The Certified Nurse-Midwife (CNM) is an Advanced Practice Registered Nurse (APRN) who is a graduate of a nurse-midwifery program and is nationally certified. Many states recognize this specialty and some do not. This Article will cover the CNM and touch on the lay Midwife as well. Specialties CNM Knowledge
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Certified nurse-midwives (CNM) are educated in the two disciplines of nursing and midwifery. They provide primary healthcare to women of childbearing age including: prenatal care, labor and delivery care, care after birth, gynecological exams, newborn care, assistance with family planning decisions, preconception care, menopausal management and counseling in health maintenance and disease prevention. CNMs attend a very small percentage of births in the United States.
The CNM dates back to the early 1920's when Mary Breckinridge started a program in Kentucky using nurses from other countries. As the need for licensed professional nurses grew, programs started growing and now all CNM must be educated as RN's, complete a Nurse-Midwifery program, and become certified as nurse-midwives. Programs must adhere to the standards of midwifery practice in the United States as set forth by the American College of Nurse-Midwives (ACNM).
The CNM works closely with Obstetricians and Gynecologists (OB-GYN physicians). They take on what is considered "low-risk" pregnancies. Should the midwife recognize the gravida is high-risk, he/she will consult and refer immediately to the OB-GYN. The majority of CNM work in hospitals and in poor, rural townships/cities. They also are employed in birthing centers and Health Departments. The role of the CNM has greatly enhanced the quality of healthcare for women in the past 40 years in areas where OB-GYNs are not available.
For the past several years, there has been much discussion about the education process for the APRN. Most APRN programs have moved to the Doctor of Nursing Practice (DNP) as the minimum entry into practice for Nurse Practitioners (NP) and the DNP or Doctor of Nurse Anesthesia Practice (DNAP) for Certified Nurse Anesthetists (CRNA). The Clinical Nurse Specialist (CNS) seems to follow along the same lines.
According to the 2020 FAQ from the American College of Nurse-Midwives (ACNM):
QuoteThe type of academic credit and degree awarded may be different for each program. All (Accreditation Commission for Midwifery Education) ACME-accredited midwifery education programs award a Masters Degree and/or Doctor of Nursing Practice (DNP) degree; some programs offer a master's completion option for CNMs who do not have Master's degrees; and several programs offer a post-graduate certificate option for those graduate-prepared advanced practice nurses who want to expand their practice to include midwifery. Upon graduation from an ACME-accredited program, individuals are eligible to take the national certifying exam offered by the American Midwifery Certification Board (AMCB). Upon successful completion of this exam, individuals are granted a Certificate in either Nurse-Midwifery or Midwifery.
Georgetown University School of Nursing and Health Studies - (MS, BSN to DNP)
Texas Tech University Health Sciences Center School of Nursing - (MSN, Post Graduate Certificate)
Baylor University College of Nursing - (Doctor of Nursing Practice-DNP)
California State University, Fullerton School of Nursing - (MSN/Post-Master's Certificate)
University of Colorado, Anschutz Medical Campus, College of Nursing - (MS, Post-Graduate Certificate, DNP )
Emory University Nell Hodgson Woodruff School of Nursing - (DNP, BSN-MSN, MSN or MSN/MPH, Post Graduate Certificate)
Vanderbilt University School of Nursing - (MSN, Post Graduate Certificate)
The difference between the two is their training.
Lay midwives are not nurses, rather, they're those who have had direct training in midwifery through self-study and the majority, apprenticeship. Some lay midwives later decide to enter into a Masters Nursing Program and combine Nurse-Midwifery with the program.
A licensed midwife is sanctioned by her/his state after she/he passes a test administered by the state's medical board licensing division. Licensing requirements differ among states; some, like Oregon, do not require licensing at all. Lay midwives in eight states - Indiana, Iowa, Kentucky, Maryland, Missouri, North Carolina, Virginia, and Wyoming - and in the District of Columbia legally are not able to become licensed midwives. So while you may be able to have a legal homebirth in those states, a lay midwife could risk arrest by attending.
Many Insurance companies will not cover the CNM. The following is one company that provides competitive premiums for the CNM and Midwifery Student.
Contemporary Insurance Services
According to salary.com, the average annual salary in the U.S. is $110,963 with a range between $102,034 and $125,739.
According to Glassdoor, the national average salary for a CNM in the U.S. is $106,576.