Helping You Learn About Nurse-Midwife Career Options
Midwifery is one of the most versatile and sought-after health care careers today. This is due partly to the variety of licensing options and work environments available to them. According to the American College of Nurse-Midwives (ACNM), the number of practicing certified nurse-midwives (CNMs) has grown steadily from only 275 in 1963 to over 7,000 today. In fact, over 306,000 births were attended by midwives in 2005. To help you learn more about the diversity provided by a nurse-midwife career, we've compiled a brief description of the licensing options and work settings available to you if you choose this rewarding profession.
Nurse-Midwife Career Licensing Options
While midwifery is growing in the United States, it is already a well-established norm in many countries throughout the world. In the United Kingdom, for example, midwives act as primary health care providers at the majority of births. In places like the U.K. where midwifery is more common, standards for certification are more uniformly legislated. However, since the U.S. is still relatively new to the industry, our standards of practice still vary widely from state to state.
By becoming a certified nurse-midwife, you are assured the option of practicing legally in any of the 50 states or the District of Columbia. CNMs account for a large percentage of practicing midwives today. They enjoy the most versatile nurse-midwife careers and are free to practice in any of the work settings listed below, as permitted by state law. For more information on obtaining CNM status, see our Nurse-Midwife School page.
Direct-entry midwives are educated in midwifery, but are not also nurses. The following are types of direct-entry midwives that currently serve patients in the U.S.:
- Certified Midwives (CMs) – These well-trained professionals complete accredited midwifery programs and pass the same certification exam from the American Midwifery Certification Board (AMCB) that CNMs take. They simply do not have a background in nursing. They are currently only licensed to practice as CMs in New York, New Jersey and Rhode Island.
- Licensed Midwives (LMs) – These highly-trained midwives practice independently in 24 of the 50 states, often in private practices, birth centers and homes. Many LMs are also Naturopathic Physicians (ND, LMs), providing midwifery care to their primary care patients.
- Certified Professional Midwives (CPMs) – These midwives are certified by the North American Registry of Midwives (NARM), and must confirm certain educational standards and pass a written examination. Generally, NARM certifies a broader spectrum of midwives, accepting portfolio evaluation in lieu of an accredited midwifery degree.
- Lay Midwives – These are unlicensed midwives who are often trained via apprenticeship or self-study. Laws regarding their practice vary by state.
Nurse-Midwife Career Work Settings
CNMs make up a richly diverse group—including men and women of all ages, backgrounds, cultures and beliefs—and the opportunities they have to utilize their unique skills are as varied as their backgrounds. In a nation where the vast majority of births are highly medicated and the cesarean-section rate continues to rise to over 30 percent of single child births,* nurse-midwives offer women an alternative choice of birthing environment. Midwives share in this unique mission regardless of their certification level; however, CNMs can generally practice in any of the work settings below.
The ACNM reports that nearly 95 percent of CNM-attended births occur in hospitals. In fact, hospitals across the country are starting to offer large midwifery practices for patients who prefer the personalized attention and freedom of choice midwifery provides, but who still want to give birth in a hospital where medical intervention can be quickly provided, should the need arise.
Working as a nurse-midwife in a hospital setting is a highly collaborative experience. These nurse-midwives work on teams that share call time, patients and delivery hours, and also consult with physicians and other medical professionals regularly.
Private Practices & Clinics
In their 2007 survey, the ACNM reported that over one-third of responding CNMs and CMs worked in private practices or community health organizations. Midwives who work in clinics and private practices may work in conjunction with physicians, or in teams of midwives. These individuals enjoy a collaborative workplace, but don't have to deal with as many bureaucratic rules or feel pressure to conform to certain medical procedures that are often commonplace at hospitals.
Birth Centers & Home Births
Those who spend their nurse-midwife careers in birth centers and homes are often cherished by their patients. Offering the most personalized and flexible of midwifery care, these midwives can provide for their patients a birthing environment as safe and effective as one found in a conventional low-risk hospital birth.* But since many birth centers are operated by either a single or a small group of midwives, some business acumen and networking are necessary to build a successful practice.
Getting Started in Your Nurse-Midwife Career
As midwifery grows in scope and acceptance throughout the U.S., more and more nurse-midwives are sure to bring their own diverse experiences and passion to the profession. If you would like to be one of them, search our database of accredited nurse-midwifery schools to get started.
ACNM Compensation and Benefits Survey, 2007
CDC National Center for Health Statistics, 2009
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