Nurse-midwives are valuable members of the multidisciplinary healthcare team, whether in the maternity or medical care model. Thanks to their broad scope of practice and their dual expertise in both advanced practice nursing and midwifery, certified nurse-midwives (CNMs) are able to work in an array of settings, where they provide care, support, and counseling as it relates to maternal and women’s health issues.
CNMs have legal authority to practice in any number of settings, including hospitals, private practices, birth centers, health clinics, and home birth services. While the majority of CNMs work for an employer, those with an entrepreneurial spirit often set up their own midwifery practices in the community of their choice.
Midwife Careers By State
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
According to statistics published by the American College of Nurse-Midwives (ACNM), the majority of all nurse-midwives (35 percent) work in hospitals and medical centers, followed by physician practices (29.9 percent). Other settings in which nurse-midwife jobs are found include:
- Community health: 8.4 percent
- Academic institution: 7 percent
- Health agency: 4 percent
- Midwife practice: 3.7 percent
- Government/military: 3.3 percent
- Own practice: 2.9 percent
The ACNM report also revealed that the vast majority (63.5 percent) of nurse-midwife jobs are found in urban settings, followed by suburban settings at 27 percent, and rural settings at 9.5 percent.
General Scope of Practice for Certified Nurse-Midwives
Certified nurse-midwives are qualified to provide healthcare to women across the lifespan, including gynecological, obstetrical, menopausal, and family planning care. Depending on state laws and the practice setting in which they work, CNMs may practice autonomously or in collaboration with other members of a physician-led healthcare team and may provide either primary or specialty care for women.
Although a nurse-midwife’s job description depends on the practice setting and on the scope of practice appropriate to that setting, general job responsibilities and duties include:
- Diagnosing, treating, and managing care of women (including well woman visits and care of chronic and acute illnesses)
- Conducting physical examinations, ordering tests, and interpreting medical histories
- Ordering and managing care based on diagnostic tests and procedures
- Providing regular checkups throughout a woman’s pregnancy
- Providing post-partum care and checkups
- Delivering babies
- Providing counseling on family planning, contraception, and pregnancy-related issues
- Prescribing pharmacologic treatments (depending on state regulation)
- Providing care of the healthy newborn in the first 28 days of life
Successful nurse-midwives possess the skills, knowledge, and compassion to care for women from adolescence and beyond menopause. They are dependable, caring healthcare providers who effectively communicate with the patients and families they serve.
Successful CNMs must also:
- Form positive and collaborative relationships with other members of a multidisciplinary healthcare team
- Possess strong organizational skills
- Be highly motivated and detail-oriented
- Possess a high level of integrity and initiative
- Prioritize and use their time efficiently
- Identify and resolve problems in a timely manner
- Skillfully gather and analyze information
- Easily adapt to changes in the work environment and deal with unexpected changes or delays
Nurse-Midwife Job Description: Providers of Gynecologic and Obstetric Care
Nurse-midwives working in hospitals, medical centers, and birthing centers oversee the assessment, planning, implementation, and evaluation of nurse-midwifery care to their antepartum, intrapartum, and postpartum patients. Job duties and responsibilities of nurse-midwives providing maternity care in these settings include:
- Performing physical examinations
- Managing labor and spontaneous delivery
- Conducting diagnostic and therapeutic procedures
- Ordering and scheduling laboratory studies
- Prescribing appropriate interventions and medications
- Assessing patients for change in status and institute appropriate interventions
- Initiate necessary emergency interventions, as needed
- Providing patient and family education related to prenatal, intrapartum, postpartum, and newborn care
- Performing and participating in quality/performance improvement activities and clinical research
Antepartum Care
- Diagnosing pregnancies
- Taking general and obstetrical clinical histories
- Estimating date of delivery
- Performing clinical examinations, to include measurement of uterus, fetal position, fetal heart, and vital signs of patient
- Ordering and evaluating preventive and routine screening procedures
- Diagnosing and treating complications during pregnancy, to include hypertension, bleeding, threatened preterm delivery, bacterial/viral infection, etc.
- Referring women with complicated or high-risk pregnancies to the proper specialists
- Providing advice and counseling to patients in preparation for birth
Intrapartum Care
- Monitoring labor
- Recognizing and transporting patients in need of a more higher level of care
- Identifying and managing complications of the postpartum patient
- Providing support during labor and delivery
- Delivering babies
Postpartum/Newborn Care
- Taking vital signs of mother and newborn
- Performing clinical examination of mother
- Assessing uterine involution
- Checking for postpartum complications (hemorrhage, infection, fever, etc.)
- Performing general newborn examination (condition of cord, weight, head circumference, temperature, etc.)
- Encouraging breastfeeding
- Providing immediate newborn care with a focus on airway, warmth, and breastfeeding
- Providing nutrition counseling
- Providing preventive care to newborn, including immunizations
Job Description for Nurse-Midwives Practicing Well-Woman Care
The job scope of CNMs working for midwifery practices, OB/GYN practices, and community health clinics/agencies often extends beyond the childbearing woman to encompass well-woman care for patients beginning at adolescence and extending beyond menopause.
Therefore, the job description for nurse-midwives in these settings includes the following duties and responsibilities:
- Performing breast and pelvic examinations
- Taking and recording vitals, including blood pressure, pulse rate, weight, etc.
- Educating women on self-breast exams, exercise, disease prevention, healthy diets, etc.
- Counseling women on pregnancy prevention, contraception, and other family planning methods
- Providing pre-conception counseling
- Diagnosing and treating diseases and disorders of the genital, urinary, and rectal organs
- Ordering and examining diagnostic tests and blood work
- Referring patients to specialists, as needed