is a midwife a nurse

Is a Midwife a Nurse? What is the Difference?

In the field of nursing, there is a common misconception that all nurses are the same. However, the truth is, nursing is a diverse field with multiple specialties, each requiring specific education, training, and certification. And one such specialty is midwifery. So, yes, nurses seeking a specialization can choose midwifery as one of the options.

But to answer the question, ‘is a midwife a nurse’, we’d have to consider the education, training, and certifications held by a midwife.

In the United States, there are four different types of midwifery credentials:

  • Certified nurse midwife (CNM)
  • Certified professional midwife (CPM)
  • Certified midwife (CM)
  • Direct-entry midwife (DEM)

Out of these, only CNMs can be called nurses. That’s because only registered nurses with a bachelor’s degree in nursing and an active RN license can pursue the CNM pathway.

Difference between nurses and midwives

Nursing and midwifery roles can differ on the basis of education, certification, scope of practice, and area of practice. These differences can become more prominent if we consider the different midwifery credentials.

But to put it simply, the main difference lies in the patient demographic they treat. While nurses see all kinds of patients, treating a variety of illnesses, midwives advise and assist women during pregnancies and childbirth and, at times, even post-partum.

Differences in education and exams

Nurses and midwives follow completely different educational pathways:

  • Nurses: Nurses are required to have an associate’s/ bachelor’s degree in nursing. After completing one of these programs, they become eligible for the NCLEX exam, conducted by the National Council of State Boards of Nursing (NCSBN).
  • Certified nurse midwife: These midwives are licensed nurses who pursue a specializing degree in midwifery that has been accredited by the Accreditation Commission for Midwifery Education (ACME). After completing the program, they must appear for the certified nurse-midwifery exam, which is administered by the American Midwifery Certification Board (AMCB). Nursing candidates pursuing these programs must produce an active RN license and proof of a master’s degree or higher to qualify for the exam.
  • Certified midwife: CMs need to have a bachelor’s degree or higher and complete prerequisite courses in science and healthcare to qualify for admission to an ACME-accredited midwifery program. Like CNMs, they must also have proof of a master’s degree to qualify for the midwifery exam. CNMs and CMs appear for the same national certification exam, which is conducted by the AMCB.
  • Certified professional midwife: CPMs need a high school diploma or an equivalent degree to qualify for admission to an accredited midwifery program. They also need to complete prerequisite courses in statistics, microbiology, anatomy, and physiology and have experience in childbirth education or a doula certification. To appear for the qualifying exam, conducted by the North American Registry of Midwives (NARM), candidates must either graduate from a Midwifery Education Accreditation Council (MEAC) accredited program or complete NARM’s Portfolio Evaluation Process. Even AMCB-certified CNMs or CMs with at least ten community-based birth experiences can qualify for this exam. Applicants also need either an active certification or evidence of a completed course in adult CPR and neonatal resuscitation.
  • Direct entry midwife: DEMs are independent practitioners and have more flexibility in terms of an educational pathway. They can be trained through apprenticeship, self-study, a midwifery program, or even a college-level non-nursing program. Registered Midwives and Licensed Midwives are examples of DEMs. DEMs often get certified as CPM for further professional growth.

Differences in licensing and certification

  • Nurses: Most registered nurses (RNs) gain a practice license from state nursing boards after passing the NCLEX. This allows them to practice as a nurse and qualify for further certification into specialties like midwifery or critical care. The RN license must be renewed every 2-3 years. All US states recognize the RN credential, allowing them to practice all over the country.
  • Certified nurse midwife: CNMs become certified once they pass the national certification exam for midwives conducted by AMCB. After this, they must apply for state licensure. Licensing agencies for CNMs can include Boards of Nursing, Boards of Medicine, Boards of Midwifery/Nurse-Midwifery, and Departments of Health. The CNM certificate must be renewed every 5 years. All 50 US states recognize CNMs as certified professionals and allow them to practice as midwives, nurse-midwives, advanced practice registered nurses or nurse practitioners.
  • Certified midwife: CMs are also certified after passing the national certification exam conducted by AMCB, after which they can apply to state boards for licensing. Licensing agencies for CMs can include Boards of Midwifery, Medicine, Nursing, Complementary Health Care Providers, and Departments of Health. The CM certification must be renewed every 5 years as well. However, the CM certification is only recognized in the District of Columbia and 11 US states – Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island and Virginia.
  • Certified professional midwife and direct-entry midwife: For CPMs and DEMs pursuing the examination pathway, they must pass the national certification exam that is conducted by NARM. After this, they can apply for state licensing. Licensing agencies include Boards of Midwifery, Medicine, Nursing, Complementary Health Care Providers, Departments of Health, and Departments of Professional Licensure or Regulation. For CPMs, their certification needs to be renewed every 3 years. CPMs are legally recognized in 37 US states and the District of Columbia.

Also read: Exploring Full Practice Authority: Empowering Nurse Practitioners for Enhanced Care

Differences in scope of practice

  • Nurses: Registered nurses work as a part of a healthcare team, providing primary care to patients. They carry out treatment plans, track recovery progress, and educate patients. With more experience, they can also become charge nurses and be responsible for allocating resources and assigning patients. At times, RNs can also supervise LPNs/LVNs.
  • Certified nurse midwife and certified professional midwife: Both CNMs and CMs have a similar scope of practice. They provide ongoing assessment and care during pregnancy, childbirth, and the postpartum period. They can conduct physical exams, prescribe medications and even order and interpret diagnostic tests. They can work in a number of healthcare settings.
  • Certified midwife and direct-entry midwife: CMs and DEMs can work individually or through midwife organizations to provide education, counseling to pregnant women, and hands-on care during childbirth. They also provide maternity and baby care in the 6-8 week long postpartum period immediately after childbirth. They can conduct physical exams and order tests, and some states even allow them prescriptive authority.

Final thoughts

Both nurses and midwives play crucial roles in providing primary care to their respective patient demographics despite their differences in roles and responsibilities. While nurses provide a wide range of services, including administering medications, monitoring patient vital signs, and educating patients, midwives focus on providing primary care to women throughout their reproductive lives.

They play critical roles in promoting health, preventing illness, and providing compassionate care to patients. Their expertise and dedication contribute significantly to the overall healthcare system and the well-being of individuals and communities.

References:

  1. https://www.ncsbn.org/nclex.page
  2. https://www.midwife.org/accreditation
  3. https://www.amcbmidwife.org/
  4. https://narm.org/
  5. https://www.meacschools.org/
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