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A Career as a Midwife

Certified nurse midwives care for pregnant women before and during childbirth—and many also serve as primary care providers for women throughout their lives.

smiling midwife with newborn and parents
smiling midwife with newborn and parents

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. 

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).

Career Overview

As advanced practice nurses (APRNs), CNMs are highly trained medical professionals who are educated as registered nurses (RNs) and midwives. At a minimum, they’ve earned a degree from a graduate-level nursing program in midwifery.

Because of their high level of education as APRNs, CNMs can perform many of the same duties and tasks as a physician.

CNMs must also qualify for certification from the American Midwifery Certification Board (AMCB) and be licensed in the state in which they practice. CNMs are licensed to practice in all 50 states, the District of Columbia, and U.S. territories with varying degrees of autonomy.

While CNMs comprise the majority of midwives in the U.S., there are other ways to practice midwifery. However, midwives who don’t qualify as CNMs aren’t RNs and have less authority and autonomy in providing services. They also may not be qualified to deliver babies in hospital settings.

Midwife Duties, Roles, and Responsibilities

Because of their high level of education as APRNs, CNMs can perform many of the same duties and tasks as a physician. A CNM is qualified to deliver the following services related to gynecological, obstetrical, and primary care:

  • Provide prenatal education, counseling, and monitoring of mother and baby
  • Monitor maternal and fetal health during labor
  • Assist during labor and delivery
  • Provide routine and emergency medical care for infants at birth
  • Prescribe and administer comprehensive care for all contraceptive methods
  • Provide physical, mental, genetic, and sexual health assessments
  • Perform health and laboratory screenings
  • Diagnose and treat common medical conditions
  • Prescribe medication (in some states)
  • Manage treatment of chronic conditions, including referrals to appropriate health care service providers

While CNMs provide care with a holistic approach, their clinical training is rooted in nursing, which guides their professional options.

“All certified nurse midwives are bound by the Nurse Practice Act in force in the state where they are practicing as all are registered nurses, whether certified as holistic or not,” says Kathleen Bell RN, MSN, CNM, AHN-BC, MS1-BC, special advisor to the board of directors of the Oregon Holistic Nurses Association.

CNMs can support births in hospitals, birthing centers, and homes, depending on the state in which they practice. Most CNMs provide for women who give birth in hospitals, but Bell says that birthing centers that are outside of hospitals are popular with holistic CNMs.

Education to Be a Midwife

CNMs complete clinical training in both general practice and midwifery. At minimum, a CNM must:

  • Hold an active RN license
  • Complete an accredited Master of Science in Nursing (MSN) program with a midwifery specialty
  • Pass the certification exam administered by the American Midwifery Certification Board (AMCB)
  • Qualify for licensure in the state in which they plan to practice

Holistic CNMs can meet their requirements in a holistic-based MSN program in midwifery or choose post-graduate training in holistic nursing after completing a traditional MSN program. Certification as a holistic nurse is granted by the American Holistic Nurses Credentialing Corporation (AHNCC).

Midwives who are not CNMs can pursue other educational pathways, though their duties and autonomy aren’t as broad as those of a CNM. 

  • Certified Midwife (CM): A CM takes the same certification exam as CNMs and provides similar services, but they aren’t RNs. They can earn a bachelor’s degree in any field and then a graduate degree from a midwifery program. Only six states recognize CMs: Delaware, Hawaii, Maine, New Jersey, New York, and Rhode Island.
  • Certified Professional Midwife (CPM): A CPM primarily supports births in birth centers and/or homes after meeting the standards of the North American Registry of Midwives (NARM), which includes completion of a program accredited by the Midwife Education Accreditation Council (MEAC) or NARM’s Portfolio Evaluation Process (PEP).
  • Registered Midwives (RMS) and Licensed Midwives (LMs): The designation and authority of registered and licensed midwives vary by state, since some states require registration and others require licensing. RMs and LMs typically support home births, though they may also work in birthing centers, depending on their credentials.

“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.

Midwife vs Doula

Midwives and doulas both support women through pregnancy and birth, but their roles and required education are starkly different. Some women have a doula and a CNM.

Certified Nurse MidwifeDoula
Minimum education is a Master of Science in Nursing with specialization in midwiferyNo requirement for minimum education, though many doulas take doula training courses
Certification from the American Midwifery Certification Board (AMCB)Certification from DONA International, the International Childbirth Education Association (ICEA), and other organizations is optional
RN licensure and CNM licensure required in the state in which you practiceNo state licensure is required
Formal clinical training in primary and OB/GYN careTraining to specialize as a birth doula or postpartum doula is optional
Advanced practice registered nurse (APRN) with the authority to educate, counsel, and monitor mother and baby during prenatal, labor, delivery, and postpartum phasesNon-clinical healthcare specialist who gives emotional support and physical comfort to women during pregnancy, labor, delivery, and sometimes during the postpartum period
Authorized to prescribe medication and treatmentNot authorized to prescribe medication or treatment

Midwife Workplaces

CNMs provide services in a range of settings. Here are the top five workplaces for CNMs, according to the U.S. Bureau of Labor Statistics (BLS):

  • Offices of Physicians: CNMs in physicians’ offices provide obstetrical, gynecological, and primary care for women beginning in adolescence. They also provide education and services related to sexual health and contraception.
  • Outpatient Care Centers: CNMs in outpatient care centers provide obstetrical, gynecological, and primary care services, depending on the center’s focus. Birth centers, including holistic birth centers, can be included in this category.
  • Offices of Other Healthcare Practitioners: CNMs can provide a range of services in office settings. CNMs who practice holistic nursing may work with like-minded CNMs, nurse practitioners, doulas, or other professionals in alternative therapies in a holistic-based practice.
  • Colleges, Universities, and Professional Schools: CNMs in educational settings work as faculty instructors in traditional and holistic midwifery programs.
  • Local Government: Certified nurse midwives who work for local government may provide healthcare at city or county hospitals and clinics. They also might run programs to educate women about obstetrical, gynecological, and primary care.

If your perception of a CNM is a healthcare professional who supports home births, you may be surprised to find that most CNMs support births in traditional hospital settings. This is because CNMs must meet specific criteria when supporting births in any environment, and a hospital setting meets those requirements best.

A CNM’s autonomy can vary by state. For instance, in 27 states, CNMs can have their own independent practices and work without the supervision of a physician.

“All CNMs must practice with physician ‘backup,’ in case the client’s situation requires medical/surgical intervention,” Bell says. “In the case of out-of-hospital births, pre-approved practice protocols must be in place for referral to another facility with guaranteed admission and physician acceptance of the CNM clientele.”

A CNM’s autonomy can vary by state. For instance, in 27 states, CNMs can have their own independent practices and work without the supervision of a physician.

“Some states have full autonomous practice, meaning a CNM can practice within the scope outlined by their credentialing with American Midwifery Certification Board,” says Amber Wilson, CNM, DNP, host of the “Journey to Midwifery podcast. “Other states require a written agreement with a physician that may only be for writing prescription medication, or it can be as far as having a formal written agreement with a physician to practice as a midwife.”

Advancing Your Career

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.”

Earning a Doctor of Philosophy (PhD) or Doctor of Nursing Practice (DNP) can help you move your career and salary to the next level.

A PhD can prepare you to conduct research, develop healthcare policies, and teach at a university.

A DNP can qualify you to direct clinics or programs and teach at many post-secondary institutions.

If you want to continue to work with women, you can enhance your practice by earning skills in complementary or alternative therapies or certification in a specialized field like holistic nursing. Holistic nurses can train in additional treatment modalities such as aromatherapy, massage, and reiki to enhance their services and potentially increase their earnings.

anna giorgi

Written and reported by:
Anna Giorgi
Contributing Writer

kathleen bell

With professional insight from:
Kathleen Bell RN, MSN, CNM, AHN-BC, MS1-BC
Special Advisor to the Oregon Holistic Nurses Association Board of Directors

sarita bennett

Sarita Bennett, DO, CPM
President of Midwives Alliance of North America

amber wilson

Amber Wilson, CNM, DNP
Host of the “Journey to Midwifery” podcast