According to a September 2015 article in The Columbus Dispatch, Ohio women are increasingly turning to midwives as they look to personalize their birthing experiences, and statistics are proving this to be true.
The American College of Nurse-Midwives reported that from 1989 to 2013, the percentage of births in Ohio attended by certified nurse midwives (CNM) rose nearly every year. In 2013, CNMs and CMs attended nearly 8 percent of all hospital births in Ohio – that’s an increase of more than 8 percent since 2005.
Nurse-midwives have become fixtures in hospitals, according to The Columbus Dispatch, delivering babies and influencing policy. These policy shifts have included the move toward developing accommodations that allow families to stay together in the hours immediately after a C-section, and encouraging skin-to-skin contact and breastfeeding as soon after giving birth as possible. The article also revealed what many already know: expectant mothers in the care of nurse-midwives are less likely to have C-sections or inductions and spend less time in the hospital – all of which lower healthcare costs and raise the quality of care for women.
As advanced practice registered nurses (APRN) skilled in midwifery, nurse-midwives provide women with care from adolescence through menopause, including gynecologic, well woman, obstetric care, and more.
One of the most pressing issues among Ohio’s nurse-midwives is House Bill 216, more commonly referred to as the APRN Modernization Bill. If passed, it will allow advanced practice nurse registered nurses (APRNs) in Ohio, such as nurse-midwives, to work independent of physicians. Proponents of the bill argue that allowing APRNs to practice independently will make it easier for women in rural areas to gain access to care. It is expected that 20 to 30 percent more APRNs will relocate to Ohio to practice if the law is passed.
Steps to Becoming a Certified Nurse-Midwife in Ohio
Registered nurses in Ohio interested in becoming nurse-midwives must have an unencombered RN license in good standing and national certification in nurse-midwifery to qualify for a state certificate of authority to practice as an APRN through the State of Ohio Board of Nursing:
Step 1. Earn a Qualifying Degree in Nurse Midwifery
The first step toward earning an APRN certificate of authority as a nurse-midwife in Ohio involves the completion of a nurse-midwifery graduate degree program accredited by the American Commission for Midwifery Education (ACME).
In Ohio, there are ACME-accredited nurse-midwifery programs located in Cleveland, Columbus, and Cincinnati. However, even RNs not living near these Ohio cities can complete a graduate degree in nurse-midwifery, thanks to the many online programs now available.
Institutions that offer web-based study allow students to satisfy all or some of the didactic requirements of their nurse-midwifery program through a distance-learning platform. Many programs also offer part-time study as a way to accommodate today’s working RNs.
Not all RNs in Ohio entering a graduate degree program in nurse-midwifery do so with the same level of education. Therefore, the structure of these programs may differ to accommodate RNs at different stages of their education:
- MSN/MS Programs: Master of Science in Nursing (MSN) with a focus in nurse-midwifery and Master of Science (MS) in Nurse Midwifery degree programs are designed for RNs that possess Bachelor of Science in Nursing (BSN) degrees.
- RN–to-MSN Programs: RN-to-MSN degree programs in nurse-midwifery are designed for RNs that possess an associate’s degree in nursing and therefore must complete both their BSN and MSN before seeking licensure as a nurse-midwife in Ohio.
- Post-Graduate Programs: Post-graduate certificates in nurse-midwifery are designed for RNs that possess an MSN and want to apply for initial APRN licensure as a nurse-midwife or for currently licensed APRNs seeking to add the nurse-midwife specialty to their APRN license.
Dual-Focus Nurse-Midwife/Women’s Health Nurse Practitioner Programs
In addition to offering traditional nurse-midwife graduate/post-graduate programs, many institutions have begun offering dual-focus programs that allow students to broaden their scope of practice to include serving as primary care providers for women and their families. One such dual focus option that has gained in popularity in recent years is the nurse-midwife/women’s health nurse practitioner program.
This unique program allows students to complete a wide-ranging, comprehensive course of study in women’s health. Upon graduation, students are then eligible to take the Women’s Health Nurse Practitioner Board Certification Exam in addition to the Certified Nurse-Midwife (CNM) Exam.
Students enrolling in an accredited nurse-midwifery program must possess a valid and unencumbered RN license, a Bachelor of Science in Nursing (BSN) degree and, depending on the institution:
- Minimum undergraduate GPA
- Minimum GRE score
- Letters of recommendation
- RN experience
Master’s Degrees in Nurse-Midwifery: Program Content and Components
All ACME-accredited nurse-midwife programs include two components: a didactic component and a clinical component. Full-time programs take about two years to complete.
The core of a nurse-midwife program contains coursework in pharmacotherapeutics, health assessment, pathophysiology, and research, among others, as well as a number of courses aimed specifically at nurse-midwifery, such as:
- Well-woman care for nurse-midwifery
- Antepartum care
- Intrapartum, postpartum, and newborn care
- Integration and professional issues for nurse-midwifery
The clinical requirements of a nurse-midwife program in Ohio may consist of up to 1,000 hours of practice in a number of clinical settings. The goal of clinical rotations is to give students the opportunity to apply their didactic learning in real-world settings. Most institutions require students to participate in clinical rotations in a number of different settings as a way to provide students with a well-rounded education.
Students of campus-based programs usually complete their clinical rotations at pre-determined sites close to campus, while online programs partner with many sites throughout the U.S. to allow students to complete their clinical sequences at sites close to home.
In Ohio, nurse-midwife students may complete part of their clinical requirements at one of these facilities:
- MacDonald Women’s Hospital, Cleveland
- Comprehensive Women’s Care, Columbus
- Suma Health System, Women’s Center, Wadsworth
- Mercy Women’s Care – St. Charles, Oregon
- Ohio State Center for Women’s Health, Columbus
- Midwives of Dayton, Washington Township
Step 2. Take and Pass the National Certification Examinations
After graduation from a nurse-midwifery program, RNs in Ohio must take and pass the Certified Nurse-Midwife (CNM) exam through the American Midwifery Certification Board.
Graduates of nurse-midwife/women’s health nurse practitioner degree programs may also take and pass the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation if they are pursuing WHNP board certification in addition to CNM certification.
Both examinations consist of 175 multiple-choice questions, and candidates must take both exams through one of the Applied Measurement Professionals (AMP) testing centers located throughout the U.S.
Once candidates have applied for their CNM and/or WHNP exam through the appropriate certification agency and received approval to test, they must schedule their exam through Applied Measurement Professional (APM) test centers. In Ohio, candidates may take their exams in:
- Brook Park
Step 3. Apply for APRN Certificate of Authority as a Nurse-Midwife through the State of Ohio Board of Nursing
Candidates that have achieved their CNM certification would then apply for an APRN certificate of authority as a nurse-midwife by completing the Advanced Practice Registered Nurse (APRN) Application Certificate of Authority (COA) and providing the Board with the following:
- $100 application fee (made payable to Treasurer, State of Ohio)
- Verification of CNM designation (verification should be sent directly to the Board)
- Verification of graduation from a nurse-midwifery program (institution must send a signed and sealed transcript directly to the Board)
Physician Collaboration Requirements
All nurse-midwives in Ohio must identify a collaborating physician and enter into a standard care arrangement (SCA) with a collaborating physician before engaging in practice. The SCA must be signed by both the CNM and the collaborating physician and be retained and available upon request at each practice site. The information that must be included in the SCA can be found here.
Prescriptive Authority Requirements
Licensed CNMs in Ohio seeking prescriptive authority must complete a Certificate to Prescribe Externship Application and send it to the Board, along with a check or money order for $50 (payable to the Treasurer, State of Ohio).
To receive prescriptive authority in Ohio, nurse-midwives must provide proof of the completion of an advanced pharmacology course taken within the past 3 years.
Step 4. Exploring Career Opportunities as a Nurse-Midwife in Ohio and Maintaining Credentials
Nurse-midwives in Ohio have a wide array of choices when it comes to practice settings. These APRNs may practice in hospitals, women’s health clinics, OB/GYN practices, and birthing centers, just to name a few. Many also choose to open their own birthing center or midwifery practice in Ohio.
Just a few of the locations where nurse-midwives in Ohio may start or advance their nurse-midwifery career include:
- Mahoning Valley Birth Center, Youngstown
- Center for Humane Options in Childbirth Experiences, Columbus
- Family Birthing Center, Chippewa Lake
- Mercy Medical Center, Canton
- Women’s Health & Birth Center, Steubenville
- Ann Burba Crane Center for Women and Babies, Columbus
- Firelands Birthing Center, Sandusky
APRN Certificate of Authority Renewal
Nurse-midwives in Ohio must renew their APRN certificate of authority by providing the Board with proof that they have maintained their CNM certification.
Nurse-midwives must renew their APRN certificates of authority before July 1 of all odd-numbered years. The cost of renewal is $85. Renewal forms can be found here.
CNM Renewal Requirements
Nurse-midwives must renew their CNM certification every 5 years through the American Midwifery Certification Board. The Board’s Certification Maintenance Program allows CNMs to meet continuing education requirements by completing one of the following:
- Option 1: Complete at least 3 AMCB Certificate Maintenance Modules during each five-year certification cycle and at least 20 contact hours of approved continuing education units; pay annual fees
- Option 2: Retake the AMCB Certification Examination and pay the $500 examination fee in lieu of annual fees
WHNP Renewal Requirements
Nurse-midwives in Ohio who also possess a WHNP certification must renew it every three years. WHNPs must complete a continuing competency assessment as a condition of their certification renewal through the National Certification Corporate at the beginning of each maintenance cycle and complete a specific number of continuing education credits hours based on the results of the assessment.
Salaries for Certified Nurse-Midwives in Ohio
Certified nurse-midwives in Ohio who were new to the field earned an average starting salary of $73,790, a full $7,850 more than the national average for this category according to the US Bureau of Labor Statistics (BLS). The median salary among certified nurse-midwives in Ohio was $94,390 that year, while the most experienced certified nurse-midwives whose salaries fell within the top 10% earned an average of $120,260.
The number of jobs for certified nurse-midwives is increasing dramatically throughout the country as the demand grows for gentler, less invasive antepartum, intrapartum, and postpartum care. The BLS estimates that the number of CNMs will grow by 31% nationwide between 2012 and 2022.
Regional Distribution of Certified Nurse Midwives in Ohio
The Ohio Action Coalition which is co-led by the Ohio Hospital Association and the Ohio League for Nursing produced a 2015 report entitled The RN & APRN Workforce in Ohio: An Overview of 2013 Licensure Renewal Data. In 2013, they identified 255 licensed certified nurse-midwives practicing in the state.
Nurse midwives were the most likely of all of the categories of advanced practice registered nurses to have prescriptive authority. Nearly 81% of Ohio’s certified nurse-midwives could prescribe medicine in 2013.
The report provided data on the percentage of APRNs who were located in different regions of the state. Northwest Ohio had a much higher percentage of APRNs with CNM certification than other regions of the state. Southwest Ohio had the second highest number of nurse midwives, while the eastern part of the state had the lowest percentages.
Since most of Ohio’s nurse midwives have prescriptive authority, they are well equipped to provide gynecological and obstetric care in parts of Ohio with a recognized shortage of OB-GYN physicians. In 2015, the Ohio State Medical Association published the Statehouse Update: Ohio’s Physician Shortage, which documented the testimony the Ohio Health Care Efficiencies Study Committee heard from key healthcare industry leaders regarding the looming physician shortage in the state.
The American Congress of Obstetricians and Gynecologists published a fact sheet on OB-GYN professionals in Ohio as of 2014, which showed that 26 Ohio counties completely lacked any OB-GYN physician. Certified nurse-midwives are seen as a solution to this shortage.
Salaries for Nurse Midwives in the Cleveland and Columbus Areas
The US Bureau of Labor Statistics provides a detailed analysis of the salaries for nurse-midwives in the Cleveland-Elyria-Mentor area and Columbus as of 2014.