It the past 20 years, the number of midwife-attended births in the US has more than doubled. Certified nurse midwives (CNMs) attended nearly 321,000 births in the United States in 2013 alone, representing about 8 percent of all births in the US that year.
Certified nurse-midwives are advanced practice registered nurses (APRNs) who serve as licensed healthcare providers in all U.S. jurisdictions and territories. Federal law defines them as primary care providers, as their services encompass primary healthcare services for women, from adolescence and beyond. These services most often include:
- Preconception care
- Pre-natal and post-natal care
- Care for the newborn (during the first 28 days of life)
- Treatment of make partners for sexually transmitted infections
CNMs have prescriptive authority in all 50 states.
According to the American College of Nurse-Midwives (ACNM), CNMs’ practice beliefs include:
- Watchful waiting, allowing the normal process to occur without intervention
- The use of interventions and technology when faced with current or potential health problems
- Consultation, collaboration, and referral with other members of the healthcare team so as to provide patients with optimal care
The American College of Nurse-Midwives reported that nearly 95 percent of all CNM-attended births occurred in hospitals in 2013, while 3 percent occurred in freestanding birth centers, and 2.6 percent occurred in homes. Further, more than 50 percent listed hospitals/medical centers or physician practices as their principal employers.
According to the Bureau of Labor Statistics, nurse-midwives earned an average, annual salary of $97,700 as of May 2014, with the top 10 percent earning more than $129,140 on average.
The top-paying industries for nurse midwives during the same period were:
- General medical and surgical hospitals: $104,400
- Outpatient care centers: $97,690
- Offices of physicians:$96,820
- Colleges, universities, and professional schools: $95,160
- Specialty hospitals: $84,260
Earning an MSN in Nurse Midwifery
Like other APRN roles (nurse practitioners, nurse anesthetists, and clinical nurse specialists), certified nurse midwives must complete a Master’s Degree in Nursing (MSN) or post-graduate certificate. An MSN is the minimum educational requirement to become nationally certified and state licensed to practice as a CNM.
The traditional route to becoming a nurse-midwife involves earning a Bachelor of Science in Nursing (BSN) while becoming licensed as a registered nurse, and then completing an MSN program in nurse-midwifery accredited by the Accreditation Commission for Midwifery Education (ACME).
However, the ACME recognizes a number of MSN programs for nontraditional students. Programs may include:
- RN-to-MSN programs: Designed for practicing RNs who possess an associate’s degree; includes both BSN and MSN components and results in earning both degrees
- Entry-level (also referred to as generic or accelerated) MSN programs: Designed for students with a bachelor’s or graduate degree in a discipline other than nursing; includes both BSN and MSN components and results in earning both degrees
- Dual master’s degree programs, designed for nurses seeking a graduate degree with an in-depth concentration in a related field, such as business MSN/MBA, public health MSN/MPH, health administration MSN/MHA, public administration MSN/MPA, etc.
Many institutions offer flexible programming options for students, such as distance learning and part-time/evening courses. The ACME reports that six out of the 39 accredited programs provide the majority of their didactic material through online curricula, and more than half offer entry-level MSN programs for candidates with bachelor’s degrees in fields other than nursing.
A number of institutions now offer combined Nurse-Midwifery/Women’s Health Nurse Practitioner programs. These unique programs consist of core content of two APRN specialties (nurse midwifery and women’s health) with distinctly similar roles. These programs prepare graduates to earn dual certification as a nurse midwife and women’s health nurse practitioner.
After graduating from a nurse-midwife MSN program, graduates must sit for the American Midwifery Certification Board exam and apply for a state license as a CNM.
Those that graduate from a combined nurse-midwife/women’s health nurse practitioner program may additionally sit for the certification exam through the National Certification Corporation and apply for a state license as a Women’s Health Care Nurse Practitioner (WHNP). Graduates of these programs are allowed to hold dual certification as a nurse-midwife/women’s health nurse practitioner.
Format and Curriculum of MSN Programs for Nurse Midwives
Nurse-Midwifery MSN Program – Schools of nursing, colleges of allied health, and medical centers house ACME-accredited nurse-midwifery programs. Nurse-midwife MSN programs focus on the integration of research and nurse-midwifery practice, with an emphasis on delivery high-quality, patient-centered care.
In addition to core coursework in pathophysiology, pharmacology, health assessment, and research and leadership, courses in a nurse-midwife MSN program include:
- Primary care of women
- Comprehensive antepartum care
- Midwifery practicum
- Comprehensive perinatal care
- Advanced nurse-midwifery role development
Clinical rotations often include working in a variety of ambulatory and community sites, including rural and medically underserved clinics.
Nurse-Midwifery/Women’s Health Nurse Practitioner MSN Program – Nurse-midwifery/women’s health nurse practitioner (WHNP) programs allow students to broaden the scope of their practice beyond a CNM or WHNP. These programs combine the core areas of both nurse-midwife and women’s health nurse practitioner MSN programs, preparing students to become competent practitioners capable of providing a full range of primary care across all stages of a woman’s life.
Unlike nurse-midwifery programs, these combined graduate programs encompass not only the family planning and gynecologic needs of women, but care for the rest of the family through the diagnosis and management of common acute and chronic health conditions, as well.
The core curriculum of a nurse-midwifery/women’s health nurse practitioner program includes:
- Advanced health assessment
- Nurse-midwifery management of the antepartum, intrapartum, and postpartum woman
- Well woman healthcare and care of the newborn
- Nurse-midwifery management of complications
- Health promotion and disease prevention
- Assessment and management of common primary care signs and symptoms
- Clinical pharmacology
- Issues in nurse-midwifery professional practice
Clinical residences in these programs include rotations in antepartum, intrapartum, postpartum, well woman’s health, newborn, and primary care.
Difference Between Certified Nurse-Midwife and Certified Midwife Programs
The ACME accredits both nurse-midwife and midwife programs, although they are not the same. Midwife programs prepare certified midwives (CMs), while nurse-midwife programs prepare certified nurse-midwives (CNMs).
Although the ACNM recognizes both CNMs and CMs, the two are distinct professions, as CNMs are registered nurses while CMs are not. The vast majority of midwives in the U.S. are CNMs. The American Midwifery Certification Board reported that there were about 11,000 CNMs licensed in the US as of February 2015, compared to just 88 CMs.
Like CNMs, CMs are licensed, independent healthcare providers, and both complete the same education and must pass the same American Midwifery Certification Board-accredited certification examination to receive the professional designation.
However, the CM credential has not received recognition in all states. Certified midwives have authority to practice in Delaware (by permit), New Jersey, New York, and Rhode Island, while they have prescriptive authority in New York and Rhode Island only.