Midwives take care of individuals during pregnancy, labor, birth, and the postpartum period. When delivery takes place in the home or birth center setting, the midwife is also responsible for taking care of the newborn. Midwives may also provide gynecology services.
There are two types of midwives in the United States:
Direct-Entry Midwives are educated or trained as midwives without having to become nurses first. They may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). The legal status and requirements for direct-entry midwives vary from state to state. They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs). The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives.
Nurse Midwives are educated and licensed as nurses first, and then complete additional education in midwifery. They are known as Certified Nurse-Midwives (CNMs). CNMs are licensed to practice in all 50 states. They are usually licensed in individual states as Nurse Practitioners (NPs) and practice mainly in a hospital setting.
Midwives follow the Midwives Model of Care, as defined by the Midwifery Task Force:
“The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes. The Midwives Model of Care includes:
- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
- Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
- Minimizing technological interventions
- Identifying and referring women who require obstetrical attention
- The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”
There are several ways to become a midwife in the United States. Choosing the path that best fits your personal philosophy and professional goals will require you to decide what you want to do as a midwife and which avenue of preparation will best get you where you want to go.
A Certified Professional Midwife (CPM) has earned national certification through the North American Registry of Midwives (NARM). NARM conducts examinations and issues certification to CPMs. Client continuity of care and clinical birth experiences in out-of-hospital settings (birth center or home) are required for certification. Education can be obtained through a MEAC-accredited or non-accredited school or program, or through apprenticeship. Midwifery practice guidelines, an informed consent document, and an emergency care plan are required. Graduates of a MEAC-accredited program must pass the NARM national written certification examination. Graduates of other educational programs or routes must complete the NARM Portfolio Evaluation Process (PEP) and pass a skills practical examination in addition to the written examination.
As NARM puts it:
“The main purpose of a certification program is to establish entry-level knowledge, skills, and abilities necessary to practice competently. A Certified Professional Midwife’s (CPM) competency is established through training, education and supervised clinical experience, followed by successful completion of a skills assessment and written exam. The goal is to increase public safety by setting standards for midwives who practice The Midwives Model of Care predominately in out-of-hospital settings.”
MEAC standards incorporate the nationally recognized core competencies and guiding principles set by the Midwives Alliance of North America and the requirements for national certification of the North American Registry of Midwives.
MEAC-accredited schools prepare students to sit for the NARM examination. Students who graduate from MEAC-accredited schools are eligible for certain benefits from NARM, such as a simplified application process and the option for early certification testing.
Graduates from MEAC-accredited schools have the highest rate of passing the NARM examination of all midwifery students.
There are a variety of midwifery schools and programs. Some are accredited by one of the two national midwifery accrediting agencies: the Midwifery Education Accreditation Council (MEAC) or the Accreditation Commission for Midwifery Education. Some are not accredited. Some are state licensed. Some are run by a state or community midwifery group.
Midwifery programs may be onsite, online, correspondence, or “hybrid,” which refers to a combination of onsite and online education. Most midwifery programs are 2 to 3 years long. Some will have hospital-based clinical training, some will place students with midwives in birth centers and homebirth practices, some will include a center as part of the school, and some correspondence courses do not include a clinical component.
To find out more about MEAC accredited schools please contact the schools directly. Here are some questions you might want to ask when considering a midwifery school or program:
- What education and training are required in the state in which you want to become licensed? Does the school/program you’re considering meet these requirements?
- How well does it fit with your personal philosophy and orientation to health care? Is its orientation primarily medical? Does it include holistic “alternative” modalities?
- Who are the teachers, what kind of credentialing and experience do they have?
- What clinical placements does the school provide?
- Does graduation fully prepare you to become nationally certified?
- Is the school/program licensed by the state Department of Education? Is it approved by the agency that licenses midwives in your state?
- Does the school offer financial aid?
- How transferrable is the education to meet the licensing requirements in any other state, province, or country in which you might want to practice in the future?
- Is the program in a freestanding private proprietary school or in a larger institution: a private or public college or university?
- Who owns the school? How long has it been in existence? What kind of a reputation does it have, what do graduates, practicing midwives, and those who didn’t complete the program have to say about it?
- What are the prerequisites for admission? How large are the classes? How many apply and how many are accepted?
- What is their graduation rate? Their pass rate on the national certification exam? Where do their graduates work?
- What is the cost for tuition, books, equipment, supplies, and other requirements?
- Will I need a computer and internet access?
- Does the class schedule fit in with my personal, family, and job demands? Will I be able to work and go to school? If not how will I support myself?
- If I want to go on to another health care field, will the credits or course content be accepted by other schools?
Federal financial aid (grants and loans) is available at several MEAC accredited-institutions and programs. For information about Federal Student Aid, visit the US Department of Education page.
Additionally, some MEAC-accredited institutions and programs offer scholarships. Please contact individual schools to inquire about the possibility of scholarships.
The MEAC-accredited institutions that are authorized under Title IV to offer federal financial aid with MEAC as the Title IV gatekeeper are:
- Birthingway College of Midwifery
- Birthwise Midwifery School
- Florida School of Traditional Midwifery
- Midwives College of Utah
Additionally, the following programs offer Title IV federal financial aid through their institutional accreditors (not MEAC):
Several MEAC-accredited midwifery schools offer at-a-distance or low residency programs. These programs enable students to complete much of their education through an online format and through local preceptorships and apprenticeships (when available). Each of these individual programs may involve different amounts of time spent away from one’s home to complete graduation requirements.
If at this time, there aren’t any MEAC-accredited schools physically located in your area that you could attend on a weekly basis, one of these at-a-distance or low residency programs might be the best choice for you. These programs were designed because many aspiring midwifery students, like you, are not able to or are not interested in relocating to attend school, and yet we need more midwives all across the country!
The schools that offer at-a-distance or low residency programs include:
- Birthwise Midwifery School (low residency)
- Midwives College of Utah (distance education)
- National College of Midwifery (distance education)
- National Midwifery Institute (correspondence education)
- Bastyr University Master of Science in Midwifery Program
- Mercy in Action College of Midwifery (distance education)
- MEAC’s Decision Regarding the Out-of-Country Clinical Training Moratorium, April 22, 2015
- An African’s Message for America, January 2015
- The Forum on Education Abroad Annual Conference – It Takes a Campus & More: The Faces of Education Abroad, March 25-27, 2015, in New Orleans, LA
- International Registry of Midwives