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Get to know a nurse-midwife

Learn what you might not know about pursuing this career

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The World Health Organization designated 2020 as the Year of the Nurse and the Midwife. In honor of a year aimed at increasing awareness about nursing and midwifery, we asked Susan E. Stone, CNM, DNSc, FACNM, FAAN, president of the
American College of Nurse-Midwives
, what it’s like to be a nurse-midwife in the United States today.
By Lisette Hilton
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Nurse.com:
How does one become a nurse-midwife?
Stone:
A nurse-midwife is educated in both disciplines of nursing and midwifery. For nurses who pursue nurse-midwifery, it requires a bachelor’s degree in nursing, then a master’s degree in midwifery.
There are 38 programs across the U.S. The American College of Nurse-Midwives Accreditation Commission for Midwifery Education website lists the programs and whether they are more distance learning or more traditional onsite programs.
Midwifery is different than other advanced practice nursing specialties when it comes to clinical requirements. Advanced practice nurses often have to have 500 or 600 hours of clinical.
Midwifery is competency-based, so the number of clinical hours is based on how long it takes for a nurse to become competent in midwifery care. Typically, that is around 600 to 700 hours — sometimes more and sometimes less depending on their prior experience.
Some midwifery programs do require that you have labor and delivery experience. That is an important question to ask when you’re assessing which program you want to go to.
Susan E. Stone
CNM, DNSc, FACNM, FAAN
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• Acute Care Adult-Gerontology Nurse Practitioner
• Primary Care Adult-Gerontology Nurse Practitioner
• Family Nurse Practitioner
• Family Psychiatric Mental Health Nurse Practitioner
• Certified Nurse Midwifery 

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There has never been a more critical time to become a Seattle University DNP prepared nurse practitioner. We educate and inspire leaders to transform health care for a just and humane world. Our program offers five areas of study in either acute or primary care. Attend an online information session to learn more.
Uncommon Care in Uncommon Times
Nurse.com:
What is the scope of practice?
Stone:
Nurse midwifery is a rewarding profession if you enjoy doing maternity care, caring for women and public healthcare. The scope of practice of the midwife covers caring for women from about puberty all the way to post-menopause. Many midwives have focused on caring for teenagers or caring for perimenopausal women. Many midwives have a focus on doing maternity care.
We are licensed in all 50 states, but some states allow midwives to practice independently. Others have certain requirements. For example, here in Kentucky, we can practice independently except when prescribing certain drugs, like narcotics.
The American College of Nurse Midwives is attempting to change legislation in all 50 states so that we can practice independently, meaning that we don’t have a physician supervising us

Watch our video on the Year of the Nurse and Midwife

Nurse.com:
How do midwives work within the healthcare team?
Stone:
First of all, it would be irresponsible for a midwife to say: ‘I practice all by myself. I’m totally independent.’ That’s not the way any healthcare provider should work in this day and age. We all know that we need collaborating physicians, collaborating nurses, physical therapists. Whatever it is that our patients need, we need to collaborate within that system.
We really are part of a collaborative healthcare team, and we do believe strongly in our ability to work with other providers to provide women with the care they need at a point in time.
A woman may see a midwife throughout her entire pregnancy, for example, and never really need to see a physician. That’s fine for a low-risk, normal woman. But the midwife has to have the ability to consult if she sees through risk assessment and the assessments that a woman has a problem that is not within our scope of practice.
Nurse.com:
What are some things that people often don’t know about nurse-midwives?
Stone:
Ninety-eight percent of U.S. nurse-midwives work in a hospital system. There’s a certain percentage that do home births and a small percentage work in free-standing birth center births.
It’s going to be interesting with this coronavirus how many more birth centers we get because women are going to be more interested in out-of-hospital births. The reason they work mostly in hospitals is because that’s where women in our country go to have their babies. That’s our culture.
Many midwives will have their own practice, separately — an office practice for prenatal care, postnatal care and things like annual exams, birth control, family planning and more. But when they attend births, it’s most often done in a hospital-based practice.
Nurse.com:
How is midwifery in the U.S. different than in other parts of the world?
Stone:
In the U.S., midwives attend about 8% of births. Some stats say up to 10%. In England, for example, 50% of the births are attended by midwives. In Sweden, 70% are attended by midwives. Primarily in Europe and most other developed countries, including China, Japan, India, France, Scotland, Spain and Italy, midwives are the primary frontline provider of maternity care.
In that system, obstetricians primarily care for women who are ill or have complications.
That system of care seems to have better outcomes. If you look at the maternal and neonatal mortality rate of the United States and compare it to other industrialized nations, we are the highest. We have the worst outcomes of any industrialized nation.
The Health Resources and Services Administration has focused a lot of attention around looking at other healthcare systems and trying to figure out why we have some of the problems that we have, knowing that incorporating midwifery into the system could improve the outcomes.
Nurse.com:
Is nurse midwifery a growing profession?
Stone:
For nurses thinking about going into midwifery, it is a growing profession.
New legislation is expanding scholarships for nurses to become midwives. This year, for the first time, we have (federal) money designated for midwifery education. Before it was through nursing, which means schools of nursing would have to split the money among advanced degree programs. So, the United States is understanding that we need more midwives.
This year, HRSA designated $2.5 million for nurse-midwifery scholarships. (This includes midwives that pursue master’s degrees in midwifery who are non-nurses.)
We are very interested in having nurses come in from all over the United States to come into midwifery. We need to increase the number of midwives so we can increase the number of births that we attend and increase that percentage.
About the Author
Lisette Hilton is a freelance writer.
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