Nurse-Midwifery Program Offers Flexibility and Direction

The History and Role of Midwives

Nurse Midwife Program Offers Flexibility and Direction

Since the Paleolithic Era (40,000 BCE), cultures all over the world have utilized the skills and knowledge of midwives. Early midwives began by observing other birthing mammals. Even today, midwives, including certified nurse midwives, are recognized around the world as responsible, accountable professionals trained to provide care and support through pregnancy, labor and delivery, postpartum, and beyond. 

In the United States, midwifery has changed considerably since early colonial times. Up to the 1930s, midwives attended most births in the U.S. This was the norm until laboring mothers began moving from the home to the hospital, where physicians typically attended the births.

Today, midwives are regaining popularity among American mothers. In 2019, Certified Nurse Midwives (CNMs) and Certified Midwives (CMs) attended 10.3% of all U.S. births. 

Related: Women’s Reproductive Health Issues in the Face of Changing Legislation 

There are multiple types of midwives with several routes of entry into the profession. These include CNMs, CMs, Certified Professional Midwives (CPMs), and traditional or lay midwives.  

Certified nurse midwives 

CNMs enter the profession through the field of nursing. They attend a training program through an accredited university and earn a master’s degree in nursing with a specialty in nurse-midwifery.  

Training occurs primarily in a medical setting, often a hospital. CNM’s experience and licensure allow them to practice in any birth setting, including homes, birth centers, and hospitals. They are the only type of midwife that is legally licensed in all 50 states, the District of Columbia, and all U.S. territories. 

Direct entry midwives 

Direct entry midwives, on the other hand, do not have a nursing background. They are classified as CMs or CPMs. Certified Midwives typically enter the field through a healthcare degree in an area other than nursing. However, they do earn a master’s degree in midwifery through an accredited university program.  

CMs also pass the same national certification exam as CNMs, which is administered by the American Midwifery Certification Board. However, CMs are currently only licensed in 9 states and the District of Columbia.  

Conversely, CPMs do not necessarily have an academic degree. Instead, they receive their education and clinical training through an accredited midwifery program or through the clinical hours of a hands-on apprenticeship program. They typically provide care in an out-of-hospital setting like a home or birth center. They are currently licensed in 35 states and the District of Columbia.  

Lay midwives 

Additionally, there are traditional midwives, or lay midwives, that may not be licensed or certified but are often apprentice trained and are committed to providing care in their communities.  

Certified nurse midwives in the United States 

Most midwives in the U.S. are CNMs. As of February 2022, there are 13,524 CNMs and CMs working in the United States. In 2019, 89% of CNMs/CMs attended births in hospitals, 9% at freestanding birth centers, and 8% attended births in homes.  

While midwives are well known for attending births, the scope of CNM practice continues to grow. 

A midwife’s scope of practice 

Commonly, and falsely, perceived as old-fashioned, untrained workers who attend home births for those who want a natural birth, midwives are much more than that. Midwives hold a wealth of knowledge in maternal health, obstetric care, and well-woman care.  

As independent practitioners, CNMs manage pregnancy, childbirth, and the postpartum period. They help care for healthy newborns in the first 28 days of life. They manage sexual and reproductive health, assist in family planning and preconception care, address menopausal concerns, and provide gynecological and primary care needs to individuals from adolescence across the lifespan.  

Midwifery, as practiced by CNMs, includes the ability to assess, diagnose, and provide treatment for a wide range of conditions. They can prescribe medications, admit and discharge patients from the hospital, order and interpret laboratory and diagnostic tests, and care for high-risk individuals and pregnancies, among other things. Midwives provide care to all individuals, all gender identities, and all sexual orientations. 

Accessible, quality care for all 

Nurse-midwives pride themselves on providing ethical, accessible, quality health care to all individuals while respecting human dignity and diversity. Through presence and skillful communication, they are known to offer individualized support and deliver complete and accurate information to help patients make an informed decision as an active participant in their care.  

Unfortunately, not all midwives can legally practice to the full extent of their education and training since individual states regulate their scope of practice differently. Though licensure and midwifery laws vary throughout the U.S., national standards and state laws maintain the regulation of nurse-midwifery practice, as what once was a simple trade continues to develop into an expanding and thriving profession. 

By Shawn Pompa, MSN, APRN, CNM