Guide to Certified Nurse Midwifery (CNM)

Certified nurse midwives (CNMs) are advanced practice registered nurses who work with women before, during, and after their pregnancy, and care for women and their newborn infants during labor and delivery. CNMs can provide comprehensive gynecologic and maternity care to women of all ages, from adolescence to beyond menopause, and provide women’s health care services such as gynecological screenings. Their daily responsibilities include conducting physical examinations, ordering and interpreting diagnostic tests, educating patients around taking care of their reproductive and overall health, administering treatments and providing medications, supporting women during deliveries in collaboration with a larger team of specialists, and caring for newborns shortly after delivery.

CNMs are trained in full-scope midwifery care, which is defined as the medical care of pregnant women during the prenatal, perinatal, and postnatal periods. CNMs are also trained to provide reproductive health care to non-pregnant women throughout their life. According to the American College of Nurse Midwives, one of the central aims of certified nurse midwifery is to reduce the risk of negative health complications during pregnancy, and to minimize the need for cesarean sections and other potentially higher risk interventions during labor. Achieving this goal involves a combination of ongoing primary care services, such as routine prenatal checkups, as well as sufficient care during the labor and delivery process and during the post-partum period.

CNMs work in settings that provide women’s health services, including but not limited to gynecological/obstetrics (ob/gyn) departments of hospitals, community clinics, private practices, and freestanding birth centers. They support women and their children during some of the most crucial moments of their lives, and also help to empower women by giving them the knowledge and resources to make choices as to how they want their child to be delivered–whether that be a hospital-based birth, a natural birth center, or an at-home water-based birth. Their work also has ripple effects in the families and communities of the patients they serve, as giving women the knowledge, resources, and support to take care of their reproductive health regardless of their stage in life enables them to live better lives, build a family when they are ready, and raise healthier children.

To become Certified Nurse Midwives, registered nurses must complete a graduate nursing program with a focus in nurse midwifery at an institution that has been accredited by the Accreditation Commission for Midwifery Education (ACME). During their graduate program, they must complete a minimum of 500 hours of clinical practicum. After the completion of their program, registered nurses must take and pass a certification examination administered by the American Midwifery Certification Board. They must also fulfill any state-based certification requirements prior to practicing.

Where Certified Nurse Midwives Work

where-do-cnms-work-810x300Certified nurse midwives can work in any setting that provides obstetrical and/or gynecological care to women and their newborn children. Obstetrics is defined as the medical care of women before, during, and after pregnancy, with a particular emphasis on monitoring developing pregnancies and addressing any health issues that arise, providing labor and delivery services, and offering postnatal support. Gynecology is defined as the medical care of women’s reproductive systems, which includes preventative care services, but also includes treatments and surgical procedures that address reproductive health issues such as ovarian cysts, ectopic pregnancies, and amenorrhea.

A potential advantage of training to become a certified nurse midwife is the ability to work in medical environments that provide either women’s health care, labor and delivery services, or both. Below is a more detailed description of some of the most common medical environments that employ CNMs.

Obstetrics and Gynecology (Ob/Gyn) Departments of Hospitals

Ob/gyn departments of hospitals are one of the most common settings for certified nurse midwives. Depending on whether they work in obstetrics and gynecology or only one of these disciplines, CNMs who work at hospitals and medical centers in the ob/gyn department may divide their time between outpatient consultations with patients and inpatient work with mothers in labor. Julie Stembridge, MSN, CNM is a Certified Nurse Midwife at WakeMed Physician Practices, where she serves patients in collaboration with other CNMs and physicians. In an interview with OnlineFNPPrograms.com, she explained how CNMs work in both outpatient offices, advising women on reproductive health concerns ranging from contraception to the development of a health pregnancy, and inpatient hospital settings, where they assist with deliveries.

“My responsibilities are split between time in our outpatient office and time on call at the hospital,” she explained, “In the office I see women of all ages before, during and after pregnancy. I may see a young woman who is concerned about her periods followed by a middle aged woman who is starting menopause. Our pregnant patients are also seen in the office for their prenatal and postpartum visits.”

Hospital ob/gyn departments have the advantage of having the equipment and staff on hand to manage more serious reproductive medical problems that women may experience, and as such tend to treat patients with a wider range of gynecological and/or obstetrical conditions. In her interview, Ms. Stembridge described the wide variety of patients she sees and prenatal, perinatal, and postnatal conditions she helps them to manage in her position at WakeMed. “In the hospital I am responsible for seeing all of the patients from our group. This can include laboring moms, postpartum patients, pregnant patients with complications or postoperative gynecology patients,” she said, “Our team at the hospital includes physicians, nurses, surgical techs, neonatal nurse practitioners and respiratory technologists. The majority of my patients are pregnant or recently postpartum.”

Some CNMs work at more than one hospital at a time on a per-diem basis, which can be demanding but can also provide a greater range of nursing experience. Jennifer Horch Cromar, MSN, CNM is a Certified Nurse Midwife at Marin Community Clinics (MCC) who previously worked with a physician in private practice. In an interview with OnlineFNPPrograms.com, she explained how her work as a registry nurse (a nurse who works at multiple medical locations) helped her build valuable skills. “I received my MSN from Yale in 2002. I returned to my native California and did some work as a registry nurse while I looked for a position as a CNM. Registry nurses work for companies that send them to different hospitals on a per diem basis. They do not work for one hospital, but may go to five different hospitals on five different days of the week,” she said, “As a registry nurse, I was sent to hospitals all over the Bay Area including UCSF, Alta Bates, Highland General, and many more. I think working as a registry nurse is a fantastic skill-building job. You have to be able to be adaptable and walk straight in to patient care with no orientation.”

Private Practices

Private practices are another common setting for certified nurse midwives. Similarly to ob/gyn departments of hospitals, CNMs working in ob/gyn private practices typically provide full-scope midwifery care. However, unlike hospitals which can provide both outpatient and inpatient care in one setting, private practices tend to provide outpatient care in their office, while partnering with nearby hospitals for their patients’ deliveries and for any complications that arise that require inpatient care. CNMs who work for private practices may divide their time between office consultations; routine prenatal, perinatal, and postnatal care; and assisting doctors with deliveries at the hospital.

Sonya Jubb, MSN, CNM is a Certified Nurse Midwife who works in private practice at John Muir Medical Center, where she collaborates with a physician, two nurse practitioners, and another certified nurse midwife. In an interview with OnlineFNPPrograms.com, she explained how she splits her time between outpatient consultations and inpatient care and monitoring. “We see our patients in the office, and when our pregnant patients have any complications or go into labor, we (the two CNMs or the MD) take turns being on call and cover 24/7 care for our patients that are inpatient at John Muir,” she said, “Full scope midwifery means you take care of patients during the antepartum, intrapartum and postpartum period, as well as throughout their childbearing years. We see women for their well woman exams, family planning, and gynecologic issues, through menopause and beyond.”

In her interview with OnlineFNPPrograms.com, Ms. Horch Cromar described her patient population and how she collaborated with the physician to deliver primary care services. “In private practice, I worked in an office with just myself and the doctor,” she said, “I did almost all of the well woman visits. Pregnant patients would rotate between seeing me for prenatal visits and seeing the doctor.” Private practice tends to differ from ob/gyn departments of hospitals in that they have a smaller staff; CNMs who work in private practice settings may at times need to assume the role of primary practitioner in their workplace. “The doctor I worked for would want to see a patient if there was anything wrong at all,” Ms. Cromar added, “If the doctor had a day off or was doing a delivery, I would be the only provider in the office.”

Community Health Clinics

Community Health Clinics, also known as CHCs, offer primary health care services to underserved and/or vulnerable populations. Some CHCs focus on a particular patient population, while others provide medical care to all patients across the lifespan, from childhood on through old age. To supplement the primary care services they provide, some CHCs also provide emotional counseling or connections to mental and behavioral health services.

Patients who seek care from CHCs tend to suffer from more serious health complaints due to the difficulties they encounter in accessing the knowledge, medicine, and preventative health services they need. In her interview with OnlineFNPPrograms.com, Ms. Horch Cromar explained how the patient populations that use community health clinic services differ from those of other medical settings such as private practice. “In my current job at MCC, things are very different than in private practice. Many of my patients will wait until something is really wrong before they seek out health care,” Ms. Cromar said, “So I see a lot more. Also, doctor visits are very hard to schedule. They are so booked up it can be a month or more before a patient can see a doctor (OB/GYN). NPs and CNMs in this situation manage a lot more complicated patients. The clinic is very busy, with many providers seeing patients on a daily basis.”

As community health clinics are not hospitals, they also provide inpatient care on-site. Some CHCs partner with nearby hospitals so that their high-risk patients have both intensive medical support and continuity of care. Depending on the regulations of the CHC at which they work, CNMs may be able to practice full-scope midwifery care. Before her position at John Muir Medical Center, Ms. Jubb worked at two community clinics, La Clinica and El Rio Community Health Center. In her interview with OnlineFNPPrograms.com, she explained how her scope of practice differed between these two community clinic settings. “At La Clinica I did not do full scope midwifery. I only saw patients in the clinic outpatient setting. The patients we saw in the clinic would all deliver at Sutter Solano,” she said, “This was a disservice to [our] patients because we would see them throughout their pregnancy, and then they would likely be delivered by an on call MD that they had never met. This was my main motivation for leaving and in the end took the job in Tucson, AZ at El Rio Community Health Center so I could continue my work with a similar population but also gain more delivery experience and practice full scope midwifery.”

Freestanding Birth Centers

Freestanding birth centers offer delivery options for women who do not want a traditional hospital-based birthing experience. Non-hospital delivery experiences are reserved for women who have low-risk pregnancies, and freestanding birth centers will nevertheless have connections with a nearby hospital for their patients who may need in-hospital support during their delivery.

Jodie Simms, MSN, CNM is a Certified Nurse Midwife at Lisa Ross Birth & Women’s Center, where she provides prenatal care, contraception consultations, childbirth education, labor and delivery services, and postpartum support to women. “I am trained to provide full-scope obstetric and gynecologic care,” she said in an interview with OnlineFNPPrograms.com, “I work with a great group of midwives to provide care and counseling for women at all stages of life. We focus on a holistic approach to health and wellness, trying our best in each visit to address the clients’ physical, social, emotional and spiritual needs.”

Freestanding birth centers work closely with each of their pregnant patients to identify if she has a low-risk pregnancy, or whether she needs additional medical support. “At the birth center we have strict criteria for identifying low-risk women who can safely deliver in an out-of-hospital setting. We work closely with a physician practice at UT Medical Center to develop those criteria and we collaborate with them in the care of our clients, especially those that develop complications in pregnancy, such as Gestational Diabetes or high blood pressure,” Ms. Simms added, “If a client has had a healthy pregnancy and is appropriate for birth center delivery, we help prepare women for natural birth and offer the option of waterbirth.”

Birth centers emphasize holistic health practices and patient education in order to help women have a safe pregnancy without the typical anesthetics and medical equipment. Ms. Simms explained in her interview how out-of-hospital births require attentive monitoring to allow health care staff to speedily address any health complications that arise. “When moms labor with us at the birth center we are continuously providing support and using our skills and training to help ensure a safe, healthy, and empowering birth experience for mom, baby and their families,” she said, “If complications arise, which is rare, we are able to quickly and safely transfer to the hospital. Working in this setting is very rewarding because there is greater freedom for the naturally delivering mother and greater autonomy for the midwife.”

Non-Profit Women’s Health and Midwifery Programs

Certified nurse midwives and nurse midwives in training can also find employment and fellowship opportunities through non-profit programs that bring nurse midwifery care and women’s health services and education to underserved communities both nationally and internationally. These programs may provide childbirth seminars and one-on-one health support to pregnant women, educate health care practitioners in developing countries about sound women’s health care practices, or work to bring updated medicines and medical equipment to underfunded clinics.

Before working at Lisa Ross Birth & Women’s Center, Ms. Simms was a Leadership Team Member for the non-profit organization Embrace: Refugee Birth Support, which provides childbirth classes as well as individualized guidance and support for pregnant refugee women throughout their pregnancy and during labor. In her interview, she explained the gynecological and obstetrical challenges that the refugees she helped encountered since coming to the United States.

“Clarkston, GA, has one of the largest refugee communities in the country, representing over 120 countries. Many of the women Embrace works with have recently entered the country and pregnancy and childbirth may be their first introduction to the U.S. healthcare system,” she said, “There are many challenges that Embrace volunteers navigate together with these women and their families, including ensuring adequate interpretation services at prenatal visits, empowering them to have a voice in their own healthcare and preparing them for differences in our medical system.”

Sonya Jubb, MSN, CNM also participated in international service before her work in both community health clinics and private practice, and credits this midwifery work abroad to her decision to become a nurse midwife. “The two months I spent volunteering in [a] maternity center [in Ghana, West Africa] opened my eyes and my heart to the important, critical work that nurse midwives provide worldwide,” she said.

What Certified Nurse Midwives Do

what-do-cnms-do-810x300Certified nurse midwives fulfill a wide range of responsibilities to help women maintain their reproductive health, and to ensure that pregnant mothers have a safe and successful pregnancy. Their typical workday will consist of many different tasks, including performing women’s health examinations, ordering and interpreting diagnostic tests, performing gynecological and obstetrical procedures such as IUD placements, normal vaginal deliveries, ultrasounds, and laceration repairs, and supporting physicians during more invasive or surgical delivery procedures such as cesarean section. CNMs also participate in patient education, and can also engage in staff training, research, and program development in their work setting and through larger organizations.

Women’s Health Examinations

Women’s health examinations (also known as well women exams) are a central responsibility of certified nurse midwives, and are generally comprised of a pelvic examination, breast examination, and a pap smear. Well women exams are important because many of the health problems that can afflict the female reproductive system, such as cervical cancer, breast cancer, polycystic ovarian syndrome, uterine fibroids, and endometriosis are easier to treat or prevent if detected early.

As they conduct women’s health exams, CNMs also provide advice and answer any questions patients may have around sexual health immunizations and other preventative treatments, navigating birth control options, fertility considerations, and how to conduct a proper breast self-exam. If patients show symptoms of health issues, CNMs can also order and interpret diagnostic screenings, such as ultrasounds, x-rays, and blood tests. CNMs can use the information gathered from a patient’s physical assessment to create a tailored medical care plan for the patient and her specific reproductive health needs.

Patient Education

Patient education is an instrumental part of the work that certified nurse midwives do, because it empowers women, regardless of their stage in life, to take control of their reproductive health and to make decisions that lead to better health outcomes. For their patients who are not pregnant, CNMs provide information about contraception options, how to maintain the health of their reproductive systems, and how patients can navigate changes in their reproductive development over their lifetime (ex. how to manage the onset of puberty, how to detect and address hormonal fluctuations, and how to prepare for and mitigate menopause symptoms). CNMs will also provide advice around fertility, family planning, and preparing physically and emotionally for motherhood.

For their pregnant patients, CNMs may offer advice around lifestyle choices that facilitate a healthy pregnancy, symptoms to watch for during pregnancy, and how to manage the labor and delivery process in collaboration with their care team. Patient education tends to happen naturally during patient checkups and consultations, as CNMs will often give women advice depending on their health status and any reproductive issues they are encountering.

Prenatal Care

For their pregnant patients, CNMs often provide several sessions of focused prenatal care that consists of regular checkups, prenatal screenings, patient education, and medical treatment as needed to ensure that the pregnancy is progresses normally. The frequency of prenatal visits depends on where the fetus is in its development and whether the pregnancy is low-risk or high-risk.

Low-risk pregnancies are defined as pregnancies in which the mother is 18-35 years old, healthy, and is experiencing no complications with her pregnancy. High-risk pregnancies are defined as those in which the mother is 35 or older, has gestational diabetes, is carrying multiple babies, or has a detected complication that requires monitoring, treatment, and additional support during labor and delivery. For the first to the seventh month of a low-risk pregnancy, CNMs may see a pregnant patient every four to six weeks. The frequency of visits increases as the patient nears her delivery date–between week 28 and 36, prenatal visits may increase to twice a month, while during the ninth and final month of pregnancy, a patient may need to consult with a CNM once or twice a week. High-risk pregnancies generally require more frequent prenatal care visits and more intensive monitoring.

Some ob/gyn settings use the patient education and prenatal care model Centering Healthcare. Ms. Simms explained the Centering method in her interview with OnlineFNPPrograms.com, “At Lisa Ross, we also offer Centering Pregnancy groups, which is a model of patient-centered, group prenatal care. Centering is an alternative to individual visits and brings women together who are due in the same month to meet at regular intervals throughout their pregnancy,” she said.

The Centering Healthcare model combines one-on-one time with nurse midwives with group education sessions. “Clients get time with a midwife and also learn from each other and benefit from increased time for community bonding, education and questions,” Ms. Simms said, “Research has shown that the use of the Centering model can actually lead to lower rates of pre-term birth and increased rates of breastfeeding, among other proven benefits. Facilitating Centering groups helps me build stronger relationships with my patients and is one of my absolute favorite things I get to do as a midwife.”

Labor and Delivery Services

CNMs who practice full-scope midwifery care also attend deliveries and provide medical support to patients during labor. The type of care that CNMs provide during labor and delivery depends on the pregnancy, as well as the medical setting and what type of birth experience the patient wishes to have. Below is a description of several delivery options that may be available to women depending on their health status and whether their pregnancy is low-risk or high-risk.

Traditional Hospital-Based Delivery:

Hospital-based deliveries are for women with high-risk pregnancies, and those who wish to have the most medical support during their labor. Hospitals can offer traditional epidural anesthesia and other medications, a routine IV, and the option for cesarean section. A physician oversees the birth in collaboration with CNMs, nurse practitioners, registered nurses, and medical assistants.

CNMs who attend births in hospital settings will assist the presiding physician with vaginal births, as well as cesarean sections if the pregnancy requires it. In her interview with OnlineFNPPrograms.com, Ms. Jubb explained her role as part of the labor and delivery team at John Muir Medical Center. “I also do first assisting during cesarean sections, which is a skill that many CNMs throughout the country are doing more of. I think more settings are realizing how important it is to have CNMs be able to provide that continuity with their patients beyond the normal vaginal delivery, but also assist with cesarean sections,” she said.

Natural Birth and Water-Based Birth:

Natural birth can occur at a freestanding birth center or in a hospital setting, and is defined as a delivery without the use of anesthetics, surgical procedures (unless needed due to a complication during labor), and other medical interventions typically administered during the delivery process. Water-based births can be considered a subset of natural births, and is a type of delivery method that involves the mother immersing herself in a tub of water to ease the pain and tension of the labor process. Waterbirths typically occur outside of a hospital setting, either at a freestanding birth center or at a woman’s home, under the supervision of a CNM and other trained support staff. Certified nurse midwives who attend waterbirths monitor the mother throughout the birthing process, providing both medical and emotional support.

Postnatal Support and Short-Term Neonatal Care

Immediately after a patient gives birth, CNMs will monitor her health and make sure that afterbirth complications do not arise. CNMs also follow up with new mothers several weeks after they leave the hospital, and will schedule one or more postpartum medical appointments for new mothers in order to check for symptoms such as postpartum depression or other emotional or physical health issues. In her interview with OnlineFNPPrograms.com, Ms. Stembridge explained how she works with patients who have recently given birth. “As a Nurse-Midwife, I specialize in the care of normal healthy women but I’m also trained to recognize deviations from normal,” she said, “Should a patient develop a high risk problem, I will be able to continue to participate in her care with MD collaboration. […] I’m fortunate to work with a great group of providers who all strive to deliver individualized care based on our patients’ desires.”

CNMs are also trained in monitoring the health of newborn infants. Though neonatal care is separate from nurse midwifery, depending on the health of the infant and the regulations in their work setting, CNMs may administer newborn care during the short period immediately after a mother gives birth. “Some nurse midwives deliver newborn care for the first month of life depending on their clinical arrangement,” Ms. Stembridge noted.

Research and Program Development

Certified nurse midwives can also engage in research projects and participate in the development of programs that improve systems of care in hospitals and other settings that provide women’s health services and obstetrical care. CNMs can participate in research by conducting surveys of health care needs in underprivileged areas, or investigating new methods of gynecological or obstetrical care. CNMs can also start or contribute to initiatives in and outside of their work setting that aim to improve the reproductive care of women, such as patient education programs, staff training workshops, and outreach programs that serve communities that lack access to sufficient health care.

If they work for a university-affiliated medical center, CNMs may be able to find research opportunities in their place of employment. However, CNMs can also seek out research projects outside of their work setting by networking through professional associations and contacting research groups at universities to see if they need assistance with certain women’s health research projects.

In her interview, Ms. Simms explained how she participated in a research project during her nursing program, through a partnership with Dr. Jennifer Foster, CNM, MPH, PhD. “For the project, we worked with a local community organization and did focus groups and individual interviews to help identify the needs of the community and risk factors for pre-term birth,” Ms. Simms said, “I find it very valuable and do think learning about nursing research and participating in this project enhanced my understanding of the field. Research may be something I would like to return to later in my career.”

The Challenges and Rewards of Certified Nurse Midwifery

rewards-challenges-of-certified-nurse-midwifery-810x300Certified nurse midwifery is a highly challenging field that can be both emotionally fulfilling and highly stressful. Caring for women and their children throughout pregnancy and during labor and delivery allows CNMs to be present for some of the most joyous moments of a person’s life, but on the other side of this are devastating situations CNMs must help mothers and their families navigate. Complications during a pregnancy or during labor can result in potentially fatal situations for the mother, the child, or both. Ms. Horch Cromar explained in her interview with OnlineFNPPrograms.com how nurse midwifery is not for the faint of heart.

“The most rewarding part is being able to help people. In OB, you are a part of one of the most important days of the patient’s life. That is an honor. Some days are so filled with so much joy, you can’t believe you get to have such an awesome job,” she said, “Other days are horrible. People always want to think about L&D being the ‘happy’ place to work. But sometimes things go wrong. Those days can be among the worst of your life. More than most careers, this one has high peaks and deep valleys. People will talk to you about how they had a stressful day at work and you will think, ‘You have no idea.’ I think it is important to consider this when you are thinking of becoming a midwife. Are you okay with having a job that will be emotionally very difficult?”

The barriers to effective patient care, which can include financial barriers, insurance issues, and complexities within the healthcare system that bar women from receiving the medical attention they need, can also be frustrating to overcome. “One challenge we face on a daily basis is the amount of documentation and paperwork that is a very important part of the job, but takes up more time than any of us would like,” Ms. Simms noted in her interview, “Another challenge for us is the financial struggle of working for a non-profit that serves uninsured patients and issues with insurance reimbursement…all the systemic stuff that I think should be emphasized more in school! I have had to learn a lot about insurance and billing through trainings at work and on my own.”

Despite the challenges of the field, the relationships that CNMs form with the families they work with can be immensely rewarding. “The best thing about working as a nurse midwife is sharing in the most monumental moment of a family’s life in the delivery of their children. My patients come back for well woman care [and] we continue our partnership in their care. This continuity of care is a very rewarding part of my career,” Ms. Stembridge said.

Practitioners of nurse midwifery are generally united under a shared passion for helping women receive the respectful and attentive care they deserve, not only during pregnancy and childbirth, but also throughout their life. Working with colleagues who are similarly committed to and enthusiastic about advocating for women’s health, education, and empowerment can be a uniquely rewarding experience. Ms. Simms noted that, in addition to the connections she makes with patients, one of her favorite aspects of the work she does is the relationships she has with her colleagues. “The greatest reward for me is the relationship I get to develop with my patients and also the amazing women I get to work with everyday who are all committed to providing the most patient-centered, holistic, sensitive and evidence-based care possible for the families in our community,” she said.

Alison Young, MSN, CNM, CNS is a Certified Nurse Midwife at Santa Rosa Women’s Health and Birth Center. In an interview with OnlineFNPPrograms.com, she described her reasons for entering nurse midwifery as a profession, and explained how her interest in the field began during her undergraduate years. “I started my career path as an undergraduate at UCSC while taking a course called ‘Community Studies of Health Care Inequalities,'” she recalled, “There I learned about maternal and child health in the US versus other industrialized countries and was shocked that we do not take very good care of women and babies in this country. I read countless research articles assessing this problem and most of them were written either by or about the benefits of midwifery care. I wondered what this midwife profession was all about. Before learning more about certified nurse midwifery, I thought midwives were old ladies who traveled to people’s houses, but these midwives I read about had doctorates and were conducting research.”

As she explored nurse midwifery further in her classes, Ms. Young learned about the direct impact that nurse midwives have on the health and well-being of women and children both in their community and on a national and international scale.”I met a friend in a healthcare class who was a homebirth midwife, Certified Professional Midwife, and was studying to be a nurse midwife. I told her I was interested in Maternal and Child health and I thought I might want to work in policy and change laws to protect women and children. She told me ‘just be a midwife, that’s what we do everyday.'” Certified nurse midwives are advocates for women’s physical health and emotional well-being, both through direct medical care and on a broader scale by improving women’s care programs and even influencing policy. The CNMs’ role can be an incredibly empowering one for individuals who enjoy supporting vulnerable or underserved populations and promoting women’s health at the individual, community, and national and international levels.

Advice for Prospective Certified Nurse Midwives

advice-for-students-interested-in-nurse-midwifery-810x300Registered nurses who are interested in becoming certified nurse midwives should first thoroughly research the profession and, if possible, shadow CNMs and/or volunteer in women’s health and nurse midwifery settings to get a good sense of the demands this job will have on them. “Any career in the medical field comes with challenges–long shifts, emotionally challenging cases and lives depending on your decisions,” said Ms. Stembridge, “I’d recommend that anyone considering a career in advanced practice nursing spend as much time as possible shadowing, talking with and working alongside practicing APRNs so that they can enter the career with a reasonable understanding of the demands.”

Ms. Simms similarly recommended that prospective certified nurse midwives seek out volunteer programs, fellowships, and internship opportunities that allow them to explore nurse midwifery and solidify their interest in becoming a CNM. In her interview, she explained how her decision to become a certified nurse midwife was actually the result of multiple years of work supporting underserved women during labor. “Before graduating from college, when I discovered my interest in women’s health and midwifery, I trained to become a doula, which is someone who is trained to provide physical and emotional support for women in labor,” she said. She also shadowed a nurse midwifery setting and spoke with numerous practicing CNMs in order to confirm her interest in the field. “I talked to a nurse-midwife there about the connection between midwifery and public health and I will never forget what she said to me: that nurse midwifery is public health–working with women has ripple effects on the entire community because moms just want to take care of themselves and their babies. She was right!”

Once they have determined that they would like to pursue certified nurse midwifery as a career, registered nurses should enroll in a graduate program in nurse midwifery that has been accredited by the Accreditation Commission for Midwifery Education (ACME). This program should include a minimum of 500 hours of clinical practicum in settings relevant to gynecological and obstetrical care. Nursing students may benefit from trying to secure several different clinical practicum settings so that they gain experience working with a wide variety of patients and gynecological/obstetrical practitioners.

In her interview, Ms. Stembridge described how her clinical practicums in different medical environments allowed her to care for many different patient populations, and also gave her insight into the types of preventative care that can have particularly dramatic outcomes. “I had the opportunity to have clinical rotations at a variety of settings during my midwifery program. I spent time at a private practice in the suburbs, a free standing birth center and a large tertiary care center,” she said, “My time at Nativiti Birth Center was invaluable in learning the importance of patient education, fostering close relationships with patients as well as the impact of healthy behaviors on pregnancy outcomes.” Ms. Stembridge’s subsequent clinical rotation at a tertiary medical center gave her experience in managing a wide variety of patient conditions under tight time constraints. “At Vanderbilt University Medical Center, I worked alongside our program faculty with a population of patients that varied from low risk to high risk. We often had multiple patients laboring at once thereby requiring development of triage and time management skills,” she recalled.

During their program, and if their schedule allows, nurse midwifery students may wish to seek out volunteer opportunities, fellowship programs, or internships that offer them additional experience in nurse midwifery settings, as well as potential professional connections. “Do everything you possibly can!” Ms. Horch Cromar advised, “Grab any experience or class or volunteer activity that you can get your hands on. Talk to all kinds of different nurses and midwives and doctors about their careers and ask for their advice.”

Ms. Stembridge recommended that students also network with their class cohort and focus on creating a mutually supportive peer group during their graduate nursing program. “In school, nurture friendships with your classmates; they are the only people who will truly understand the challenges you are facing,” she said. Ms. Simms similarly advised students to seek and provide peer support, while also connecting with professional associations early on, before graduation. “Lean on your classmates for support and find at least one mentor you can talk to. The American College of Nurse Midwives (ACNM) also has a mentoring program for students and new midwives who need support outside of their institution or community that is available to anyone. I do highly recommend joining ACNM as a student (they have a special discounted rate for students) and trying to attend at least one convention,” she said.

After completing their accredited graduate nursing program, prospective CNMs must take and pass the certification examination administered by the American Midwifery Certification Board (AMCB), and also fulfill any state-based licensure requirements prior to practicing. Once they begin practice, CNMs should try to achieve a degree of work-life balance by maintaining supportive friendships and seeking fulfilling activities outside of work. “Soak up as much knowledge and experience as you can. But try not to burn yourself out,” Ms. Horch Cromar cautioned, “That’s one of the biggest mistakes we nurses make. Take time for yourself. Don’t forget about the other interests in your life. Don’t neglect your family or your friendships. At least, not for long periods of time. Because you WILL neglect yourself, your family and your friends for periods of time as you go through this process. You will have to if you want to make it through. But ultimately, you want to be a whole person on the other end. So take care of yourself. It will make you a much better midwife.”

Certified nurse midwives work to improve health outcomes for women across their lifespan, advocate for women’s health, and ensure the safe delivery of babies. By committing themselves to their academic and clinical training; taking advantage of any additional midwifery experience in the form of volunteer work, internships, and fellowships; and surrounding themselves with a supportive group of fellow students and colleagues, certified nurse midwives can create a fulfilling career path that has a significant positive impact on families in their community.


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About the Author: Kaitlin Louie is the Managing Editor of OnlineFNPPrograms.com, and creates informational content that aims to assist students in making informed decisions about graduate programs. She earned her BA & MA in English from Stanford University.

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