
Licensed Practical and Licensed Vocational Nurses $48,820
Nursing Assistants and Orderlies $30,830

Common Questions About Midwives

true How Long Does It Take to Be a Midwife Nurse?

The amount of time it takes to become a CNM depends on your educational background. Students need a master's degree in nursing with a focus on midwifery to work as CNMs. Learners with a BSN can typically finish their master's degree in 2-3 years.

true Is a Midwife Higher Than a Nurse?

Yes. CNMs are APRNs and spend more time in school than RNs. CNMs possess more specialized training and additional patient-focused responsibilities compared to RNs.

true Do Midwives Deliver the Baby?

Yes. One of CNMs' responsibilities is to deliver babies in clinical settings, in addition to providing prenatal, gynecological, and post-pregnancy care for patients. Midwives with graduate-level or nursing training can also deliver babies, but this usually takes place in at-home or birthing center deliveries. A doula, however, is not qualified to deliver a baby.

true What Is the Difference Between a Nurse Midwife and a Certified Midwife?

CNMs have graduate-level nursing training while CMs have graduate training in a midwifery program but do not have training as a nurse. However, CNMs and CMs must pass the same licensure exams.

Timon Kaple is a writer and ethnographer specializing in the study of music, language, and American culture. His recent work explores how people understand their daily experiences and how those beliefs influence their actions, engagement with social media, language, work, and art. He conducts ethnographic fieldwork and teaches students of all ages about music and culture. Timon also holds the Ph.D. from Indiana University-Bloomington.

As an assistant professor of nursing and entrepreneur with nearly twenty years of varied nursing experience, Brandy Gleason offers a unique perspective. She currently teaches within a prelicensure nursing program and coaches masters students through their culminating projects. Brandy brings additional expertise as a bedside nurse and a nurse leader, having held past roles at the supervisory, managerial, and senior leadership levels. Her passion and area of research centers around coaching nurses and nursing students to build resilience and avoid burnout. Brandy is also an avid change agent when it comes to creating environments and systems that contribute to the wellbeing of students and healthcare professionals.

Header Image Credit: Diversity Photos | Getty Images

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