Educational Pathways for Midwives

January 18, 2022

Midwives are essential part of health care system around the world. They provide exceptional services not only to the mothers and the babies during pregnancy, but also educate them to be better parents. Midwifery degree is one of the most intense courses both mentally and academically. As midwives, we go through years of college and post graduate education and clinical training. We learn a lot about women’s bodies and supporting the natural processes of puberty through menopause, of everything childbearing and breastfeeding. We learn to provide excellent midwifery care – the science and the art of it. We learn prevention and management of complications and emergencies, and to collaborate or refer to a physician, when we are presented with situations beyond our broad scope of practice.

Planning to become a midwife? Do you have passionate pursuit over midwifery? In this article we will talk about the different educational pathways for Midwives. Let me walk you through the overview on the journey to your midwifery career.

Pathways to Midwifery Education

Per the ACNM position statement, Mandatory Degree Requirements for Entry into Midwifery Practice, a graduate degree is required for entry into midwifery practice. All midwifery education programs accredited by the Accreditation Commission for Midwifery Education (ACME) provide the necessary education for graduates to be eligible to take the examination offered by the American Midwifery Certification Board (AMCB) and become Certified Nurse-Midwives; in addition, two of the education programs provide the necessary education for graduates to be eligible to take the AMCB examination and become Certified Midwives. For a list of all the ACME-accredited midwifery education programs.

The following options may be available at the education program:

Baccalaureate degree (BA/BS) to RN and CNM/Graduate option

Typically a 3 year program commonly referred to as “graduate entry” or “direct entry” which provides nursing + midwifery education to the Bachelor’s-prepared applicant.

Diploma or associates degree (AD) RN to CNM/Graduate option

often referred to as a “bridge” program which provides a BS degree to the RN and then graduate education in midwifery.

Fully Distance option

the student does every part of the curricula study plan online, at a distance. All clinical learning experiences are in-person.

Partially Distance option

Options for some web based courses that are done at a distance and some campus based courses done on location.

DNP option

Doctor of Nursing Practice, either Post-MS Degree or direct from BS to DNP.

Post Graduate certificate option

For those graduate-prepared APRNs who want to add midwifery to their scope of practice

Graduate Completion option

For the certificate-prepared midwife who wants to add graduate education

Certified Midwife option

Graduate midwifery education for the Bachelor’s-prepared applicant. Basic health-related prerequisite courses are required. The graduate midwife is eligible to take the same national certification examination administered by the American Midwifery Certification Board as the graduate nurse-midwife. CMs are currently authorized to practice in 6 states: Delaware, Hawaii, Maine, New Jersey, New York, and Rhode Island. Several other states are currently pursuing licensure of CMs.

Routes of Entry into Midwifery

In the United States there are several pathways to midwifery education and training. Most pathways result in midwifery certification and qualify the candidate for licensing in her/his state or municipality. Candidates seeking to become certified and licensed midwives can choose among several routes of entry into the profession using nurse-midwifery or direct-entry midwifery educational programs. The most common types of midwives are listed below, including the three types of credentialed U.S. midwives, Certified Professional Midwives (CPM), Certified Nurse-Midwives (CNM), and Certified Midwives (CM).

Professional Midwives

Certified Nurse-Midwife (CNM) CNMs practice in hospitals and medical clinics and may also deliver babies in birthing centers and attend at-home births. Some work with academic institutions as professors. They are able to prescribe medications, treatments, and medical devices, therapeutic and diagnostic measures. CNMs are able to provide medical care to women from puberty through menopause, including care for their newborn (neonatology), antepartum, and intrapartum, postpartum and nonsurgical gynecological care.

· Certified Nurse-Midwife (CNM): CNM programs are graduate level programs that are only open to licensed RNs who already hold a bachelor’s degree (preferably in nursing). CNM programs grant a master’s or graduate degree. They take a minimum of 24 months to complete. After completion of an accredited CNM program, CNM candidates need to confirm that their graduate program is accredited by the Accreditation Commission for Midwifery Education (ACME) and then pass the national qualifying exam from the American Midwifery Certification Board (AMCB). AMCB is the only organization in the U.S. that issues CNM credentials.

Direct-Entry Midwife (DEM):A direct-entry midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, a college, or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings. Licensed Midwives (LM) and Registered Midwives (RM) are examples of direct-entry midwives.

· Certified Midwife (CM): The Certified Midwife (CM) credential was created to allow individuals with an undergraduate degree in a discipline other than nursing to obtain a graduate degree in midwifery and then practice as a midwife. They are trained and certified according to the requirements of the American College of Nurse-Midwives, take the same certification exam, and have the same scope of practice as CNMs. To date, only a few states have recognized the CM credential: NY, NJ, DE, ME, MO, and RI.

· Certified Professional Midwife (CPM): A Certified Professional Midwife’s (CPM) competency is established through training, education and supervised clinical experience appropriate for midwives who practice “The Midwives Model of Care” predominately in out-of-hospital settings. CPMs can train through an apprenticeship with a qualified midwife or by attending a midwifery program or school. Graduates of MEAC accredited schools are qualified to take the NARM written exam. All others must complete an Entry-Level Portfolio Evolution Process (PEP). The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.

Traditional Midwives

In addition, there are midwives who—for religious, personal, and philosophical reasons—choose not to become certified or licensed. Typically they are called traditional or community-based midwives. They believe that they are ultimately accountable to the communities they serve; or that midwifery is a social contract between the midwife and client/patient, and should not be legislated at all; or that women have a right to choose qualified care providers regardless of their legal status.

Resources for Becoming a Midwife

For Certified Professional Midwife (CPM)

· Midwifery Education Accreditation Council (MEAC)

· North American Registry of Midwives (NARM)

For Certified Nurse-Midwife (CNM) or Certified Midwife (CM)

· American College of Nurse-Midwives (ACNM)

· American Midwifery Certification Board (AMCB)

· Accreditation Commission for Midwifery Education (ACME)

Additional Resources

· International Center for Traditional Midwives (ICTC, Black Midwives and Healers)

Now that you experienced a glimpse of the possible options you have for your journey to midwifery, it is your duty to decide. But before doing so, I want to invite you to watch a video in the links provided about educational pathway discussion with Hilary Schlinger. Hilary Schlinger, CNM, has over 40yrs experience with midwifery and educational paths available for midwives. She started as a Direct Entry Midwife, then became a Certified Professional Midwife, and then transitioned into a Certified Nurse Midwife. She has ran midwifery educational programs and working on some amazing national projects. We both have great home birth online education courses we compare as well. Her knowledge and tips will inspire you!

You Tube Links for Educational Paths to Midwifery:

https://www.youtube.com/watch?v=rPuw0Xysuf0 https://www.youtube.com/watch?v=7a4Qeg36BaY

https://portal.midwife.org/education/education-pathway?reload=timezone https://mana.org/resources/become-a-midwife https://www.nationalmidwiferyinstitute.com/direct-entry-midwifery