The term midwife is used frivolously in today's American society. When one refers to a midwife, most often it is thought of as someone who provides out of hospital care to a mother and her child. Unfortunately, many are not aware of the differences among the various types of midwives found in the US today. There is quite the variety of midwives in the US today - Certified Nurse Midwives, Certified Midwives, Certified Professional Midwives, Licensed Midwives, and Direct Entry Midwives. A CNM and CM are quite similar with the only real difference being a CNM is required to hold a nursing degree and a degree in midwifery, whereas the CM is only required to hold a midwifery degree (both on the master's level). CPMs, LMs, and DEMs are quite similar as well, with the main differences being the legal status which varies state to state, licensing status which also varies, as well as the mode of education. Traditional midwives (CPM, DEM, LM) often learn through various methods of education such as traditional school of midwifery, distance learning, or by an apprenticeship. While all are referred to as midwives, there is a vast degree of educational standards separating them.
The two most well-known credentials are Certified Nurse Midwife, and Certified Professional Midwife. The educational differences between these two credentials are extreme.
A Certified Nurse Midwife (CNM) is educated in both nursing and in midwifery, and must prove competency and evidence of certification through the American College of Nurse-Midwives. They of course must have a high school diploma or GED, and must obtain a bachelor's degree in nursing, followed by a master’s degree in nurse-midwifery. A license is required. The CNM credential is recognized in each and every state.
A Certified Professional Midwife (CPM) is an independent midwife who must meet the standards of certification set forth by the North America Registry of Midwives. CPMs are not required to have a high school diploma or a GED for their traditional education or apprenticeship training routes. Some states require a license, others do not. Practicing midwifery as a CPM is illegal in many states.
Here is an example taken from the University of South Carolina and East Carolina University. USC is an associates degree in nursing and ECU is a masters in nurse-midwifery.
The only pre-requisite for the nursing program is a high school diploma with 2.5 GAP or GED, and acceptable ACT/SAT scores. I picked these two schools because they are the schools am most familiar with. I'm currently enrolled in USC as a nursing student and plan to complete my MSN at ECU in the future.
The only pre-requisite for the nursing program is a high school diploma with 2.5 GAP or GED, and acceptable ACT/SAT scores. I picked these two schools because they are the schools am most familiar with. I'm currently enrolled in USC as a nursing student and plan to complete my MSN at ECU in the future.
Bachelor's Degree in Nursing - University of South Carolina
General Education Requirements
- English Composition
- Composition & Rhetoric
- Introduction to Descriptive Statistics
- Elementary Statistics
- Introduction to Psychology
- Introduction to Sociology
- Introduction to Organic & Biochemistry
- Human Anatomy & Physiology I
- Human Anatomy & Physiology II
- Microbiology
- 1 History Elective
- 1 Fine Art Elective
- 1 General Elective
- Facilitative Communications
- Evolution of Nursing Sciences
- Clinical Nutrition
- Foundations of Community Health
- Socio-Cultural Variations
- Biophysical Pathology
Upper Level Nursing Classes
- Introduction to Health Assessment
- Foundations of Nursing Practice
- Clinical Reasoning
- Chemical Therapeutics
- Nursing Care of The Older Adult
- Evidence Based Nursing Practice
- Psychiatric/Mental Health Nursing
- Acute Care Nursing of Adults I
- Acute Care Nursing of Adults II
- Policies & Politics
- Maternity/Newborn Nursing
- Nursing of Children and Families
- Nursing Leadership
- Community Health Nursing
- Adult Health Nursing Preceptorship
- Nursing Leadership & Management Preceptorship
- 2 Nursing Electives
Master’s Degree in Nurse-Midwifery - Frontier Nursing University
- History of Nurse-Midwifery
- Pathophysiology
- Nursing Theory
- Decision Making
- Reproductive Physiology
- Research in Nurse-Midwifery
- Health Care Promotion
- Pharmacology
- Primary Care I
- Antepartum Care
- Postpartum/Newborn Care
- Community Assessment
- Intrapartum Care Women’s Health
- Market Research
- Advanced Antepartum
- Advanced Intrapartum
- Advanced Postpartum/Newborn
- Advanced Women’s Health
- Skills for a Primary Caregiver
- Nurse-Midwifery Clinical I
- Nurse-Midwifery Clinical II
- Nurse-Midwifery Clinical III
- Skills for a Nurse-Midwife
- Health Policy
- Nurse-Midwifery Clinical IV
The requirements are at least a 2.5, or “C” average in all general education requirements, and a 3.0, or “B” average in all lower level, upper level, and graduate level nursing classes. Tests are given on campus, graded, and may not be retaken if failed. Classes may only be retaken twice to obtain at least the required “C” or “B”. If the student does not satisfy the requirements for a particular class after two attempts, the student is removed from the nursing/nurse-midwifery program and not eligible to be readmitted.
It will take me approximately 7 years to complete all of the qualifications to become a Certified Nurse-Midwife.
Certified Professional Midwife Training & Certification
Here is an example of one CPM (Certified Professional Midwife) educational program that is designed to prepare a woman to sit for the NARM exam - an exam that grants the CPM credential. The program is entitled “Midwife To Be” and is a program created by a CPM from South Carolina. I was in the Midwife To Be program for 8 months before changing my direction. The program is not accredited, therefore the applicant must also complete what is known as the NARM PEP process before she is eligible to sit for the NARM exam. There are no pre-requisites for the Midwife To Be program. You do not have to have a high school diploma or GED, nor do you have to have completed any general education requirements of have taken the SAT or ACT.
The Midwife To Be program is a completely distance learning program. It is self-paced, and can be completed in as little as a few weeks if done extremely quickly, or as long as 60 years if so desired. These qualities make the MTB program very popular among potential midwives due to the flexible nature of the program. The program is broken down into 30 units, each with a different theme.
The following is a list of unit titles:
The following is a list of unit titles:
- Anatomy & Medical Terminology
- Physiology
- Fetal & Placental Development
- Lab Work
- Nutrition I and II
- Drugs and Interventions
- Childbirth Education
- Communication & Counseling
- Prenatal Care
- Risk Factors & Refferals
- Prenatal Discomforts
- Prenatal Complications I, II, III
- Labor & Delivery I, II
- Pelvimetry & Fetal Position
- Labor Support
- Birth Complications I, II, III
- Hospital Transports
- Postpartum Normal I, II
- Breastfeeding
- Postpartum Complications
- Newborn Normal
- Newborn Complications
This list may appear extensive, however if you look at the breakdown of what each unit includes, it is quite subpar. For each unit, a reading assignment in each of the four textbooks is given. This is typically around 100-200 pages total. The textbooks for the Midwife To Be program are: Holistic Midwife, Varney’s Midwifery, Birth Emergency Skills Training, and the Practical Skills Guide. The reading comes from the first four, and the necessary skills to learn come from the Practical Skills Guide. No test is given over the textbook reading – proof of comprehension is not required. There are several “Skills To Master” for each unit as well. These come from the Practical Skills Guide and range from how to glove and un-glove, to how to find fetal heart tones, and many other practices. The method by which you learn these skills is self-study (can include practicing on a study buddy, looking at videos on youtube, reading, ect). No testing is required of the skills during training. You must read and complete a short form book report on two books for each unit as well. A test is given on each book read (though not on textbooks). The test is over the content of the book and is taken online on the ‘honors system’. Books to be read, reported, and tested on range from “Spiritual Midwifery”, “The Bradley Book”, “Easing Labor Pain”, “The Baby Book”, “The Cooperative Method of Natural Birthcontrol”, and many more. I am actually unsure of what happens if you do not pass a test because I passed all of the tests I did take and the course outline doesn’t inform you of what happens if you do not pass a test. The tests are graded, but there is no GPA or educational standards to uphold. The course outline did not mention what a passing grade was. There are no formal classes, no teleclasses, no online lectures - no true teaching at all. There are skills weekends held in the creator's home which allow students to come together, learn in person, ask questions, and practice skills. Finally, each unit has a project to be completed. These projects include things such as researching your state’s PKU or vaccination laws, touring a local lab, and doing a homebirth community outreach project. The projects are not graded, and are for the student’s own reference and not turned in.
Each until also requires 40 hours of study time that must be logged. 34 of those hours are ‘study hours’ and 6 of those hours are ‘clinical hours’. Required hours include things like researching articles, doula work, watching youtube videos on birth and birth related procedures, and doing the reading assignments and test taking.
According to the instructor, the clinical hours,
“Clinical hours will be done as you can, and can include births, prenatal visits, postpartum visits, volunteering in Labor & Delivery, volunteering in Free, Medicaid and other prenatal clinics, EMT class (great to take in addition to other studies, Doula work, etc. Be creative…help out a local midwife or childbirth instructor to get your foot in the door. Take extra classes at the community college that will help (anatomy, record keeping, blood draw etc). You will have to piece your training together as other midwives before you have done.”
Because the Midwife To Be program is not accredited (and many are not – it is not at all uncommon), an applicant seeking to take the NARM exam for CPM credential must follow the NARM PEP process. Basically, this is an apprenticeship program.
The requirements are as follows:
The requirements are as follows:
- Complete an educational program geared towards CPM training
- Prove certification in neonatal resuscitation and infant CPR
- Have a skills assessment done by a preceptor (the midwife in which the student is apprenticing under)
- Have a second skills assessment done by another midwife
- Construct an informed consent document, practice guidelines, and an emergency care form
- Have three letters of personal reference
- Attend 20 births as an active participant (assistant).
- Document the following done under a senior midwife, but while acting as the primary midwife
- 20 births
- 20 initial prenatal exams
- 75 prenatal exams
- 20 newborn exams
- 40 postpartum exams
After completing the requirements, the applicant is eligible to sit for the NARM exam. The exam is 350 multiple choice questions and 75% must be answered correctly to be awarded a passing score. If the applicant achieves a passing score, she will now carry the CPM credential. If the midwife lives in a state that does license midwives, she may then apply for a license through her state board of health if she so desires.
The midwife to be program is self-paced and therefore does not have a time limit. The NARM PEP process is also self-paced and can be completed as quickly as the required births are signed off on as well as the required skills are assessed by the senior midwife. The average time most agree it takes to become a CPM from start to finish is 2-3 years.
Clearly, there is a vast difference between the two main educational routes to
midwifery in the United States. One route requires a minimum of 6 years worth of school, and one can be completed in as little as 2 years (approximately). One has an extensive list of college/graduate school classes with lectures, quizzes, tests, graded projects, case studies, and more; the other is a self-study program with tests taken online on the honors system over birth and breastfeeding books, no tests over the textbooks, no classes, no lecture, and the ability to master the required "skills" by looking up youtube videos. One requires a master’s degree, and one does not even required a high school diploma or GED.
I would venture to say that a piece of paper does not equal a competent provider; however, it certainly ensures adequate education and strict adherence to the educational standards set forth by the institution. I believe that because the term "midwife" is used to refer to both CNMs and CPMs in the US, many people simply do not understand the extreme lack of education that is required of CPMs. The educational requirements of a CNM are superior and far exceed that of a CPM. Unfortunately, the lack of education for a CPM is clear, and in my opinion it is a huge contributor to the incompetency of so many in the profession.
