Becoming a midwife has never been a more natural choice for compassionate, committed individuals interested in working with expectant mothers and newborns.
In addition to supporting the childbirth experience, a midwife can provide care across a woman’s life, including obstetrical and primary care, depending on their credentials and location.
What Is a Midwife?
Midwifery combines evidence-based practice with woman-centered care. “Midwives offer holistic care that includes not just the woman but her partner and family. Midwives look at the entire picture of the person’s life when helping care for them,” says Amber Wilson, CNM, DNP, host of the “Journey to Midwifery“ podcast.
Many midwives are advanced practice registered nurses (APRNs) who have a master’s degree and are credentialed as certified nurse-midwives (CNMs).
A certified nurse-midwife (CNM) is qualified to provide both primary and obstetrical care to women throughout their lives. CNMs provide many of the same services as physicians, but with a holistic, woman-centered perspective that offers an alternative to the traditional approach to pregnancy and childbirth.
Demand for Midwives
Both the healthcare and the alternative medicine industries are thriving, making a midwife career not only a rewarding choice but also a very promising one.
According to the U.S. Bureau of Labor Statistics (BLS), the demand for CNMs as well as other APRNs is expected to increase by 11.5% through 2035.
Steps to Becoming a Midwife
There are several educational paths that lead to different midwifery credentials, which can make becoming a midwife seem confusing. For example, do you want to become a certified nurse midwife or just a certified midwife? Following these ten tips can help you find answers and get started on the right track.
Can you imagine yourself guiding a first-time mother through her labor and delivery experience? Do you get excited at the thought of listening to a fetal heart rate monitor, measuring prenatal growth signs, and talking with moms and dads about the transition into parenthood? Are you the kind of person who can handle being on call evenings, weekends, and holidays?
Take the time to imagine yourself becoming a midwife to see if it syncs with who you are.
“Midwives ensure that the person being cared for is at the center and is active in decisions regarding the care they need,” Wilson says. “It should be a collaborative, cohesive relationship, and the midwife is there to serve the woman and her family’s needs.”
Consider whether you have these qualities, which experienced midwives say can help you succeed:
Professional integrity: As a CNM or other credentialed midwife, you’re obligated to work within the scope of practice as defined by your professional credential and state laws.
Passion for mother/baby care: You’ll need motivation, drive, deep empathy, and compassion to avoid burnout from the physical and emotional demands of this career.
Belief and trust in the wisdom of the whole and normalcy: Midwives must understand and honor the normal processes involved in the birthing experience
Willingness to be flexible and collaborative: Midwives must be open to considering individualized methods of care, with the willingness to consult, collaborate, or refer to other members of the health care team as needed.
How long does it take to become a midwife: On average it takes between 6 to 8 years to become a nurse-midwife. If you already hold a bachelor’s degree, earning an MSN degree can take between 18 to 24 months as a full-time student.
2. Get Educated About Natural Childbirth
The American College of Nurse-Midwives (ACNM)’s mission is to “promote the health and well-being of women and infants” through “the development and support of the profession of midwifery as practiced by certified nurse midwives and certified midwives.”
Certified nurse midwives assist in natural and medicated births, and often the decision on how to proceed is based on more than philosophical preferences.
Along these lines, midwifery practices can have different views on aspects of natural childbirth such as unmedicated labor and delivery, birthing locations, and physician involvement. Knowing where you stand on these issues will help you choose a path that will be most satisfying to you in the long run.
CNMs assist in natural and medicated births, and often the decision on how to proceed is based on more than philosophical preferences. Considerations such as the needs of the mother and baby, the birth location, and state laws also can be factors.
“CNMs do care for and handle many types of birth,” Wilson says. “If a CNM is caring for someone in a homebirth or birth center setting, then an epidural and anything high risk are not done there. Some out-of-hospital settings do have alternative medication such as nitrous oxide or even IV pain medication. In a hospital, a CNM can participate in most births, but might co-manage with a physician, depending on the acuity of the pregnant person.”
3. Take a Holistic Approach to Midwifery
CNMs specialize in reproductive health, but they’re trained to provide care for women from puberty through menopause. So, keep in mind that, while you’ll spend a good portion of your time on prenatal, delivery, and postpartum care, you’ll also provide primary health care, routine gynecological care, and contraception advice to women of all ages.
Perform physical exams for primary and gynecological care
Prescribe medication and treatments
Order and review lab tests for screening and diagnosis
Counsel individuals and couples on family planning and contraception
While a CNM may or may not be formally certified as a holistic practitioner, the philosophy of holistic care, which brings together physical, psychological, emotional, and spiritual well-being, is consistent with midwifery.
“We’re taking care of the whole person and her whole family, with her whole life,” says Sarita Bennett, DO, CPM, president of the Midwives Alliance of North America (MANA).
4. Learn the Difference Between CNMs and CMs
CNMs and certified midwives (CMs) both must pass a certification exam administered by the American Midwifery Certification Board (AMCB). But their education is different, and this can affect their roles. Here’s how they compare.
Certified Nurse Midwife
Certified Midwife
Active RN license required
RN license not required
Education: 1. Associate Degree in Nursing or a Bachelor of Science 2. Master of Science in Nursing or a Doctor of Nursing Practice in midwifery or MSN or DNP plus post-graduate certificate in midwifery
Education: 1. Bachelor of Arts or a Bachelor of Science in a non-nursing field 2. Master of Science in Nursing in midwifery
Most attend births in hospitals, though they may be authorized to attend births in homes, birthing centers, and office settings, depending on state laws.
Most attend births in hospitals, though they may be authorized to attend births in homes, birthing centers, and office settings, depending on state laws.
Licensed in 50 states, Washington, D.C., and U.S. territories
Licensed in Delaware, Hawaii, Maine, New Jersey, New York, and Rhode Island only
Authorized to prescribe medication in all U.S. jurisdictions
Authorized to prescriptive medication in New York, Rhode Island, and Maine only
While CNMs comprise the majority of midwives in the U.S., there are other ways to practice midwifery. Such as licensed midwives (LMs), certified professional midwives (CPMs), and lay midwives.
However, midwives who don’t qualify as CNMs aren’t RNs and have less authority and autonomy in providing services. Becoming one of these midwives means you will likely practice outside of hospital settings, depending on the laws in the state in which you practice.
5. Decide What Kind of Work Environment You Prefer
“If you’re going into this field, you have to consider, ‘What kind of midwifery do I want to practice and where?’ and ‘How autonomous do I want to be?'” Bennett says.
One of the benefits of becoming a midwife is that you have the flexibility to work in a variety of locations. Almost 95% of babies delivered by CNMs in the U.S. are born in hospitals, according to the ACNM, but CNMs can work in many types of environments.
Depending on laws in your state, you could work at:
Hospitals
Private practice alone, or with physicians or other CNM/CMs
Birth centers
Public health clinics
Military bases
Homes
When exploring educational programs, it’s important to decide where you’d prefer to work so you can find a program that matches your career preferences and goals.
6. Determine Which Type of Program Is Best for You
In addition to completing the required education, most midwives must pass a certification exam to earn their credentials. Licensing requirements in terms of education and experience may also vary by state, depending on the type of midwife certification you choose.
Type of Midwife
Required Education Options
Certified Nurse Midwife
Bachelor of Science in Nursing (BSN) and Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) in Nurse Midwifery.
Bridge program for Associate Degree in Nursing (ADN) to MSN in Nurse Midwifery.
MSN with a post-graduate certificate in nurse midwifery.
Certified Midwife
Bachelor’s degree in any discipline, completion of required science prerequisites, and Master of Science in Nursing (MSN) in Nurse Midwifery.
Certified Professional Midwife
Completion of an approved apprenticeship or educational program that may grant a certificate or degree in midwifery.
Registered Midwife/Licensed Midwife
Completion of a state-approved educational program based on the apprenticeship model.
Lay or Traditional Midwife
Education through self-study and apprenticeship.
How to become a midwife without a nursing degree
If you’re not interested in pursuing the full-on degree route, the Certified Professional Midwife (CPM), Licensed Midwife (LM), and traditional midwife paths are your options. And if you’re like many students, you’ll weigh the cost and format when you choose a program.
Federal loans, grants, and loan repayment programs are also available to midwifery students in accredited colleges or career schools that meet program criteria. You may also qualify for private student loans or school-based or private scholarships to fund your education. Talk to the financial aid director at your school to learn about all the options you have.
7. Find an Accredited Nurse Midwifery Program
Accreditation is a review process that determines whether a school or program meets established criteria for educational standards. As part of your research, make sure the schools and midwifery programs you’re exploring are accredited.
If your program isn’t accredited, you won’t be eligible for federal financial aid and student loans. Plus, if you need to change programs or schools, you won’t be able to transfer credits from a program that isn’t accredited to a school or program that is accredited.
These organizations award accreditation for MSN programs:
The Commission on Collegiate Nursing Education (CCNE)
The Accreditation Commission for Education in Nursing (ACEN)
Depending on your education and practice, it’s also important to look for these accreditations to qualify for specific post-graduate certifications.
Accreditation Commission for Midwifery Education (ACME): ACME accredits master’s, post-graduate certificate, and doctoral midwifery programs. Completion of an ACME-accredited program is necessary to qualify to take the national certification exam administered by the American Midwifery Certification Board (AMCB).
American Holistic Nurses Credentialing Corporation (AHNCC): AHNCC “endorses” holistic nursing programs at the baccalaureate, master’s, and doctoral levels, though attending an endorsed program isn’t necessary to qualify to take the holistic nurse certification exam.
Midwifery Education Accreditation Council (MEAC): MEAC accredits programs for students who want to qualify for the CPM credential awarded by the North American Registry of Midwives (NARM).
8. Look for Like-Minded Faculty
Nurse midwives share a foundation of excellent advanced training, but not all practice the same way. If you’re passionate about drug-free delivery, look for faculty members who share your convictions. If more personalized care is a priority for you, ask questions to be sure you’ll learn from professors who focus on providing that for women and their newborns.
Certified holistic nurse midwives receive expanded training in a range of holistic modalities such as aromatherapy, massage, and reiki, among others.
Some nurse midwives train during or after their master’s program to earn certification as a holistic nurse by the American Holistic Nurses Credentialing Corporation. Certified holistic nurse midwives receive expanded training in a range of holistic modalities such as aromatherapy, massage, and reiki, among others.
“One important aspect of holistic nursing is spiritual assessment and care—often not incorporated into standard CNM curricula,” says Kathleen Bell, RN, MSN, CNM, AHN-BC, MS1-BC, special adviser to the board of directors of the Oregon Holistic Nurses Association. “Another is holistic nursing’s strong emphasis on self-care.”
9. Choose a School with a Good Certification Exam Pass Rate
The AMCB administers the exam that all CNMs and CMs must pass to become certified. Attending a nurse midwife program with a high exam pass rate is one indicator of a quality education.
When you research midwife programs, Bell suggests also looking at:
Pass and dropout rates
Student-to-faculty ratio—lower is better
Faculty experience and qualifications
Variety of clinical training sights, including hospitals, community clinics, physician offices, and more
Requirements for a thesis or senior project
Research opportunities
Preparation for post-graduate certification exams
After earning your certification as a CNM, there are many ways to expand your options and advance your career, whether or not you remain at the bedside.
The path you take will depend on your goals, Wilson says: “You can get a doctorate degree or a PhD; you can teach undergraduate or graduate students. You can get involved with politics. Some CNMs run social media pages to educate on health issues, or even just ethical and policy issues. Some midwives have (and are writing) books, some publish journal articles, some have started businesses to help midwives with their career or be mentors. The possibilities are whatever you want them to be.”
10. Think About What Kind of Salary You Want to Earn
With the most formal education and preparation, CNMs usually earn the highest salaries among all types of midwives. CNMs typically work in hospitals and physicians’ offices, where they may also have opportunities for advancement in management roles.
According to the BLS, the median salary for certified nurse midwives is $134,040 Based on BLS data, O*Net reports a median annual salary of $65,790 for midwives who aren’t registered nurses, a broad classification that includes CPMs, licensed midwives, registered midwives, and lay midwives.
Earning a Doctor of Philosophy (PhD) or Doctor of Nursing Practice (DNP) can help you move your prospects and salary to the next level. A PhD can prepare you to conduct research, develop healthcare policies, and teach at a university. While a DNP can qualify you to direct clinics or programs and teach at many post-secondary institutions.
Parting Words
You’re now properly equipped to start the journey. But there is one more thing you must know. Do not confuse becoming a midwife with becoming a doula. They’re not the same thing! But some women do hire both a doula and a CNM when giving birth.
Midwives and doulas both support women through pregnancy and birth, but their roles and required education are starkly different. Certified Nurse Midwives require more education, mandatory training, and state licensure. They may also be authorized to prescribe medication and treatment.
