The American College of Nurse-Midwives estimates that certified nurse-midwives attend 12 percent of all conventional low-risk births in Delaware each year. This represents 1,300 deliveries in the state in 2013 alone, according to figures released by the Centers for Disease Control and Prevention (CDC).
Women in Delaware are more often turning to nurse-midwives for childbirth and general well-woman care throughout the lifespan. Though CNMs represent only about 0.4 percent of all nurses practicing in the state (US Department of Labor, 2014), the Delaware Office of Occupational and Labor Market Information expects the number of CNMs to increase by 17 percent statewide over the ten-year period leading up to 2022. Further adding to the growing interest in pursuing a career in nurse-midwifery among Delaware’s RNs is the fact that nurse-midwives in the state earn an average of $88,540 as compared to $70,160 for traditional RNs (US Department of Labor, 2014).
While providing comfort and palliative treatments during childbirth in addition to well-woman gynecological care, as Advanced Practice Registered Nurses (APRN), Delaware’s CNMs bring advanced medical training to clinical practice to instill confidence in the women they work with.
Steps to Becoming a Nurse-Midwife in Delaware
Registered nurses interested in becoming certified nurse-midwives in Delaware must meet national certification requirements to qualify for Advanced Practice Registered Nurse (APRN) licensure through the Delaware Board of Nursing.
Delaware RNs with licenses in good standing can follow these steps to learn how to become a certified nurse-midwife:
|Earn a Master’s Degree in Nurse-Midwifery|
|Take the National Certification Exam in Nurse-Midwifery|
|Apply for Advanced Practice RN Licensure as a CNM in Delaware|
|Explore Career Options and Keep Credentials in Good Standing|
Step 1. Earn a Master’s Degree in Nurse-Midwifery
The Delaware Board of Nursing requires all its Advanced Practice Registered Nursing (APRN) candidates, including nurse midwives, to earn a master’s degree or complete a graduate program in their field of expertise. Certified nurse-midwife candidates must also obtain national certification through the American Midwifery Certification Board (AMCB), which requires candidates to complete a master’s program approved by the Accreditation Commission for Midwifery Education (ACME).
ACME-accredited programs are found at campus locations throughout the nation, and also cater to prospective graduate students who want to complete their education online. Online programs can be particularly convenient, especially for nurses who must maintain a busy work schedule while pursuing graduate studies. There are currently no graduate programs in nurse-midwifery housed at schools with campus locations in Delaware.
Nurse-midwifery programs that offer a dual focus in the related subject of women’s health are becoming increasing popular. Dual focus Nurse Midwife/Women’s Health Nurse Practitioner (NM/WHNP) programs allow graduates to become dually certified in both areas if they so choose.
Common admission standards for nurse midwife and NM/WHNP graduate programs include:
- Current RN license
- BSN or completion of nursing prerequisite courses
- Minimum GPA
- GRE General Test
- Personal essay, video essay, or statement of purpose
- Letters of recommendation
- Curriculum Vitae
Although most candidates for nurse-midwife graduate programs already hold a BSN, ACME also accredits RN-to-MSN bridge programs in midwifery/women’s health for those that hold associate’s degrees in nursing.
Graduate Program Structure
Graduate programs can be divided into two segments, which may be completed concurrently:
- Didactic classroom education – between 40-60 semester credits
- Clinical education – around 1,000 hours
Students will gain advanced knowledge in topics that relate to women’s health and nurse midwifery, including in subjects like:
- Conducting advanced health assessments
- Legal issues and ethics in maternal healthcare
- Advanced physiology
- Women’s reproductive health
- Complicated pregnancies and deliveries
- Advanced integrated midwifery
- Nurse midwifery for the antepartum, intrapartum, and postpartum woman
- Mother and infant biostatistics
- Multicultural midwifery
- Advanced pharmacology for childbearing women
Online schools strive to develop local partnerships with healthcare facilities throughout the nation, including in Delaware, to ensure nurse-midwifery students have access to sites that would facilitate the clinical component of their education. This is done with an eye toward minimizing commuting or relocating. From an early stage in the graduate program students will be assigned a faculty member who will help identify potential local clinical education sites.
In Delaware potential clinical locations may include:
- Kent General Hospital in Dover
- Christiana Hospital in Wilmington
- Beebe Medical Center in Lewes
With a master’s degree in nurse-midwifery or women’s health/nurse-midwifery, graduates can apply to take the national exams required to become certified nurse midwives or dually certified as nurse midwives/women’s health nurse practitioners.
Step 2. Take the National Certification Exam in Nurse-Midwifery
The Delaware Board of Nursing requires candidates for APRN licensure to gain national certification in their field of expertise from an approved organization. Certified nurse-midwife candidates would obtain certification through the American Midwifery Certification Board (AMCB), sponsor of the Certificate in Nurse Midwifery (CNM).
Graduates of dual-focus nurse-midwife/women’s health nurse practitioner programs have the option of additionally becoming certified through the National Certification Corporation (NCC), sponsor of the Women’s Health Care Nurse Practitioner (WHNP-BC) credential
Exam candidates must first register with the appropriate sponsor and then sign up for a testing date with the third-party exam provider, Applied Measurement Professional (APM). Exams for both certifications are administered by APM at the H&R Block Center in Wilmington, 4756 Limestone Road, zip code 19808.
Certified Nurse Midwife (CNM) Exam – AMCB
Candidates can apply for the National Certification Examination in Nurse-Midwifery with the AMCB by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Prospective nurse-midwives can start preparing for this exam by reviewing the Candidate Handbook. Candidates have four hours to complete 175 multiple-choice questions on a computer. The test covers the topics of:
- Antepartum – 19-26 percent
- Intrapartum – 17-26 percent
- Postpartum – 15-18 percent
- Gynecology – 15-18 percent
- Women’s health and primary care – 8-16 percent
- Newborn – 7-16 percent
Successful examinees will receive a Certificate in Nurse Midwifery (CNM) from the AMCB.
Women’s Health Care Nurse Practitioner (WHNP-BC) Exam – NCC
Prospective women’s health nurse practitioners can register for this exam through the NCC’s website. Candidates can prepare for this exam by studying the WHNP Candidate Guide, and will have three hours to complete 150 computer-based multiple-choice questions. Tests may also contain up to 25 unscored pretest questions. Subjects covered on the test are:
- Gynecology – 35-40 percent
- Obstetrics – 25-30 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Pharmacology – 5-10 percent
Successful examinees will receive the Women’s Health Care Nurse Practitioner (WHNP-BC) credential from the NCC.
Step 3. Apply for Advanced Practice RN Licensure as a CNM in Delaware
Upon receiving notification of passing test scores on the Certified Nurse Midwife Exam, APRN/CNM licensure candidates would then complete and submit an application packet and all supporting materials to:
State of Delaware, Board of Nursing
861 Silver Lake Blvd., Suite 203
Dover, DE 19904-2467
Candidates who want to apply for both CNM and WHNP recognition in the state would need to complete two separate applications.
Collaborative Practice Agreement
If APRN/CNM candidates have never worked in their area of specialization before, they will need to establish a collaborative practice agreement with a physician with a license to practice in Delaware. The collaborative agreement form is included in the application packet. This agreement specifies the details regarding patient consultation and referral by the APRN to the named healthcare professional.
APRN/CNM candidates who have practiced in their field of expertise for at least two years or 4,000 hours are not required to submit a collaborative practice agreement.
APRN licensure candidates also have the option of applying for prescriptive authority for non-controlled substances if they have completed classes in all of the following areas:
- Advanced health assessments
- Diagnosis and management of problems relating to midwifery and women’s health
- Advanced pathophysiology
- Advanced pharmacology or pharmacotherapeutics
Additionally, to apply for prescriptive authority for controlled substances, APRNs need the following:
- Drug Enforcement Agency (DEA) number
- Delaware Controlled Substance Registration (CSR) – APRNs only need this if no other medical professionals have a CSR at the location of employ
Step 4. Explore Career Options and Keep Credentials in Good Standing
Certified nurse-midwife APRN licensure candidates can check the status of their application through the Division of Professional Regulation’s license verification portal. Once they have received their APRN license they can begin practicing in their new area of expertise.
APRN License Renewal with the Delaware Board of Nursing
APRN status must be renewed at the same time as the standard RN license. APRNs who hold an RN license from a compact state must renew their APRN status by September 30th of odd-numbered years.
To be eligible for renewal, APRNs must fulfill one of these requirements:
- Have at least 1,500 hours of practice in their area of focus over the preceding five years
- Have at least 600 hours of practice in their area of focus over the preceding two years
- Have completed a graduate program in their field of focus in the preceding two years
Additionally, to renew prescriptive authority APRNs must complete at least 10 hours of continuing education in the past two years that relates to pharmacology or pharmacotherapeutics
Renewing the Certificate in Nurse Midwifery with the American Midwifery Certification Board (AMCB)
This certification is maintained on a five-year renewal cycle. Certified nurse-midwives must maintain the credential by enrolling in the AMCB’s Certificate Maintenance Program, which involves completing one of the following:
- Re-examination for the Certificate in Nurse Midwifery (CNM)
- Completion of three certificate maintenance modules and 20 hours of continuing education
Renewing the Women’s Health Care Nurse Practitioner (WHNP-BC) with the National Certification Corporation (NCC)
This credential is maintained on a three-year maintenance cycle. Women’s health NPs must start by taking the NCC’s Continuing Competency Assessment. Based on their score, they would then be instructed to complete between 10-50 hours of approved continuing education every cycle.
Employers and Practice Models for Certified Nurse Midwives and Women’s Health NPs
Newly certified and licensed nurse midwives and women’s health NPs often pursue career advancement in-house at their current place of employment or where they completed their clinical education. Others choose to open their own birth centers or join forces with colleagues to form clinical partnerships where they specialize in women’s health and nurse-midwifery.
Top CNM employers in Delaware, and practice models for community-based clinics, include the following:
- Women’s Services at Kent General Hospital in Dover
- Neonatal ICU at Christiana Hospital in Wilmington
- The Birth Center in Wilmington
- Saint Francis Ob/Gyn Center in Wilmington
- Women to Women Ob/gyn in Wilmington
- Advanced Care OB/GYN in Wilmington and Bear
- Just for Women OB/GYN in Newark
- Dedicated to Women Ob-Gyn in Middletown
A December 2015 survey of job vacancy announcements for CNMs in Delaware offers insight into the types of opportunities that may be available in the state (examples presented here for illustrative purposes only and are not meant to imply an assurance of employment):
- Certified Nurse Midwife at The Birth Center in Wilmington
- Chief Nurse Executive with Christiana Care Health System in Newark
- Health Center Manager at Planned Parenthood in Newark
- Nurse Practitioner with Rehoboth Walk-In at the Beebe Medical Center in Rehoboth
- Nurse Practitioner with Westside Family Healthcare in Wilmington
Salaries for Certified Nurse-Midwives in Delaware
The median salary among the 40 certified nurse midwives who practiced in Delaware in 2014 was $89,050 according to the US Bureau of Labor Statistics. Nurse midwives in Delaware whose salaries fell within the top 10% earned an average of $113,890, while nurse midwives new to the field with salaries that fell within the bottom 10% earned an average of $88,540 that year.
Job Growth Predictions and Employment Trends for Certified Nurse-Midwives in Delaware
The Delaware Department of Labor expects that the number of jobs for certified nurse-midwives in the state will increase at a rate faster than the overall average job growth rate in the state. The Department predicts a growth rate of 16.7% in the number of jobs for CNMs in Delaware between 2012 and 2022.
While many women prefer to give birth at home under the care of a midwife, Delaware made it a felony in 2013 for non-nurse midwives to practice in a woman’s home if they do not work with a licensed physician and have a written collaborative agreement on file. Certified nurse-midwives in Delaware do not face these restrictions. As of 2015, only one non-nurse midwife in the state was legally authorized to practice in Delaware, serving Amish and Mennonite women.
Delaware has one birth center that employs certified nurse-midwives: The Birth Center in Wilmington. This center is designed to handle low-risk pregnancies. High-risk deliveries take place at Christiana Hospital, which is the only hospital in Delaware that handles high risk deliveries and offers Level III neonatal intensive care, which is one of the state’s top employers of certified nurse-midwives.
The Availability of Obstetric Care Varies Throughout Delaware
Certified nurse-midwives can practice independently in Delaware and are in particularly high demand in areas with fewer OB-GYN physicians. The American Congress of Obstetricians and Gynecologists analyzed the prevalence of OB-GYN physicians in its 2014 fact sheet on Delaware.
While Delaware has a ratio of OB-GYN physicians per population that is 29% higher than the national average, these specialists are mostly concentrated in New Castle County. The national average for the number of OB-GYNs is 2.61 per 10,000 women.
New Castle County exceeds this ratio, while Kent County only has 2.0-2.4 OB-GYNs per 10,000 women. Sussex County has even fewer OB-GYNs on a population basis with less than two of these specialists per 10,000 women.