Addressing the Growing Need for Certified Nurse-Midwives

According to the World Health Organization (WHO), nurses and midwives represent more than 50 percent of the current shortage of healthcare workers. In fact, WHO estimates that an additional nine million nurses and midwives will be needed globally by the year 2030¹.

In the U.S., gaps in care are often prevalent in rural communities, especially when it comes to access to services provided by certified nurse-midwives (CNMs). According to a 2017 research article published in Health Affairs, 50 percent of rural counties have no hospital-based obstetrical services. Further, rural residents have a nine percent greater probability of severe maternal morbidity and mortality compared with urban residents².

According to a 2020 study from The Lancet Global Health, utilizing more midwife services could result in 280,000 fewer deaths in mothers, nearly two million fewer deaths in newborns, and more than two million fewer stillbirths per year by 2035³.  In addition, a 2018 study found that women who gave birth at hospitals with more midwife-attended births had lower odds of giving birth by cesarean and lower odds of episiotomy⁴.

In the U.S., midwife services are utilized in only eight percent of births, according to a 2019 article from Scientific American. Comparatively, midwives attend over two-thirds of births in the U.K. and other countries⁵.

According to the 2022 America's Health Rankings annual report, at 5.4 deaths per 1,000 live births, the U.S. ranked No. 33 out of the 38 Organization for Economic Co-operation and Development (OECD) countries measured by the study. The average rate of infant mortality among OECD countries was 4.1 deaths per 1,000 live births⁶.

As our national healthcare system reckons with a shortage of nurses and midwives and as rural and underserved populations find themselves at greater risk of maternal morbidity and mortality, it is imperative to prepare a new generation of CNMs and women's healthcare nurse practitioners (WHCNPs) who are prepared to provide culturally-concordant primary preventive care.

Though many may think of the delivery room when they hear the word "midwife,” a CNM's scope of care is much more far-ranging, providing a wide spectrum of reproductive, sexual, and primary women's health services. A CNM's focus is on gynecologic and family planning services, as well as preconception, pregnancy, childbirth, postpartum and newborn care. They also provide primary care, such as conducting annual exams, writing prescriptions, and offering basic nutrition counseling.

CNMs are able to work in all birth settings, including hospitals, homes, and birth centers, and can prescribe medications in all 50 states. While they are experts on how to cope with labor pain both naturally and using medications when needed. they also work with anesthesia providers to give access to epidurals. CNM's collaborate with obstetricians to ensure that if there is a complication, there is ready access to obstetrical services. Women who have health conditions that may put them at risk for complications often work with both nurse-midwives and OBGYNs for a highly effective plan of care. Training nine million new nurses and midwives is a tall order, but passionate healthcare professionals from around the world are advancing their scope of capabilities. Those interested in becoming a CNM must first complete nursing school, earn a master's degree or post-graduate certificate from an accredited nurse-midwifery program, pass the national midwifery certification board exam, and hold state licensure.

For practicing nurses who want to provide further healthcare services for women but are not enticed by the birthing element inherent in the work of CNMs, pursuing a master's degree or post-graduate certificate to become a WHCNP may be appealing. A WHCNP is an advanced practice nurse that specializes in continuing and comprehensive health care for women throughout their lives. WHCNPs provide well-woman care, reproductive and gynecological care, and prenatal and postpartum care. Additionally, WHCNPs focus on health promotion, disease prevention, health education, and helping patients make smart lifestyle choices. CNMs and WHCNPs also have the option to obtain a clinical doctorate. The Doctor of Nursing
Practice (DNP) is the highest degree for clinical nursing practice, allowing nurses to advance their skills and develop as leaders, researchers, and innovators to improve health outcomes.

For busy nurses balancing careers and active personal lives, a distance education program can be an excellent option for pursuing a degree or certification, particularly for those in diverse, rural, and underserved communities. With flexible online formats, nurses can choose their pace of study, complete clinical rotations in their home communities, and expand their professional networks.

To learn more about certified nurse-midwives, visit the American College of Nurse-Midwives (ACNM). To learn more about women's health care nurse practitioners, visit Nurse Practitioners in Women's Health (NPWH).

References/Resources

1 Nursing and midwifery: World Health Organization

2 Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15: Health Affairs

3 Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study: The Lancet

4 Relationship Between Hospital-Level Percentage of Midwife-Attended Births and Obstetric Procedure Utilization: National Library of Medicine

5 The U.S. Needs More Midwives for Better Maternity Care: SCIENTIFIC AMERICAN

6 Annual Report 2022: America's Health Rankings-The United Health Foundation