By assisting in prenatal and neonatal care in addition to lowering the risk of maternal and infant mortality during childbirth, certified nurse-midwives (CNMs) are a strong component to the primary health care of women. Nurse-midwives assist in labor and delivery and generally provide gynecological exams and family planning counseling. Furthermore, nurse-midwives are trained and skilled in vaginal birth deliveries and can administer epidural anesthesia. CNMs can be seen practicing in private hospitals, family planning clinics, homebirth practices, universities, and at public health departments. According to the American College of Nurse-Midwives (ACNM), approximately 70% of women who receive care from nurse-midwives are "vulnerable to poor health incomes." Nurse-midwives are considered advanced practice registered nurses (APRNs) and must therefore possess a master's degree to obtain a license.

Getting Midwife Licensure and Certification

Because nurse-midwives are responsible for providing primary care, counseling, and performing gynecological exams on patients, trained experience through higher education is necessary. The ACNM Board of Directors has determined that a graduate degree is required to enter into practice as a nurse-midwife as of 2010. Certified nurse-midwives must have graduated from an academic program accredited by the Accreditation Commission for Midwifery Education (ACME) to be eligible for certification. There are currently 43 accredited nurse-midwife programs offering master's degrees in the United States. Nurse-midwives must also pass the national examination administered by the American Midwifery Certification Board (AMCB). The certification examination consists of 175 multiple-choice questions and is taken on a computer. The fee to take the examination is currently $500, and the test must be completed within four hours.

State requirements for certification vary, so it is best to check with the ACNM's list of state legislative developments for any recently established or pending laws regarding certification in your state.

Maintaining Nurse-Midwife Licensure and Certification

Nurse-midwife certification must be renewed within a specified time frame. Nurse-midwives and other advanced practice registered nurses are required to renew their certification at a minimum of every five years, according to the APRN Consensus Work Group and the National Council of State Boards of Nursing (NCSBN). To maintain certification as a nurse-midwife, you must participate in continuing education consisting of both clinical and classroom hours. Continuing education programs should be accredited by the American Council for Continuing Medical Education.

The American Midwifery Certification Board currently has a Certificate Maintenance Program that accepts continuing education units as long as they are approved by the ACNM, Accreditation Council for Continuing Medical Education (ACCME), the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), American Academy of Nurse Practitioners (AANP), National Association of Nurse Practitioners in Women's Health (NPWH), or Accreditation Council for Pharmacy Education (ACPE). Continuing education contact hours completed by attending conferences are only accepted if the conference is clearly identified as an advanced nursing practice conference. Some alternatives that satisfy continuing education requirements include graduate and Ph.D.-level coursework in clinical midwifery practice, a formal presentation on a topic before a nursing board, or primary authorship of publication in a peer-reviewed journal or of a chapter in a peer-reviewed textbook. Additionally, being a peer reviewer of an article for a reference journal or textbook chapter, serving as a peer reviewer for an ACNM affiliate, participating in an ACNM or AMCB committee, or having direct clinical supervision over a nurse-midwifery student can also satisfy continuing education requirements.

Furthermore, nurse-midwives can prepare for continuing education units through self-study programs offered online at professional nursing websites such as Other resources for satisfying continuing education hours online include the ACNM's list of distance learning programs for nurse-midwives, some of which are offered through well-known schools like University of Cincinnati and Georgetown University.

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