Certified Nurse-Midwives (CNM)

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.

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Certified Nurse-Midwives (CNM)

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.

Scope of Practice

  • Physical Assessment
  • Prescription privileges
  • Education
  • Referrals and consultations
  • General health of women and the newborn
  • General uncomplicated lady partsl birth of the gravida and immediate care of the newborn

Regulation of the CNM

  • The state Board of Nursing (BON) licenses the RN
  • Only graduates of an accredited midwifery program are eligible to sit for certification as CNM

CNM Education

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):

Quote

The 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.

Educational Programs (not all-inclusive)

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)

Differences between CNM and Lay Midwife

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.

for the CNM

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

Salary (2020)

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.

 
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sirI

About sirI, MSN, APRN, NP

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sirI is an OB-GYN NP-BC, (Emeritus), FNP-BC, and Legal Nurse Consultant. Specialty areas include OB-GYN, trauma, med-legal consulting, forensics, and education.

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Specializes in Eventually Midwifery.

While I appreciate your article very much, you have incorrectly used "lay midwife" and "licensed midwife" interchangeably (probably just a copy and paste error).

For clarification, there are 5 types of midwives:

Certified Nurse Midwife (CNM)- an RN with a Master's level specialty that has passed national board certification (AMCB)

Certified Midwife (CM)- not a nurse, but has college education specializing in midwifery and also has passed the same exam as the CNM. This designation is only accepted in a few north-eastern states in the US

Certified Practicing Midwife (CPM)- not a nurse, but rather a graduate of a MEAC approved program or submission of portfolio directly to NARM, the certifying board for home birth midwives

Licensed Midwife (LM)- not a nurse, a midwife that is licensed individually in their particular state, may or may not be nationally certified by NARM, depending on the licensing regulations of each particular state

Lay Midwife- not licensed, not formally educated midwife, AKA traditional midwife

https://www.midwife.org/Become-a-Midwife

https://narm.org/certification/

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Specializes in Education, FP, LNC, Forensics, ED, OB.
mamagui said:
While I appreciate your article very much, you have incorrectly used "lay midwife" and "licensed midwife" interchangeably (probably just a copy and paste error).

For clarification, there are 5 types of midwives:

Certified Nurse Midwife (CNM)- an RN with a Master's level specialty that has passed national board certification (AMCB)

Certified Midwife (CM)- not a nurse, but has college education specializing in midwifery and also has passed the same exam as the CNM. This designation is only accepted in a few north-eastern states in the US

Certified Practicing Midwife (CPM)- not a nurse, but rather a graduate of a MEAC approved program or submission of portfolio directly to NARM, the certifying board for home birth midwives

Licensed Midwife (LM)- not a nurse, a midwife that is licensed individually in their particular state, may or may not be nationally certified by NARM, depending on the licensing regulations of each particular state

Lay Midwife- not licensed, not formally educated midwife, AKA traditional midwife

Hello and thank you for the additional information. You are correct as well. But this Article only covered the CNM and the Lay Midwife. The Lay Midwife is not educated (formally as you pointed out), but receives learning through apprenticeship and self-study. You are also correct in that the Licensed Midwife, not a nurse, is licensed state by state (as stated above).

Thank you for pointing out that my header did not include comparison of the other two (CPM and (CM) and that I did indeed, leave out the header about the Licensed Midwife.. I will be adding another Article later that will discuss all disciplines of midwifery.

(I will be re-formatting this Article to include your additional information). Thank you for clarification.

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Specializes in OB.
sirI said:
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.

As a CNM, I would venture to say that CNMs have greatly enhanced the quality of healthcare for women even in areas where OB/GYNs ARE available. We're not just physician-extenders, although many midwives work in settings where they are treated as such.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
LilyRoseCNM said:
As a CNM, I would venture to say that CNMs have greatly enhanced the quality of healthcare for women even in areas where OB/GYNs ARE available. We're not just physician-extenders, although many midwives work in settings where they are treated as such.

I totally agree with you (CNM), LilyROseCNM

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Specializes in Eventually Midwifery.

I just wanted to include the extra information about other types of midwives so that people were aware of what they are :)

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Specializes in Nurse-Midwife.

I think defining CNMs as APRNs - advanced practice registered nurses - gets complicated when the AMCB has a pathway for becoming a midwife - equivocal to the CNM - without first becoming a nurse.

The Credential CNM and CM

There are many articles and opinions out there on this one. Is midwifery an APRN specialty, or is it a distinct profession with a nursing entry to practice? Hmmmm.

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Specializes in Eventually Midwifery.
queenanneslace said:

There are many articles and opinions out there on this one. Is midwifery an APRN specialty, or is it a distinct profession with a nursing entry to practice? Hmmmm.

If I am understanding correctly, those that are NOT nurses do not receive the credential CNM, rather receive the CM after passing the same boards. The CM can only practice in a few north east states. Therefore, a CNM is still considered an advanced practice registered nurse, while a CM is a Certified Midwife. I think ?

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Specializes in Eventually Midwifery.

...so, I guess midwifery is both, depending on the type midwife. Also, the scope of practice is distinct for a CNM as they provide well woman care across the lifespan, have prescriptive authority, etc., whereas the CM focuses mostly on perinatal care.

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Specializes in Nurse-Midwife.

A 2010 issue of the Journal of Midwifery and Women's Health devoted quite a few articles to the discussion of regulation of midwifery practice.

If you have access to this journal, or can get to a library that does -there are quite a few articles discussing the relationship between nursing and midwifery.

https://onlinelibrary.wiley.com/toc/15422011/2010/55/5

The article I really appreciated was by Helen Varney Burst: Nurse-Midwifery Self-Identification and Autonomy

Another good resource on the development of the CM credential - which by certification is an equivalent credential to the CNM - and includes the same scope of practice and training (independent practitioners providing well-woman care, gynecology, primary care as well as antepartum, intrapartum and postpartum care) - is a book that's a few years old now titled "Midwifery & Childbirth in America" by Judith Rooks.

[May I link to a Google book? Is that allowed?]

Midwifery and Childbirth in America - Judith Rooks - Google Books

Go to page 247, there's a good overview of the development of both the CPM and the CM credentials by MANA and ACNM respectively.

CMs do not have recognition by most states - perhaps, because state BONs license CNMs dually as nurses and CNMs, or advance practice nurses. There is some concern that if CNMs are licensed as APRNs - as many states are currently pushing for uniform APRN licensure across multiple advance practice nurse specialties, that barriers to recognition of the CM credential will be increased.

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queenanneslace said:
I think defining CNMs as APRNs - advanced practice registered nurses - gets complicated . Is midwifery an APRN specialty, or is it a distinct profession with a nursing entry to practice? Hmmmm.

Yes, it is classified as APRN, the CNM. As stated in the original Article, there are 4 types:

CRNA

NP

CNS

CNM

All states do not recognize the CNS or the CNM, however. And, in some states only the nurse practitioner is recognized as RNP only, not an APRN IF they do not have a Masters degree; they can practice only in their state and no other unless they have a Masters.

I know this is a little off-topic, but the CNS in many states can practice as NPs and in some they are not recognized at all (as I stated) and must take a post-Masters as NP. We have a couple practicing CNS here at allnurses who had to do a post-Masters as NP in order to be recognized as APRN.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
mamagui said:
If I am understanding correctly, those that are NOT nurses do not receive the credential CNM, rather receive the CM after passing the same boards. The CM can only practice in a few north east states. Therefore, a CNM is still considered an advanced practice registered nurse, while a CM is a Certified Midwife. I think ?

You are correct mamagui.

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