Socalbirth | Schools and Training

Becoming a Midwife

Miracle Birth

Discover pathways into the midwifery profession, learn about licensure and certification, training opportunities and explore programs of study.

SCHOOLS AND TRAINING

Nurse-Midwifery | Direct-Entry Midwifery

There are two types of midwives in the United States: Nurse Midwives and Direct-Entry Midwives. The roads into each type of midwifery differ. There are many things you must consider before deciding the route which is best for you. The following may help you make a decision.

NURSE-MIDWIFERY

Nurse-Midwives are trained in both disciplines of nursing and midwifery.

Degree Required:

CNMs are Registered Nurses who have obtained Masters of Science (MSN) Degrees with an emphasis in Nurse-Midwifery/Women’s Health.

Place of Practice:

Nurse-Midwives work in hospitals, clinics, birth centers and homebirths. Few hospitals employ nurse-midwives. Some CNMs work doing prenatal care and well woman gynecology in clinic settings and do not deliver babies.

Certification:

American College of Nurse Midwives

Legality and Licensure:

CNMs can practice in all 50 states. The regulating body is the Board of Registered Nursing (BRN). The American College of Nurse Midwives (ACNM) administers the examination for Certification.

Minimum Requirements for Entry into Nurse-Midwifery Education:

A Registered Nurse license is required before admission to Nurse Midwifery program. Programs vary in terms of the minimum degree requirements. Some programs only require a Associates Degree in Nursing (ADN) where other programs require a Bachelor’s Degree in Nursing (BSN). Nursing programs require pre-requisite science coursework in Anatomy, Physiology, Chemistry, Microbiology and general education in social sciences, English, etc.

There are Accelerated Bachelor Degrees in Nursing Programs which allow persons with a Bachelors Degree in a non-nursing subject to obtain a second Bachelors in Nursing. These are accelerated, intense 3 year programs leading to a BSN and RN licensure.

There are “bridge” programs which allow a Licensed Vocational Nurse (LVN) to obtain a BSN and/or a MSN (in Nurse Midwifery) as well.

There are also Masters-Entry Level Nursing Programs which allow persons with a Bachelors in a non-nursing subject to obtain a RN in year 1 and a MSN with a concentration in Nurse-Midwifery/Women’s Health in years 2 and 3. In California, there is only one Masters Entry Level Program with an emphasis in Nurse-Midwifery; it’s at University of California at San Francisco (UCSF).

As Nurse-Midwifery programs are master’s level, coursework in statistics, the Graduate Records Exam (GRE) and a thesis are required.

Post-Masters Certificates are also available if the student already has a Master’s degree in another subject.

Type of Learning Environment:

Nurse-Midwifery education is either traditional, on-campus university program or distance learning. Two programs for distance learning are Philadelphia University and Frontier Nursing University (formerly Frontier School of Nursing), which allow students to remain in their own community and learn though a combination of on-site and virtual classrooms. Clinical training is arranged by a Nurse-Midwife instructor in the students community. Traditional financial aid is available (federally subsidized loans, grants) and scholarships are also available for CNMs willing to work in under-served communities while a student and after graduation.

Nurse-Midwifery students obtain supervised clinical experience through a university or charity hospital nurse-midwifery practice, and/or with a Nurse-Midwife preceptor in clinics, hospitals and/or out of hospital environments. There are minimum required numbers of prenatal visits, labor managements, newborn exams, well woman gynecology visits to obtain before graduation. Programs are usually 2 years in length. At the end of the program, students must write and publish a master’s thesis and take the ACNM board exam for licensure.

Estimated Salary:

Depends on place of practice. Hospital Nurse-Midwives can make $70-90,000.00 annually. Homebirth or birth center midwives will make as much as their volume allows.

Barriers to Practice

The primary barriers to practice are:

CNMs are not employed by all hospitals. Only 6-7% of US births are with Nurse-Midwives.
Because few hospitals employ nurse-midwives, many do not deliver babies, and instead do prenatal care and well woman gynecology in clinics.
Most CNMs are unable to obtain independent hospital privileges to admit their own patients. This means they must do out-of-hospital birth or work at prenatal and family planning clinics.
CNMs doing homebirth or birth center may have difficulty obtaining physician back up and malpractice insurance.

Educational Programs

Go to: Nurse-Midwifery Education

DIRECT-ENTRY MIDWIFERY

Direct Entry Midwives enter the profession directly without first becoming nurses. National certification is available (Certified Professional Midwives-CPMs) and state licensure (Licensed Midwives-LMs) is also available in some states, including California. About 1% of U.S. births are attended by direct-entry midwives.

Degree Required:

A high school diploma is the minimum requirement for entry into midwifery schools leading to the Certified Professional Midwife credential.

Place of Practice:

Certified Professional Midwives and Licensed Midwives work in birth centers and do homebirths, and increasingly, also in clinics. They do not have hospital privileges at this time.

Certification:

North American Registry of Midwives provides a pathway to become a Certified Professional Midwife (CPM).

Legality and Licensure:

Legality of non-nurse midwifery varies from state to state. To check that status of midwifery state by state, go to: MANA’s State Chart . In California, CPMs may take the licensing examination to become Licensed Midwives (LMs). The regulating body is the California Medical Board Division of Midwifery Licensinglocated in Sacramento, CA. Telephone: 916-263-2393.

Minimum Requirements for Entry into Direct-Entry Midwifery Education:

A high school diploma is the minimum requirement for most programs.

Type of Learning Environment:

With few exceptions, Direct-Entry midwifery education is not university based and does not lead to a traditional degree (i.e., Associates, Bachelors, Masters). There is only one university-based direct-entry midwifery program leading to a traditional degree in Seattle, Washington at Bastyr University (formerly Seattle Midwifery School). National College of Midwifery, based in Santa Fe, New Mexico offers Associates, Bachelors, Masters and Doctoral degrees in Midwifery through a distance-learning format.

Direct-Entry Midwifery Education is usually a combination of academic distance learning and supervised clinical training (apprenticeship). Students are trained by midwife-preceptors in out of hospital settings; either the students’ communities or the midwives’. Please note: in California, apprenticeship is no longer allowed. Students must be enrolled in a California Medical Board approved midwifery school. Midwife-preceptors must be officially approved by the school. In California, it is not acceptable for an individual midwife to provide supervised clinical training (“apprenticeship”) to one or many students, unless they are officially enrolled in an approved midwifery school. In addition the preceptor must be physically present at all times when the student is conducting care of clients, and the student’s status must be made known to the client. For more information, see The California business and professional code 2505-2521 governing Licensed Midwifery. See also: Summary of The Midwifery Licensing Act of 1993

Some direct-entry midwifery education programs may require college courses in Anatomy and Physiology, but in general, the science requirements are not as rigorous as Nurse-Midwifery programs.

Traditional financial aid is not available for most programs.

Clinical training is obtained through out-of-hospital midwifery practices, though there are high volume birth centers out of state and country as well that allow for total immersion into midwifery practice.

To obtain required experiences for certification and licensure in a short period of time, (between 3 months and 1 year) students train under supervision of midwife instructors. Most educational Programs are 3 years in length, with an additional 1-2 years in some cases, depending upon the time it takes for the student to obtain required clinical experiences (prenatal visits, labor managements, newborn exams, etc.). Once the student has met all academic and clinical requirements, they may take state licensing exams to become a LM and/or the NARM certification exam to become a CPM.

California Challenge Program

Midwives who are CPMs may apply for the California License by entering the California Challenge Process. This mechanism allows midwives who did not graduate from an approved midwifery program to sit for the licensing exam. An applicant who graduated from a midwifery school must ask the school to submit paperwork to be verified by The Medical Board. If the school is no longer in operation, the student must provide sufficient documentation to validate graduation from the program. Students pursuing the license through the Challenge Process must be enrolled in an approved midwifery school while obtaining required experiences in the State of California. If they are not enrolled in a midwifery school, they must go out of state to obtain clinical experiences. Apprenticeship is no longer a legal educational pathway in California, according to The California Medical Board.

Estimated Salary:

Depends on place of practice. Fees for homebirth services vary from region to region. Homebirth or birth center midwives will make as much as their volume of births monthly allows and the rate of compensation for homebirth in their community. In Los Angeles in 2011, the average homebirth is $4000. Insurance reimbursement is limited to PPO. Medi-Cal and HMO plans do not reimburse LMs in California who do out of hospital birth at this time, though LMs are working in Medi-Cal clinics doing prenatal and gynecology care and are approved Medi-Cal providers. Lack of insurance reimbursement plays a limiting role in the number of people who can afford homebirth.

Barriers to Practice

There are numerous barriers to practice. They include the following:

CPMs are not legally recognized in all 50 states.
Licensure is available on a state by state basis. If the midwife moves to a new state, she must take the licensing exam in that state. California licenses are reciprocal in Florida and Washington.
Malpractice insurance is not readily available, and is expensive, usually more than a homebirth midwife can afford.
LMs do not have privileges for prescribing medications. This is a barrier for LMs working in clinics.
LMs have not yet obtained hospital privileges and as they are not nurses, it is unlikely they will any time soon. This means their practices are limited to homebirth, birth center and clinic practice.
Most LMs do not have training in well-woman gynecology and family planning (distinct from Nurse-Midwives who obtain more training in this area) this limits the practice to prenatal care and births.
In some states they are not able to be paid through Medi-Caid.
Some insurance plans reimburse LMs, but most will not pay CPMs unless they are also liscensed.
In some communities LMs have difficulty finding physician supervision and/or consultation which is required by law and is necessary to ensure safe homebirth.
In some states LMs cannot sign birth certificates or disability forms.
Most LMs are on-call 24 hours a day/7 days a week, rather than shift work which is available as a hospital based midwife. They have their own independent practices, thus income may fluctuate greatly.
Society still has many misconceptions about homebirth and midwives which may be problematic in a bad birth outcome.