According to the U.S. Bureau of Labor Statistics, the certified nurse-midwife (CNM) profession is expected to grow as much as 31% from 2014 to 2024—which is unusually fast. As a result, there will be a need for many more CNMs.
In honor of National Midwifery Week, we break down what a CNM does and why you consider becoming one. After all, they do a lot more than “deliver” babies.
What CNMs Do (and Don’t)
First of all, it’s important to use the correct terminology. “We use the words ‘attend the birth,’ as the mother ‘delivers’ her baby—it is a more respectful term for the mother,” says Barbara A. Anderson, DrPH, CNM, RN, FACNM, FAAN, owner and manager of an educational consulting company which offers private consulting for educational programs including midwifery, nursing, and public health. She also serves on the Board of Directors for the American College of Nurse-Midwives (ACNM).
“We like to say we ‘catch’ them because the mother does all the work of delivering them,” says Kerri D. Schuiling, PhD, CNM, FACNM, FAAN, provost and vice president of academic affairs at Northern Michigan University in Marquette, Michigan. “The CNM’s role during a birth is to attend to the mother during her labor, and carefully assess the progress of the labor and how the fetus is withstanding the stress of the labor. It is a supporting role. We see ourselves as working with women during labor and birth. We also provide support to family members present, but our main role is supporting the mother as she labors to give birth.”
A huge misconception regarding CNMs is that they only attend to a woman during birth. In fact, CNMs as well as certified midwives (CM) are legally qualified to provide full care to women throughout their lives, explains Anderson. According to the Birth Institute, CNMs don’t solely focus on birth; they can provide care for women from puberty through menopause.
“They are educated to provide pre-conceptual, interconceptual, prenatal, intrapartum, and postpartum care to women,” says Anderson, as well as “care of the newborn, family planning services, and ongoing women’s health care including primary care, gynecological care, and health education of the well woman.” Just as there are both male and female OB-GYNs, there are also both male and female CNMs. “There are no gender differences on scope of practice.”
Schuiling says that CNMs work in hospitals (and they are credentialed to do so by the hospital) as well as birthing centers and homes. Anderson adds that in the United States, most CNMs practice in a hospital setting. There are, however, a number of freestanding birth centers owned and operated by CNMs, CMs, and certified professional midwives (CPM).
The Differences: CNMs, CMs, and CPMs
There are quite a few differences between CNMs, CMs, and CPMs. Schuiling explains that, overall, for an RN to become a CNM, s/he must earn a bachelor’s degree in nursing and then a graduate degree in nurse-midwifery.
The ACNM states on its website, “Certified nurse-midwives are registered nurses who have graduated from a nurse-midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME) and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Nurse-midwives have been practicing in the U.S. since the 1920s.”
According to the ACNM, some programs do work with people who are not RNs: “If the applicant has a bachelor’s degree, but not an RN license, some programs will require attainment of an RN license prior to entry into the midwifery program; others will allow the student to attain an RN license prior to graduate study. If the applicant is an RN, but does not have a bachelor’s degree, some programs provide a bridge program to a bachelor’s degree prior to the midwifery portion of the program; other programs require a bachelor’s degree before entry into the midwifery program.”
Like CNMs, CMs also need a bachelor’s degree from an accredited college/university as well as successful completion of specific science courses. Then CMs need to graduate from a midwifery education program accredited by ACME.
The International Confederation of Midwives, says Anderson, a branch of the World Health Organization, is the body that sets global standards for the education of midwives as well as the practice of the profession, and allows for country-specific adaptation. The ICM standards are supported by the ACNM, which is the national organization of CNMs and CMs. Both CNMs and CMs must pass the American Midwifery Certification Board’s examination and continue to get recertified every five years.
CPMs are the most different in that they only are required to have a high school diploma or equivalent. “CPMs do not necessarily have formal education and may be trained in the apprenticeship model. They do not meet the educational standards of the ICM, but they are regulated and certified by the North American Registry of Midwives. The CPM credential is accredited by the National Commission for Certifying Agencies,” explains Anderson. Unlike CNMs and CMs, CPMs do not treat women throughout their entire lives. Their work is focused on “the management of prenatal birth and postpartum care for women and newborns” says the ACNM.
Another big difference between CNMs, CMs, and CPMs is their legal status. The ACNM states that CNMs can be licensed in all 50 states in addition to Washington, DC, and the United States territories. CMs can be licensed in New Jersey, New York, and Rhode Island. They may also be authorized to practice in Missouri or Delaware. CPMs are regulated in 28 states, but this may vary “by licensure, certification, registration, voluntary licensure, or permit.”
Rewards of the Job
“I love the autonomy of advanced practice nursing and the ability to provide the type of care you believe in and that you know you make a difference,” says Schuiling, who is also a co-editor of the ICM’s official publication, the International Journal of Childbirth. “The hours are definitely hectic and long, but the rewards of working with new families are so very hard to explain. It really is such a miracle to be present at birth.”
Anderson says that “I love working with families, helping women to experience personal fulfillment and good health in childbearing, helping fathers and family members to feel engaged in this powerful life experience, and helping infants to be welcomed and embraced in their families.”
As for the best part of working as a CNM: “The best part is being part of this miracle,” says Anderson. “There is a wonderful proverb that states, ‘The greatest job is to become a mother; the second greatest is to be a midwife.”