What Is a Certified Nurse-Midwife (CNM)?

A certified nurse-midwife (CNM) plays an essential role in women’s health care. Certified nurse-midwives provide prenatal and postpartum care, attend women during labor and delivery, and can also serve as primary health care providers for women who are not pregnant.

Definition of a Nurse-Midwife

While women have received assistance in childbirth for decades, the modern profession of midwifery requires specialized education and training.

To work in this profession, CNMs must have an active RN license and graduate from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education and pass a national certification exam administered by the American Midwifery Certification Board (AMCB).

If you’re interested in a career in nurse-midwifery, learn more about how to become a nurse-midwife.

What Does a Nurse-Midwife Do?

The job responsibilities of a nurse-midwife vary widely depending on the work setting. Most CNMs care for women during labor and birth, often reducing the need for medical interventions such as epidurals, cesarean births, or episiotomies. They may conduct prenatal checkups and provide comprehensive gynecologic care to women in all stages of life.

CNMs have prescriptive authority in all U.S. jurisdictions and can educate patients on family planning strategies. Additionally, certified nurse-midwives may teach or research topics related to women’s health such as contraception, maternal-child health care, breastfeeding, gynecological care, and HIV/AIDS.

Because CNMs follow a woman- and family-centered model of care, they are critical advocates for policymaking and health care reform. Certified nurse-midwives can also direct their own midwifery practices.

Certified Nurse-Midwife (CNM) vs. Certified Midwife (CM) vs. Certified Professional Midwife (CPM)

There are several different types of midwife. Though they share similar names, the licensing requirements, job descriptions, and salary ranges differ considerably. Below is a closer comparison of a certified nurse-midwife (CNM), certified midwife (CM), and certified professional midwife (CPM).

A certified nurse-midwife has stringent licensing requirements. CNMs must obtain their registered nurse (RN) license through a two- or four-year degree-granting program and completion of the NCLEX-RN exam. They must apply to a midwifery education program, most of which require a bachelor’s degree, and earn certification through the AMCB. After completing education and certification requirements, certified nurse-midwives can prescribe medication, including controlled substances and contraceptives, in all 50 states. (The scope of practice varies from state to state. Check your state’s regulations regarding midwifery for the most up-to-date information.) The median annual wage of CNMs is $103,770, according to 2018 data from the Bureau of Labor Statistics (BLS).

A certified midwife (CM) follows a very similar path to CNMs but earn a bachelor’s degree in non-nursing fields. They must successfully complete health and science coursework required by the graduate midwifery education program they’re enrolled in, but a nursing license is not necessary. The AMCB certifies CMs, but as of 2019, CMs can only prescribe medication in New York, Rhode Island, and Maine. The BLS does not have specific salary data for certified midwives.

The majority of CNMs and CMs practice and attend births in hospitals, but they also work in freestanding birth centers and offices.

Typical job duties for certified nurse-midwives and certified midwives are similar and may include:

• Preconception care
• Prenatal checkups
• Maternal support during labor
• Delivering newborns
• Caring for stable newborns during the first month of life
• Gynecologic and family planning services
• Comprehensive assessment, diagnosis, and treatment
• Physical assessments
• Patient admission, management and discharge
• Ordering laboratory and diagnostic testing
• Health promotion and disease prevention
• Wellness education and counseling

A certified professional midwife does not need a bachelor’s or graduate degree. The certification requirements vary by program but usually include life science courses (anatomy, physiology, microbiology) and relevant experience such as childbirth education and doula certification. The NARM maintains certification for CPMs, and CPMs are the only NCCA-accredited midwifery credential that requires out-of-hospital experience. Certified professional midwives have a more limited scope of practice than CNMs and CMs.

Typical job duties for certified professional midwives include:

• Prenatal checkups
• Maternal support during labor
• Delivering newborns
• Caring for stable newborns in the first days of life
• Maternal and well-baby care for the first six to eight weeks of life
• Comprehensive assessment
• Consulting with or referring to health care professionals in case of abnormal or dangerous conditions

Certified professional midwives usually attend patients in their homes, at birthing centers or in professional offices. The BLS does not have specific salary data for certified professional midwives.

Top Skills Needed as a Nurse-Midwife

In addition to coursework, clinical experience, and health care training, certified nurse-midwives also need the following skills:

• Empathetic listening
• Observation and questioning
• Calmness in stressful or high-pressure situations
• Caring, understanding approach
• Collaborating with other health care providers

Important personality traits for nurse-midwives include:

• Patience
• Professionalism
• Responsibility
• Cultural competency

Midwifery is characterized by several important hallmarks, including normalization of menarche, pregnancy, birth, and menopause; promotion of woman- and family- centered care; advocacy for informed choice, shared decision-making, and individual agency; incorporation of evidence-based practice into clinical routines; and empowerment of women as partners in their own care, among other key beliefs.

Midwife History

Midwives have practiced informally throughout history, long before physicians developed the field of obstetrics and medicalized childbirth in the 18th and 19th centuries. After the professionalization and commercialization of medicine in the United States, midwives were often relegated to attending women classified as low-income in rural areas. By 1935, midwives attended less than 15 percent of U.S. births, down from about half of all births in 1900.

Midwifery slowly began to regain traction starting in 1925, when nurse Mary Breckinridge founded the Frontier Nursing Service in Kentucky; 30 years later, the American College of Nurse-Midwives (ACNM) was formed. Mid-century nurse-midwives, though few in number, had a significant influence on birthing practices that are now much more common. Nurse midwives advocated for family-centered maternity care, including inclusion of fathers in the delivery room, childbirth education, mother-baby rooming in, and breastfeeding. These practices, along with the integration of midwifery in general, have been linked to improved measures of both maternal and infant health.

With the critical shortage of maternity care, particularly in rural areas, certified nurse-midwives are becoming increasingly important. If you want a rewarding career helping mothers and babies, consider becoming a certified nurse-midwife.