Midwifery Schools and Careers Guide
| | A midwife is an expert in normal birth and is recognized throughout the world as the most appropriate maternity care provider for most women. Learn the responsibilities of a midwife from the beginning of a patient's childbearing cycle to well after the delivery of the patient's baby. |
General Midwifery Information
Careers in Midwifery
- What careers exist for midwifery school graduates?
- What is the average salary?
- What is the difference between a Licensed Midwife and a Certified Nurse Midwife?
Midwifery Laws and Licensure
- Does a student become certified and/or licensed before practicing?
- What are the state-by-state requirements for becoming a midwife?
Midwifery Prerequisites
Midwifery Tuition and Financial Aid
Midwifery Accreditation
Choosing a Midwifery School
- How long does it take to become a midwife?
- What are the advantages in first becoming a nurse before becoming a midwife?
Some answers provided by the author of Educational and Career Opportunities in Alternative Medicine, Rosemary Jones. Additional answers provided by Kate McConnell, from the Seattle Midwifery School.
What is a midwife?
Midwives are trained professionals who offer care, education, counseling, and support of women and newborns during pregnancy and the postpartum period. The midwifery model of care includes: monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, and prenatal care; continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological intervention; and identifying and referring women who require obstetrical attention. Midwifery may be practiced in an out-of-hospital or hospital setting. (from "What is a Midwife?" Midwives' Alliance of North America brochure)
Two broad categories of midwives exist in the United States: nurse-midwives and direct-entry midwives. Direct-entry midwives focus their professional preparation on midwifery alone, while nurse-midwives are educated in both nursing and midwifery.
Midwifery Model vs. Medical Model Judith Pence Rooks, in Midwifery and Childbirth in America (1997, Temple University Press) addresses the difference between the midwifery model and the medical model of maternity care: "Whereas medicine focuses on the pathologic potential of pregnancy and birth, midwifery focuses on its normalcy and potential for health. Pregnancy, childbirth, and breastfeeding are normal bodily and family functions. That they are susceptible to pathology does not negate their essential normalcy and the importance of the non-medical aspects of these critical processes and events in people's lives. Midwives know about the medical risks, identify complications early, and collaborate with physicians to assure medical care for serious problems. But attention to the medical aspects of these complex processes, while essential, is not sufficient. Midwives focus on each woman as a unique person, in the context of her family and her life. The midwife strives to support the woman in ways that empower her to achieve her own goals and hopes for her pregnancy, birth and baby, and for her role as mother. Midwives believe that women's bodies are well designed for birth and try to protect, support, and avoid interfering with the normal processes of labor, delivery, and the reuniting of the mother and newborn after their separation at birth."
What is the history of midwifery?
Many books have been written on this topic alone. A couple of valuable and extensive resources include:
- Midwifery and Childbirth in America by Judith Pence Rooks
- (1997, Temple University Press)
- Lying In: A History of Childbirth in America by Wertz and Wertz
What careers exist for midwifery school graduates?
Most direct-entry midwives are self-employed in independent, private midwifery practices. Others work in public or community health agencies in administrative, educational, or counseling positions. Salaried job opportunities for licensed midwives are limited. The majority of direct-entry midwives practice in out-of-hospital settings and oversee births at homes and birth centers. In the winter of 1999, the administration of a Seattle hospital indicated that it was receptive to the possibility of granting licensed midwives hospital privileges. The Midwives Association of Washington State (MAWS) created a task force to work with the administrators of this hospital on this idea.
Nurse-midwives can be employed in hospital group practices or in independent, private midwifery practices.
What is the average salary?
Midwifery income is largely dependent on the type of practice and the geographical location of the practice. Many midwives choose to practice in rural communities or among the poorer neighborhoods. However, Midwifery is becoming a more popular childbirth option among many people in the country.
Midwifery salaries are more commonly comprised of a base salary plus bonuses depending on the midwife's practice. Today, many midwives own their own business or share a partnered business so their salaries are not as largely impacted from productivity bonuses. According to the American College of Nurse-Midwives, the median midwife salary in 2004 was $70,000 with 27% of nurse-midwives receiving productivity bonuses.
What is the difference between a Licensed Midwife and a Certified Nurse Midwife?
A Licensed Midwife attends an independent midwifery school and is only accepted for practice in about 11 states. A Certified Nurse-Midwife has a nursing degree and can practice anywhere in the U.S.
In the states that license midwives, students sit for a licensing exam after completing their education and take the professional title of a licensed midwife (LM). The licensed midwife generally works in an independent practice. Some LMs deliver babies in the home or in birthing centers.
Certified nurse-midwives (CNM) are trained and regulated as part of the nursing profession. Many have established independent practices, but they also can be found working in HMOs, hospitals, private clinics and birth centers. A CNM must be a registered nurse before beginning training to become a midwife (or must earn the nursing degree during the midwifery training).
Does a student become certified and/or licensed before practicing?
Midwifery in the United States is regulated by state law and largely influenced by national certification. Laws and regulations vary considerably for both nurse-midwives and direct-entry midwives. Anyone interested in becoming a midwife should become knowledgeable about the laws affecting midwives in any state in which she expects to practice.
In order to practice as a nurse-midwife, one must be a certified nurse-midwife (CNM). This certification is recognized across the United States. Nationally speaking, direct-entry midwives might be certified professional midwives (CPMs), certified midwives (CMs), or might choose to practice without national certification. Regulation in Washington state, for example, is quite stringent and requires direct-entry midwives to sit for a state licensure exam and become licensed midwives (LMs) or naturopathic doctor/licensed midwives (ND/LMs) in order to practice legally.
Washington state's licensure exam includes two components: the CPM exam, created by the North American Registry of Midwives (NARM), as well as a section specific to Washington state laws, regulations, and standards of practice. Those who pass the exam become LMs and are eligible to complete the NARM certification process to become registered nationally as a CPM without sitting for an additional exam.
What are the state-by-state requirements for becoming a midwife?
Direct-entry midwives (LM) are licensed in the following states: Alaska, Arkansas, Arizona, California, Colorado, Florida, Louisiana, Minnesota, Montana, New Hampshire, New Mexico, New York (Certified Midwives certified by ACNM only), Oregon, South Carolina, Tennessee (licensing starts January 2001), Texas, Vermont (licensing starts January 2001), and Washington.
The requirements vary by state, but usually require training by a state-recognized program or apprenticeship, assisting at a minimum number of births in the secondary or primary position, and passing a state approved exam. The North American Registry of Midwives provides a national certification exam for midwives. This exam may not be required for licensure. In a few states, the NARM designation, Certified Professional Midwife (CPM), qualifies a woman to practice as a midwife. It is important to note that some states specifically prohibit the practice of midwifery by anyone who is not a licensed certified nurse-midwife.
Certified nurse-midwives (CNM) are licensed in all fifty states and the District of Columbia and their requirements include certification by the ACNM (American College of Nurse-Midwifery).
In Canada, midwifery is defined on a provincial basis and prospective midwives should check with their provincial authorities for requirements.
What are the prerequisites for attending midwifery school?
Prerequisites vary from program to program. For example, Seattle Midwifery School provides training for direct-entry midwives. Prerequisites include the following:
- Earn a high school diploma or its equivalent.
- Demonstrate proficiency in the English language.
- Complete 45 quarter credits or 27 semester credits of college course work with a cumulative grade point average of 2.8 or better.
- Complete an approved Labor Support Course
- Complete the following courses with a minimum of 3.0 or pass equivalent challenge exams:
- Biology: One year of high school or 3 college-level credits.
- English: 3 college-level credits.
- Human Anatomy and Physiology: 5 college-level credits (preferably a two-quarter course).
- Math: 2 years of high school math (with the past ten years) or 3 credits of college-level math.
- Microbiology: 5 college-level credits.
- Social Science: 5 college-level credits.
Most nurse-midwifery programs require that students receive a bachelor's degree in nursing and a master's degree in midwifery.
What kind of tuition can I expect?
Independent schools vary greatly, running from $2500 to $5000 per year (most are four year programs). CNM programs are generally located in larger universities and tuition is the equivalent of most master's programs.
Is financial aid available?
MEAC is recognized by the U.S. Department of Education, enabling MEAC accredited schools to apply to participate in federal student financial aid programs. See information on accreditation, below.
What organizations accredit midwifery schools?
There are two organizations that accredit direct-entry midwifery schools. First is the Midwifery Education Accreditation Council (MEAC). MEAC adheres to the national standards of direct-entry midwives set forth by the North American Registry of Midwives (NARM). MEAC is recognized by the U.S. Department of Education, enabling MEAC accredited schools to apply to participate in federal student financial aid programs. The other organization is the Accrediting Council for Continuing Education and Training (ACCET), which is recognized by state and federal agencies for vocational training. ACCET-accredited schools are eligible to receive federal financial aid.
You can view a list of MEAC Accredited Schools.
Nurse-midwives receive their training at the university level, usually by completing a bachelor's degree in nursing followed by a master's level midwifery program. The American College of Nurse-Midwives (ACNM) and the ACNM Certification Council sets the standards for the education and certification of nurse-midwives.
What is the value of attending an accredited school?
Accreditation equals accountability and, in the eyes of some, legitimacy. The accrediting organization sends to the school representatives with backgrounds in finance and education, as well as a community representative for peer review (in this case, a midwife). The accreditation process includes a thorough review of all school files such as educational materials related to the curricula, student files (to check for completeness of prerequisites and coursework), and faculty files (ensuring instructors' experience is adequate for their particular subject matter). The school's fiscal records and most recent audit are reviewed to determine that the school is financially solvent. In-depth interviews are conducted with students, faculty, and staff members. Accreditation is granted for a specific amount of time (often about three to five years). After this time has lapsed, the school must apply for re-accreditation.
Students who attend an accredited school can be assured that their learning institution has met the standards of the accrediting organization and shows the promise of growth, solvency, and vitality for the long term.
How long does it take to become a midwife?
There are a number of routes to the nurse-midwife designation and all are accredited by the American College of Nurse Midwifery. These include: nurse-midwifery education programs BA/BS to RN/CNM-graduate program diploma or associates degree (AD) RN to CNM-graduate program master's program (for those that already have a bachelor's degree in nursing) post-master's certificate (for those that have a master's in nursing)
If you hold a BA or BS in a field other than nursing, you may be able to take a master's program that combines the nursing and midwifery -- in other words, you don't have to go back and take a four year nursing degree to get into the midwifery program.
Some nurse-midwifery programs are open to AD (associate degree) RN, which also takes less time to complete than the four year nursing bachelor's degree. These programs will allow you to do one of the following: earn a baccalaureate degree and certificate in nurse-midwifery; or earn a baccalaureate degree and master's degree in nurse-midwifery; or earn a master's degree in nurse-midwifery. Length of training and the actual degree earned varies by institution.
Direct-entry midwifery programs can take up to 2.5 years to complete, but some programs are much shorter. Several programs are accredited to prepare students to become certified professional midwives (CPMs) - See accredited schools below. Neither of these estimates takes into account the time necessary to complete prerequisites for admission into a particular program.
What are the advantages in first becoming a nurse before becoming a midwife?
Perhaps the biggest advantage is that the certified nurse-midwife credential (CNM) is recognized nationally and accepted as legitimate in every state. CNMs are welcomed into many hospital systems as maternity care providers, whereas direct-entry midwives often are not.
An aspiring midwife needs to examine all of the differences between nurse-midwifery and direct-entry midwifery before settling on the appropriate route of entry for her or himself. These differences range from the philosophical (working inside or outside of the medical model) to the pragmatic (making a living in a chosen community).
Search our directory and find more: Massage Therapy Schools, Acupuncture, Chiropractic, and more.