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What Is a Certified Nurse Midwife (CNM)?

A certified nurse midwife, sometimes referred to as a CNM or simply a nurse midwife, is an advanced-do registered nurse (mail-baccalaureate) who specializes in women's reproductive health and childbirth. Non only practice they attend to women during pregnancy, childbirth, and mail service-partum, they also are responsible for preventive women'southward health maintenance.

Why Are Certified Nurse Midwives So Of import?

Nurse midwives differ from physicians primarily considering they are first and foremost nurses. They arroyo patient intendance with a holistic view - not merely focusing on the physical needs of the patient, but the mental and psychosocial needs also.

Co-ordinate to the American Higher of Nurse-Midwives (ACNM), the benefits of Certified Nurse Midwife (CNM) assisted births include:

Lower rates of cesarean births
Lower rates of labor induction/augmentation
Significant reduction of third and 4th-caste perineal tears
Less use of regional anesthesia
College rates of breastfeeding

Additionally, women cared for past CNMs were more likely to receive:

Prenatal instruction
A more hands-on approach and closer relationship with their provider
Fewer technological and invasive interventions

From a financial standpoint, the use of CNMs in obstetric and gynecological care tin can reduce health care costs. This is due to:

An increment in access to care
Less invasive medical interventions required
Reduced number of cesarean births
Reduced utilise of pharmacological pain management interventions

Using a midwife also opens the possibility of home births—an pick which helps lessen the female parent's anxiety and reduce the possibility of feeling "rushed," which may issue in labor-inducing drugs or cesarean delivery.

How to Get a Certified Nurse Midwife

Those interested in the field of midwifery should enjoy working with women from various backgrounds, relish educating patients and promoting preventive and holistic wellness. They should be skilled in building trusting relationships and should exist able to remain unbiased, piece of work well under force per unit area, and be able to provide support during emotionally charged events.

Certified Nurse Midwife Education Requirements and Training

Nurse midwives are avant-garde-practice registered nurses who have completed a minimum of a Master'south of Science in Nursing (MSN) degree. A Doctor of Nursing Practice (DNP) is a post-graduate caste and is another option, but is non required for entry-level nurse midwifery.

To advance to an MSN, a student must showtime complete an accredited nursing plan and obtain a Bachelor'southward of Scientific discipline in Nursing (BSN) degree. Later on that, the successful completion of the NCLEX-RN is needed for licensure. The length of fourth dimension it takes to complete an MSN program depends on the nurse's starting point:

Nursing students enrolled in a BSN plan consummate in virtually 4 years
RN to BSN takes about two years
BSN to MSN takes about ii years

Both online programs and classroom programs are available to adapt students. Both types have pros and cons depending on students' needs, therefore researching individual schools is encouraged.

The grooming needed to become a nurse midwife is incorporated in the advanced degree program. General advanced-practice courses are completed in the start office of the programme. Once the general courses are completed, students can choose a midwifery specialty track. Additionally, since in that location can exist a lot of overlap between Women'due south Health Nurse Practitioner (WHNP) curriculum and midwifery, many programs offer dual certification for each.

Educational Prerequisites

Requirements for midwifery programs vary from institution to establishment. The American College of Nurse-Midwives lists the twoscore schools that are accredited past the Accreditation Commission for Midwifery Education and describes which degrees are available (MSN, DNP, etc.).

They also have a reference list in which prospective students can review the various requirements for the different midwifery programs and explore available options. For example, some institutions:

Allow non-nurses into the curriculum
Practise not require experience in nursing or labor and delivery before access
Offer an ADN to MSN bridge program
Crave a BSN before admission
Offer an accelerated entry to the nurse midwifery program

Due to the considerable variability in program requirements, students are encouraged to visit the website to see which establishment would best fit their needs.

The curriculum for nurse midwifery can vary depending on the educatee'south starting point and educational institution, but should include courses and clinical practise rotations focusing on:

Health promotion and maintenance
Advanced pathophysiology
Advanced wellness assessment
Pharmacology for advanced do nurses
Primary care of women
Part of the nurse midwife
Care during pregnancy, labor, birth, and postpartum, to include newborn intendance
Women's wellness

Schools that offer DNP programs also include courses in education, leadership, and advocacy.

Certified Nurse Midwife Program Specialties

While there are no formal specialties for nurse midwives (information technology is a specialty in and of itself), they can cull which clinical focus area to work in, such as:

Chief care/clinics
Nativity centers
Hospitals
Community health centers
Educational activity
Inquiry

Examination, Licensure, and Certification

After completing graduate or post-graduate pedagogy with a focus in midwifery, candidates can apply and examination for certification. The American Midwifery Certification Board (AMCB) outlines the requirements for testing/certification such every bit:

Submitting proof of licensure as an RN or NP
Completion of a graduate program accredited past the Accreditation Commission for Midwifery Education (ACME)
Verification by the director of the NM programme confirming all program requirements were met, along with the appointment of completion
Attestation by the manager of the NM programme that the applicant performs at a safe, competent beginner level

Applicants can endeavor the exam 4 times, but all attempts must be within 24 months of program completion. Certification is valid for five years, and the AMCB offers re-certification options.

Certified nurse midwives also must register with their land's Board of Nursing. Some states offering certification simply by applying, if the graduate program meets the state's educational standards. Otherwise, nurses can submit certification obtained through the AMCB. Nurses are encouraged to cheque their country Board of Nursing to identify specific requirements.

Learn more virtually midwifery schools and post master's midwifery graduate certificate programs.

Midwifery FAQs

What Is the Deviation Betwixt a Certified Midwife (CM), Certified Nurse Midwife (CNM) and Certified Professional Midwife (CPM)?

All midwives provide prenatal, labor and delivery, and postnatal care to patients. The major differences can be found in teaching requirements as well as scope of practise.

A Certified Midwife (CM) has obtained his or her certification through the American Midwifery Certification Board (AMCB), has completed an undergraduate degree, and completed required health and scientific discipline courses as office of their Midwifery Plan. It is important to annotation that this private does not take to have an undergraduate degree in a medical specialty but rather has taken courses to fulfill the requirements.

The CM scope of practice includes main healthcare services for women from adolescence through menopause, family planning, prenatal, childbirth, mail-partum intendance, STI prevention/treatment as well as a broad array of education and counseling services. CMs only in certain states have the power to prescribe medications and obtain licensure. This certification is not recognized in some states.

A Certified Nurse Midwife (CNM) has too obtained certification through the AMCB. Ane of the major differences between a CM and CNM is the CNM has completed an undergraduate nursing degree and obtained their RN license. The CNM, similar the CM, has completed the Midwifery Programme. The major difference between the CM and CNM is that in all states, CNMs have the ability to prescribe medications and obtain licensure.

The scope of do of Certified Professional Midwives (CPMs) is narrowed to prenatal, childbirth, postpartum, and half dozen-8 weeks of care for mother and baby following commitment. CPMs do not have whatsoever prescribing abilities in whatever states. However, in some they tin can obtain boosted instruction requirements for medications administration. In more than than one-half of the U.s.a., the CPM can obtain licensure that is regulated past different licensing agencies.

Can Midwives Perform Vacuum-Assisted Births? Forceps Delivery? C-Sections?

While CNMs are trained to handle sure aspects of labor and recognize potential complications, they likewise know when to seek collaboration with an OBGYN MD. For example, complications can ascend such every bit a driblet in fetal center rate or excessive bleeding. The midwife is trained to bring an OBGYN in to manage the situation and perform the necessary interventions that are outside his or her telescopic of practice.

Vacuum-assisted delivery involves using a suction device to guide the baby through the birth canal. This process is done to help avoid a C-department. Every bit with whatsoever medical intervention, there are risks associated with vacuum-assisted births such as minor scalp injuries, skull injuries, hematomas, and hemorrhage. Depending on the land and employer, CNMs can perform vacuum-assisted deliveries if trained and comfy doing so.

Forceps delivery involves using forceps to extract the babe as the mother pushes. As with vacuum-assisted delivery, there are risks involved which include soft tissue harm in both mother and baby, also as lacerations. CNMs can perform forceps commitment if trained to do so, just this ultimately depends on the state and employer.

CNMs are not permitted to perform C-sections. Still, some states and organizations allow nurse midwives to act as kickoff-help during the procedure. This ways they tin help apply pressure to remove the babe, continue the surgical field articulate of blood (via suction and blotting), suturing, and even sometimes closing.

How Does a Women's Health Nurse Practitioner Differ from a Certified Nurse Midwife?

Women's Health Nurse Practitioners are APRNs who specialize in the care of women throughout the lifespan. They focus on reproductive and gynecological health also as preventive health maintenance. Additionally, some can address specific chronic wellness bug. Certified Nurse-Midwives also manage the reproductive health of women, but focus mainly on pregnancy, labor, and childbirth.

The pedagogy for both WHNPs and CNMs is like. Both are advanced-practice nurses who complete either a master'southward degree or higher. However, students may choose either the Women's Wellness runway or the Certified Nurse Midwife runway. While the course of report is similar and may accept overlap, the CNM rails emphasizes labor, childbirth, and the immediate mail service-partum and neonatal menses.

Both WHNPs and CNMs can work in dispensary settings. WHNPs tin can act as a patient's primary care provider. This means that they tin care for patients from an early historic period through the aging years. They tin piece of work in the inpatient setting too, such as in emergency rooms or rounding on patients who are admitted with women's health-related atmospheric condition. They may fifty-fifty work alongside physicians as kickoff-assist during surgical procedures.

In clinics, CNMs educate patients on family unit planning, prenatal wellness, and the labor process. CNMs spend a meaning amount of time in hospitals and nascency centers. They care for patients during the antepartum, intrapartum, and postpartum periods. Additionally, they assess and stabilize a newborn following nascence. They may also intervene/refer during aberrant birth situations, or when a mother or fetus needs more than intensive care.

Do Midwives (CNMs) Demand Malpractice Insurance and How Much Does It Cost?

Equally with any healthcare provider, malpractice cases threaten even the most cautious certified nurse-midwife.

Depending on the organization or facility the CNM is employed, malpractice insurance may or may not be required. Some organizations provide malpractice insurance for their providers, and therefore, additional coverage is not necessary for employment. Even so, many would argue the benefits of conveying additional coverage because employer-paid coverage may non exist adequate in covering fiscal losses, and representation may be lacking in quality.

The toll of malpractice insurance tin can vary. Cost can depend on the state of employment, years of experience, setting, and the coverage chosen. CNMs tend to pay more than the more years of experience they have (more deliveries mean more potential for lawsuits). The cost tin can be equally low as $5,000-$6,000 per year or exceed $20,000 per year. CNMs in a group practice may pay lower rates depending on how many providers they are in practice with. Additionally, some physicians who are engaged in a collaborative agreement with a CNM due to their state's scope of practice laws may even be charged fees past the CNM's malpractice insurance visitor.

CNMs may consider doing further research with the following companies:

Coverys
Contemporary Insurance Services
GeneralStar

What Are Midwife (CNM) Hours Like?

The hours a certified nurse midwife (CNM) works vary depending on the system, facility, or practice group, as well equally their preference. Some tin can work eight-hr days, 40 hours a calendar week in the clinic. Some may work ten or 12-60 minutes shifts in the hospital. Some may work both shifts during a workweek.

Additionally, since childbirth is unpredictable, and babies are non always born during business concern hours, some CNMs may likewise exist on telephone call for 24-hour periods of fourth dimension. A shift could be incredibly decorated with laboring mothers, or an entire shift can become by without one admission. CNMs must too exist prepared to piece of work overnight shifts every bit well.

Because of the variable shifts available, certified nurse midwives should visit the arrangement's website or speak with a manager or HR department earlier applying to talk over scheduling needs. Most facilities are flexible in their scheduling, merely nurse midwives should acquit a little research beforehand.

Can Midwives Evangelize Multiples (Twins, Triplets, Etc)?

While CNMs accept many benefits, many parents-to-exist and even educatee nurses interested in a career as a CNM are curious as to their limitations in the delivery room. For example, are there any situations in which a CNM is not qualified to assist? More than specifically, delivering multiples (twins, triplets, etc.)?

CNM roles and duties are dependent on the land, as each land has its own telescopic of practise laws. Some states allow contained practise while others require an MD nowadays. It as well depends on the facility or system. Some private practices may enable CNMs to manage delivering multiples, while others do non. Larger organizations frequently have specific practice limitations also.

In brusque, from an educational standpoint, a certified nurse-midwife Tin can manage multiple births. The question is if they are restricted by land and organizational regulations. CNMs should bank check with their country board of nursing to make up one's mind their specific telescopic of practice and for any physician oversight/collaborative understanding requirements. Additionally, they should check with their employer to find out if in that location are whatsoever facility-based restrictions. Above all, a CNM needs to experience comfortable asking for assistance when needed.

What Is the Difference Between Midwife (CNM) Led Births and MD Led Births?

Many expecting parents explore the midwife-led birth choice but are concerned as well as curious well-nigh the care they will receive when the fourth dimension comes to give birth. It'due south important to recognize that nurse-midwives are advanced-practice nurses, therefore take more all-encompassing formal didactics and clinical training than registered nurses. They are oft precepted by other nurse-midwives and have physician oversight while in training. A certain number of clinical hours are required to graduate and obtain certification. Rest assured, nurse midwives are well-prepared to care for patients during the prenatal period likewise as the labor and birthing procedure.

The American College of Nurse-Midwives study that midwife-led births resulted in:

Lower Cesarean rates
Lower rates of labor induction
Reduced perineal tears
Lower use of regional anesthesia
Higher breastfeeding rates

In addition to the higher up, births attended to by midwives are enhanced every bit a result of the Midwife Model of Intendance. This model emphasizes monitoring not only the concrete implications of childbirth but the psychological and social well-existence of the patient. Patients also can enjoy individualized education, counseling, and post-partum support.

While midwife-led births are patient-centered and as safe as doc-led births, it should be noted that midwives are trained to recognize potential complications and collaborate with physicians when necessary.

Career and Outlook

According to the Bureau of Labor Statistics, advanced practice nurses, in general, accept a promising job outlook. The field is expected to grow 31% by 2024—much faster than average. Growth is projected to occur due to health care legislation leading to a college number of wellness care consumers, a nationwide physician shortage, and a stronger push for preventive health maintenance.

With babies existence built-in every minute, and with many parents-to-be exploring culling birthing scenarios which don't always involve a traditional infirmary environment, the employment outlook for CNMs in detail remains positive. With the choice to piece of work in a variety of women's health settings, or to take on patients on their own in certain states, CNMs have the opportunity to shape their careers equally they see fit.

Certified Nurse Midwife Responsibilities & Duties

Nurse midwives have a wide variety of responsibilities and duties in the field of women's health. The ACNM lists the cadre competencies in particular that all nurse midwives should demonstrate. Responsibilities include:

Women's health maintenance
- Encouraging preventive health screenings/tests
- Educating on women'south wellness problems such equally sexuality, responsible sexual behaviors, and menopause
- Recognizing and treating gynecological disorders such equally infertility, sexually transmitted diseases and infection, besides every bit urogynecological disorders
Family unit planning
- Educating on bachelor contraception, allowing patients to make informed choices
- Educating, treating, or referring for infertility
- Educating/counseling on unexpected pregnancies
- Educating, counseling, and treating the various concerns surrounding menopause
Antepartum period
- Confirming and dating pregnancy
- Educating on environs, health habits, and nutrition in relation to pregnancy health
- Screening for domestic violence, substance abuse, and high-risk behaviors during pregnancy
- Screening/testing for potential built disabilities with the consent of the mother
- Monitoring fetal development, and recognizing deviations from the normal progress of gestation
Intrapartum flow
- Assessing labor and labor progress
- Monitoring the mother and fetus during labor, and recognizing deviations from normal labor
- Managing complications during labor, including emergencies
- Administering pharmacological and not-pharmacological interventions for pain
- Facilitating labor if needed
- Delivering the newborn
- Performing episiotomies (start and second degree) if needed
- Delivering the placenta
Postpartum care
- Assisting mother with uterine massage after birth
- Educating mothers on physiologic changes that can last until half dozen weeks later birth, including:
  - Potential discomforts
  - Psychosocial coping
  - Lactation
  - Resuming sexual action and contraception
- Recognizing and treating deviations from normal postpartum progress
- Newborn care
  - Facilitating the transition from fetus to newborn, including:
    - Establishing and maintaining newborn respirations
    - Cord clamping
    - Stabilizing the temperature of the newborn
    - Assisting with feeding/latching
    - Promoting bonding and attachment
    - Recognizing deviations from the normal newborn period, and managing complications
  - Evaluation and treatment of the newborn to include
    - Initial concrete assessment (APGAR)
    - Ongoing assessment for well newborns up to twenty-viii days of life
    - Monitoring feeding and weight gain
    - Educating caregivers on normal newborn care
    - Ordering preventive care/screenings such equally:
      - Center ointment
      - Vitamin K injections
      - Hearing tests
    - Intervening or referring for abnormal conditions/situations to include:
      - Built malformations
      - Poor transition to extrauterine life
      - Infection
      - Postpartum depression
      - Stillbirth
      - Multiple-births

Working Atmospheric condition

Nurse midwifery tin exist an enriching, notwithstanding challenging career. A typical work setting for nurse midwives includes:

Developing an emotional involvement with patients. Nurse midwives must interact closely with women and families. They must work hard to educate patients on common women'southward wellness issues and monitor them through the life bridge which can include births, but also terminate-of-life care. This leads to close caregiver/patient relationships that are valued both past the midwife besides as the patient.
Potential occupational hazards. As with any profession in wellness intendance, nurse midwives are exposed to bloodborne pathogens, infectious diseases, and other possible contaminates. They must always do safely and use personal protective equipment when providing patient care during a loftier-take a chance process.
Occasional loftier-stress situations. Nurse midwives are sometimes faced with busy, stressful shifts that can include emergencies. They need to be able to work well under pressure and think and human activity quickly while maintaining prophylactic. They should also take an adequate support arrangement to assistance them cope with the stress and emotions many caregivers experience.
Remaining aware of legalities/scope of practise concerns. Nurses, peculiarly advanced-do nurses, must be conscientious and accurate in their work. Medical errors can cause harm or even the death of patients. They need to be up to date on standards of care and exercise, technology, and safe practices. Dwelling births tin isolate mothers from quick emergency care, so nurse midwives that assist in home births need to have a programme in place to safely deliver newborns in the home-based setting. Conveying malpractice insurance is highly recommended for health intendance providers, especially avant-garde practitioners.

Salary and Employment

According to Payscale, nurse midwives earn a median salary of $90,672 annually. This tin vary depending on land/city of residence, type of employer, and caste held.

Co-ordinate to the ACNM, certified nurse midwives and certified midwives (not-nurses) attended 332,107 births in 2014, which accounted for 8.3% of total births in the U.S. While this percentage may non seem like much, certified nurse midwives accounted for more than 90% of midwife-assisted births. Additionally, the charge per unit of midwife-assisted births has risen every yr since 1989.

United states with the highest employment of nurse midwives according to the Bureau of Labor Statistics are:

California
New York
Georgia
Massachusetts
Maryland

Become more precise details of a midwife salary.

Helpful Organizations, Societies, & Agencies

American Higher of Nurse-Midwives
National Association of Certified Professional Midwives
North American Registry of Midwives
Midwifery Today
American Midwifery Certification Board

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Source: https://www.registerednursing.org/nurse-midwife/