Points to consider if you want to become a midwife
Which kind of midwife should you become?
need to consider how much education you want, what setting(s) you want
to practice in, what state(s) you might want to live and practice in,
and what income level is important to you, because these factors differ
pretty much along the lines of the two categories of midwives. We
recommend that you interview several different kinds of midwives with
different practices before making a decision.
Setting: Are you interested in practicing in the hospital setting or primarily out-of-hospital?
practice mainly in medical settings and in almost every state are
required to have some kind of agreement with a physician in order to
practice (which means your work situation is dependent on the physician
letting you practice, even though you may both be competing for the
same clients/patients). However, since CNMs are trained as advanced
practice nurses, and are under "doctor supervision" they can "do" more
in terms of using drugs for pain relief, some kinds of well-woman care,
even in some instances assisting at cesarean births, depending on the
state and the physician they work with/for. Fewer than 2% of CNMs
attend home births; in some states quite a few CNMs work in birth
Direct entry midwives also usually are
able to spend much more time with women during prenatal care visits and
usually stay with the birthing woman throughout labor and delivery.
While some CNMs are able to practice like direct entry midwives, most
are limited by hospital and doctor policies, and busy practices,
sometimes mandated by HMOs, may mean the CNM just comes in to catch the
baby and is not able to provide the continuous hands-on care we
associate with the Midwives Model of Care.
contrast, almost all direct entry midwives attend births in homes or in
free-standing birth centers, although a very few licensed midwives are
now getting hospital privileges or hospital employment. What direct
entry midwives are legally able to do in terms of drugs and minor
interventions depends on each individual state law. On the other hand,
direct entry midwives are generally much freer to use alternative
methods including homeopathic, herbs, massage and imagery for pain
relief and encouragement of labor
Education and accredited programs
terms of education, while in the past a baccalaureate degree was not
required to become a CNM, the trend is toward requiring this degree,
and moving toward requiring a Masters Degree. For example, even now to
practice as a CNM in Oregon, you must have a Bachelors Degree, even if
you already got your CNM credential without that degree. The American College of Nurse Midwives
has made it quite clear that they are moving toward all their midwife
programs eventually requiring a Masters; they are already phasing out
programs that did not require a Bachelors.
ACNM's Department of Accreditation accredits nurse-midwifery programs.
For more information about direct entry midwifery education programs,
especially those accredited by MEAC, email MEAC or call 928-214-0997.
The Certified Professional Midwife
credential, by contrast, is not degree-oriented or program-based. A
college degree is not required, and the emphasis is on what you know
rather than how you learned it. The rigorous credentialing process
validates that you have all the knowledge, skills and experience
necessary to practice as an entry level midwife, as determined by a
comprehensive task analysis involving hundreds of midwives encompassing
the full range of midwifery from CNMs to apprentice-trained rural
midwives. The CPM credential is available to any kind of midwife,
including CNMs, who meet the requirements.
Direct entry midwifery programs increasingly are being accredited by the Midwifery Education Accreditation Council (MEAC)
a federally recognized accrediting agency, which as of January 2004 has
accredited or pre-accredited nine programs located in 11 states
(Arkansas, Florida, Maine, New Mexico, Oregon, Texas, Utah, Vermont and
Washington). All include a structured curriculum, mostly in formal
classroom settings, as well as apprenticeship elements ("one on one
learning by experience with a mentor having a significant relationship
with a student"). Pre-accredited programs have met all requirements for
accreditation except that they do not yet have the required number of
graduates who are certified or licensed. For more information about
direct entry midwifery education programs, especially those accredited
by MEAC, email MEAC or call 928-214-0997.
this time you can become a midwife and qualify for CPM certification
without completing a MEAC-accredited program. Ask actively practicing
direct entry midwives for their suggestions on how to go about becoming
a midwife. For example, many start out being childbirth educators or
doulas first, and there is also a lot of "book learning" you can do
even before you are in a position to actually apprentice or go to a
Some midwives end up with combined
training - they either started out as direct entry midwives, but at
some point went back to school to become a CNM in order to practice
legally, or for income or job security, or to be able to serve more and
higher risk women, or for some other reason. So they are CNMs but
retain their direct entry midwife orientation. Alternatively, other
women become CNMs, but wanting to acquire a less medicalized fear-based
approach to birth, subsequently work with direct entry midwives in an
for a CNM ranges from around $30,000 to $80,000, depending on where she
practices and what she does. The higher income brackets include CNMs
with management positions in urban hospitals, and CNMs in teaching
positions in nurse-midwifery programs. For DEMs the income range
generally is lower, and depends on factors like the location (urban or
rural), which state (legal or not, insurance coverage or not), and how
many births a DEM does in a given period of time.
consideration is whether you want to work for someone else or have your
own practice (ie, your own business). Almost all direct entry midwives
have their own businesses; the majority of nurse-midwives are employees
of hospitals or doctors or birth centers and even those in private
practice must of necessity be closely aligned with one or more doctor
practices - relatively few are entrepreneurs in the way that most
direct entry midwives are. Being an employee often means regular hours,
vacations and employee benefits. Being self-employed can mean longer
and more unpredictable hours, but also more flexibility. Either way is
likely to affect the kind of care you are able to offer to your clients.
On the CfM web page is a Legal Status Chart
showing the legal status of direct entry midwives in every state.
Direct entry midwives practice in all states, but are vulnerable to
investigation and arrest in those states with no functional regulatory
While CNMs are legal in all states, the need
for doctor collaboration or practice agreements means most CNMs are
vulnerable to the ability of doctors to terminate or refuse to
participate in practice agreements with midwives, and their ability to
influence hospitals to refuse privileges to midwives (who in many cases
are competing for the same clients as the doctors are).
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