Although the focus of nurse-midwifery has long been on the childbearing woman, today’s nurse-midwives provide primary/gynecological care and family planning, counseling, and education services to women throughout their lifetime.
Their broad scope of practice allows them to fit seamlessly into any number of healthcare settings, including birthing centers, midwifery practices, hospitals, and medical centers, among others.
While most nurse-midwives focus their careers on clinical practice, many may also choose to make contributions to the areas of research, policy, and education.
Although job responsibilities and duties of nurse-midwives vary along with the settings in which they practice, all of these advanced practice nurses have a few things in common:
- All nurse-midwives possess a graduate-level degree accredited by the Accreditation Commission for Midwifery Education (ACME).
- All nurse-midwives possess national certification as a CNM through the American Midwifery Certification Board.
- All nurse-midwives possess a state-issued advanced practice RN license or specialized nurse-midwife license.
A master’s or higher degree is the starting point for achieving a career as a nurse-midwife. Here’s what to expect:
Understanding the Components of a Master’s Degree Program in Nurse-Midwifery
About half of all nurse-midwifery master’s programs are offered either partially or entirely online, which allow students to complete didactic requirements through web-based study. Institutions that offer online programs partner with clinical sites across the country, allowing students to complete the clinical portion of their program at sites close to home.
A master’s degree in nurse-midwifery, most often designed as a Master of Science in Nursing (MSN) with a focus on Nurse-Midwifery or a Master of Science (MS) in Nurse-Midwifery, is designed for RNs who possess a Bachelor of Science in Nursing (BSN).
As of 2014, 28 of the 39 ACME-accredited programs in nurse-midwifery were structured as MS or MSN programs. The majority of institutions house nurse-midwifery programs in Schools of Nursing or Colleges of Allied Health.
Generally consisting of two years of study (or three years for part-time programs), master’s degrees in nurse-midwifery prepare students for entry-level nurse-midwifery practice through a core curriculum consisting of didactic coursework and clinical experiences designed to teach:
- The management of women’s primary care
- Reproductive care
- Prenatal and postpartum care
- Labor and birth
- Newborn care
The core of a master’s degree in nurse-midwifery (which is the same for Doctor of Practice and graduate certificate programs in nurse-midwifery) meets the ACNM’s Core Competencies for Basic Midwifery Practice and provides students with the opportunity to master content in the following areas:
- Physiology and pathophysiology: general, reproductive, pregnancy, fetal, and neonatal
- Pharmacology: primary care, women’s health, and perinatal pharmacology
- Clinical management: Women’s primary care, reproductive care, care during pregnancy birth, the postpartum periods, and care of the newborn
- Psychosocial issues and cultural literacy
- Leadership, professional roles, and issues
- Research methods and applying evidence to clinical practice
Students of nurse-midwifery programs complete didactic (classroom) study concurrently with clinical rotations, which provide them with the opportunity to work alongside expert clinicians and gain hands-on experience in real-world settings, such as:
- Hospitals/medical centers
- Home birth settings
- Health clinics
- Private OB/GYN practices
- Private midwifery practices
- Birth centers
- Planned Parenthood clinics
- S. Armed Forces
The clinical rotations within a master’s degree in nurse-midwifery program often include more than 1,000 hours of practice, both in inpatient and outpatient settings.
Many programs in nurse-midwifery culminate in a comprehensive scholarly paper or capstone experience.
The traditional master’s degree in nurse-midwifery requires candidates to possess:
- Current and unencumbered RN license
- Bachelor of Science in Nursing (BSN)
- Minimum undergraduate GPA
- Minimum GRE scores
- Letters of recommendation
Many institutions also require students to sit for an admissions interview or submit a relevant admissions essay.
The Option for Dual Specialization in Nurse-Midwifery and Woman’s Health
Many institutions, professional associations, and employers have begun realizing the value of dual specialization. Dual focus programs allow students to broaden their foundation of knowledge and professional opportunities. One such program that has been gaining in popularity is the nurse-midwife/women’s health nurse practitioner (NM/WHNP) program.
While nurse-midwives provide primary care to childbearing women, the women’s health nurse practitioner focuses on the primary healthcare needs of women across the life cycle, with a focus on health promotion, disease prevention, health education, and counseling. As such, a master’s program that includes dual specializing in both nurse-midwifery and women’s health provides students with a broader scope of knowledge in women’s health.
Graduates of these programs are uniquely eligible to become daully-certified if they choose to take both the Certified Nurse Midwife (CNM) exam through the Accreditation Commission for Midwifery Education (ACME) and the Women’s Health Nurse Practitioner (WHNP) examination through the National Certification Corporation.
Depending on the state, graduates of these programs may also pursue an Advanced Practice Registered Nurse (APRN) license with two specialties.
Additional areas of study within a CNM/WHNP program often include:
- Health promotion and disease prevention
- Assessment and management of common primary care signs and symptoms
Accreditation Requirements for Nurse-Midwifery Degree Programs
All nurse-midwifery programs that ACME accredits are offered at the graduate level. Accredited programs must adhere to the American College of Nurse-Midwives (ACNM)’s Core Competencies for Basic Midwifery Practice, which encompass the fundamental skills, knowledge, and behaviors expected of a new practitioner.
The Core Competencies serve as guidelines for educators, students, healthcare professionals, consumers, employers, and policymakers alike, and constitute the basic requisite competencies expected of all graduates of ACME-accredited nurse-midwifery programs.
Midwifery education, according to the ACNM, is based on an understanding of health sciences theory and clinical preparation, both of which shape the knowledge, judgment, and skills required to provide primary healthcare management to women and newborns. The ACNM encourages each educational program to develop its own method of addressing healthcare issues beyond the scope of the current core competencies.
Professional Responsibilities of Nurse-Midwives
The professional responsibilities of certified nurse-midwives include, but are not limited to, the following:
- Promoting the hallmarks of midwifery
- Understanding the history of midwifery
- Understanding the legal basis for midwifery practice
- Understanding national and international issues and trends in women’s health and maternal/newborn care
- Supporting legislation and policy initiatives that promote quality healthcare
- Understanding issues and trends in healthcare policy
- Understanding information systems and other technologies designed to improve the quality and safety of healthcare
- Possessing a broad understanding of bioethics as it relates to the care of women, newborns, and families
- Practicing within the ACNM Philosophy, Standards, and Code of Ethics
- Possessing the ability to evaluate, apply, interpret, and collaborate in research
- Participating in lifelong learning, peer review, and self-evaluation
- Developing leadership skills
- Understanding licensure, clinical privileges, and credentialing
- Understanding practice management and finances
- Promoting the profession of midwifery
- Supporting the growth of midwifery through participation in midwifery education
- Understanding the structure and function of the ACNM
Fundamental Components of Midwifery
The fundamental components of midwifery—and nurse-midwifery programs—include:
- Anatomy and physiology, including pathophysiology
- Normal growth and development
- Psychosocial, sexual, and behavioral development
- Basic epidemiology
- Pharmacokinetics and pharmacotherapeutics
- Principles of individual and group health education
- Bioethics related to the care of the woman, newborn, and family
- Clinical genetics and genomics
Elements of Nurse-Midwifery Care
A graduate-level program in nurse-midwifery, whether it is a master’s in nurse-midwifery (MSN or MS), a post-graduate certificate in nurse-midwifery or a Doctor of Nursing Practice (DNP) in nurse-midwifery, must contain the following elements:
Midwifery Care of Women:
Nurse-midwives must independently manage primary health screening, health promotion, and care of women from adolescence through the lifespan using the midwifery management process. Midwifery care of women may be organized by:
- Post-pregnancy care
Midwifery Care of the Newborn:
Nurse-midwives independently manage the care of the newborn immediately after birth and continue to provide care to well newborns up until 28 days of life.