Certified Nurse Midwife (CNM) Jobs

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Jobs in nurse-midwifery are:

  • Elite: Only 5,000 nurse-midwives were actively licensed in the US as of May 2014. The advanced clinical skills that nurse midwives bring to antepartum, intrapartum and postpartum care makes them highly sought after and places a premium on the services they provide.
  • Valued: In 2013, CNMs attended 320,983 births in the U.S., representing 12 percent of all vaginal births that year. Most states recognize nurse-midwives as independent healthcare providers with prescriptive privileges.
  • Lucrative: The average annual salary for nurse-midwives was $97,700 as of May 2014, while those with salaries in the 90th percentile earned an average of $129,140.
  • Increasing Significantly: It is projected that the number of actively licensed CNMs will increase by 25 percent during the ten-year period between 2014 and 2024. Compare this to the overall average projected job growth rate for this period of just 7 percent.

Statistics originally published by the US Department of Labor, Bureau of Labor Statistics in May 2014.

Nurse Midwife Job Description: Well-Women Care, Childbirth and Neonatal Care

According to the American College of Nurse-Midwives, nurse-midwife jobs involve providing a full range of primary health services for women, from adolescence to beyond menopause, which include:

  • Primary care
  • Gynecologic and family planning services
  • Preconception care
  • Care during pregnancy and childbirth
  • Postpartum care
  • Care of the normal newborn during the first 28 days of life
  • Treatment of male partners for sexually transmitted infections

Though hospitals are by far the biggest employers of certified nurse-midwives, they also frequently serve as leaders of community health clinics, obstetrician-run OB/GYN clinics and nurse midwife-run women’s health clinics. They also often establish independent nurse-midwifery and women’s health practices of their own, or enter into partnerships with other nurse-midwives or nurse practitioners. Though it is still quite uncommon, they may also attend home births.

The Midwifery Philosophy of Care

Regardless of the settings in which they work, nurse-midwives adhere to a philosophy of care that ensures the women and infants they work with receive high-quality, consistent care aimed at respecting basic human rights. Nurse-midwives recognize the important relationship between the health of women and the well-being of families, communities, and nations.

For example, nurse-midwives honor the normalcy of women’s lifecycle events. This means job duties include:

  • Watching and waiting (without interventions) for normal processes to take place
  • Appropriately using interventions and technology to address both current and potential health problems
  • Consulting and collaborating with other members of the healthcare team and making referrals when necessary

The nurse-midwifery philosophy of care also includes respecting the best model for a woman and her family, which may include:

  • Promoting a continuous and compassionate partnership
  • Acknowledging a person’s life experiences and knowledge
  • Providing individualized methods of care and healing backed by the best evidence available
  • Understanding the therapeutic use of human presence and skillful communication

The Midwifery Model of Care

Nurse-midwives follow the Midwifery Model of Care, which recognizes CNMs as specialists in normal birth. In fact, a large part of a CNM’s attention is on the pregnant woman within the context of her family and life, as opposed to just focusing on the birthing process itself. A CNM’s job description therefore likely includes paying close attention to, and addressing:

  • The woman’s expectations and experiences of pregnancy
  • The woman’s knowledge and opinions
  • The woman’s questions and worries
  • The woman’s satisfactions and dissatisfactions
  • The woman’s comfort and discomforts
  • The woman’s desires, decisions, and actions and their effect on:
    • The pregnancy
    • The fetus
    • Labor and delivery
    • Breastfeeding
    • Postpartum recovery
    • Development as a mother

The CNM job description includes helping women make changes conducive to healthy pregnancies, infants, and families, and recognizing and managing deviations from the norm.

Job Duties and Responsibilities of Nurse-Midwives According to ACNM Core Competencies

The American College of Nurse-Midwives’ (ACNM) Core Competencies for Basic Midwifery Practice breaks down the skills, behaviors, and knowledge required for new nurse-midwives, making it the ideal resource for understanding the many job duties and responsibilities of nurse-midwives.

The Competencies are organized into the following areas of nurse-midwifery practice:

Midwifery Management Process

The Midwifery Management Process, which applies to all areas of nurse-midwifery clinical care, identifies the following job duties/responsibilities of nurse-midwives:

  • Evaluate the woman or newborn
  • Identify problems or diagnoses and healthcare needs based on the collection of subjective and objective data
  • Anticipate any potential problems or diagnoses
  • Evaluate the need for intervention, collaboration, or referral with other healthcare team members
  • Develop a comprehensive plan of care in partnership with the woman
  • Ensure the efficient implementation of a plan of care
  • Evaluate the effectiveness of the plan of care

Midwifery Care of Women

Nurse-midwives independently manage primary health screening, health promotion, and the care of women from adolescence throughout the lifespan using the midwifery management process. Job duties and responsibilities include:

  • Adhering to nationally defined goals and objectives for health promotion and disease prevention
  • Assessing the woman’s physical, mental, and social health
  • Making screening and immunization recommendations as to promote health and detect and prevent disease
  • Implementing management strategies and therapeutics as to facilitate the woman’s health and promote healthy behaviors
  • Identifying normal and deviations from normal in the following areas:
    • Cardiovascular/hematologic
    • Endocrine
    • Eyes, ears, nose, and throat
    • Gastrointestinal
    • Mental health
    • Musculoskeletal
    • Neurologic
    • Respiratory
    • Renal
  • Implementing strategies and therapeutics for treating common health problems, including infections, self-limited conditions, and mild or stable presentations of chronic conditions
  • Overseeing issues related to the preconception period, such as:
    • Individual/family readiness for pregnancy
    • Factors such as family and genetic/genomic risk
    • Factors such as environmental and occupational factors, lifestyle, nutrition, and medications
    • Health and lab screening
    • Fertility awareness, symptoms of pregnancy, cycle charting, etc.
  • Overseeing issues related to gynecologic care, such as:
    • Human sexuality
    • Common screening tools and diagnostic tests
    • Common gynecologic problems
    • Contraceptive methods
    • Sexually transmitted infections
    • Counseling regarding sexual behaviors
    • Counseling, clinical interventions, and/or referral for unplanned pregnancies, infertility, and sexual/gender concerns
  • Overseeing issues related to the peri-menopausal and post-menopausal periods, such as:
    • Physical, mental, and sexual effects of menopause
    • Health maintenance and promotion counseling and educating
    • Managing/alleviating common discomforts
  • Overseeing issues related to the antepartum period, such as:
    • Maternal and perinatal morbidity and mortality
    • Confirming and dating pregnancy
    • Promoting a normal pregnancy
    • Addressing common discomforts of pregnancy
    • Health risks, such as domestic violence, infections, and substance use/abuse
    • Emotional, psychosocial, and sexual changes during pregnancy
    • Guidance regarding birth, breastfeeding, parenthood, and change in family dynamics
    • Addressing placental physiology, embryology, fetal development, and indicators of fetal well-being
  • Overseeing issues related to the labor and birth period, such as:
    • Confirming and assessing labor and its progress
    • Maternal and fetal status
    • Managing complications, abnormal intrapartum events, and emergencies
    • Facilitating the woman’s physiologic labor progress and supporting her psychosocial needs during labor and birth
    • Coping with labor pain
    • Pharmacologic and non-pharmacologic strategies for facilitating maternal coping during labor
    • Spontaneous vaginal birth
    • Performing episiotomy repair and first/second degree lacerations
  • Overseeing issues related to the postpartum period, such as:
    • Physical involution following a pregnancy that ended in a spontaneous or induced abortion, preterm birth, or term birth
    • The management of strategies and therapeutics that facilitate a healthy puerperium
    • Discomforts of the puerperium
    • Self-care
    • Psychological coping and healing following pregnancy
    • Readjustment of relationships and roles
    • Facilitating lactation
    • Resuming sexual activity, contraception, and pregnancy spacing

Midwifery Care of the Newborn

CNMs independently manage the care of the newborn immediately following birth, up to 28 days of life. Job duties/responsibilities during this time include:

  • Maintaining the maternal and fetal history and assessing the risk factors of the newborn
  • Preparing and planning for birth based on the ongoing assessment of the mother and fetus
  • Facilitating the physiologic transition for newborns by:
    • Establishing respiration
    • Cord clamping and cutting
    • Regulating the newborn’s body temperature
    • Establishing newborn feeding
    • Overseeing the bonding and attachment between mother and newborn
    • Providing emergency treatment, such as stabilization and resuscitation
  • Evaluating the newborn
  • Developing a plan of care for the newborn for the first 28 days of life in conjunction with the woman and family
  • Overseeing preventive care of the newborn (testing, screening, eye ointment, vitamin K, etc.)
  • Addressing issues such as:
    • Minor and severe congenital malformations
    • Poor transition following birth
    • Infections
    • Post-partum depression and its effect on newborns
    • End-of-life care for stillbirth

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