Midwife Jobs

By an allied health world contributing writer
Published: February 3rd, 2010

Are there other types of midwives aside from CNMs and CMs?

In addition to CNMs and CMs, there are other types of midwives in this country, including Certified Professional Midwives (CPM), licensed midwives, and lay midwives. These midwives are only able to attend birthing women at home or in birth centers. They mainly care for women during the maternity cycle but do not provide the full range of women's health care that CNMs/CMs offer.

CPMs, licensed midwives and lay midwives are not standardized groups and don’t have educational requirements. To become a Certified Professional Midwife, no degree is required but the national certification exam administered by the North America Registry Midwife Jobs

of Midwives must be passed. CPMs are legally allowed to perform out-of-hospital births (those at home and in birthing centers) in over 20 states.

The term “Licensed Midwife” is used by some states to license lay midwives, individuals with no formal training, and in other states to license CNMs.

Where are midwives employed?

Certified Nurse-midwives and Certified Midwives are taught to practice in hospitals, birth centers and homes. However, the vast majority of these professionals (97%) only practice in hospitals. The majority of midwives are employed by hospitals and medical centers. About 30% of midwives are employed by physicians. In the hospital setting a midwife manages the labor, conducts the delivery, and writes orders for the nurse to carry out, the same as any physician would. Those employed by physicians enjoy establishing their own client base and building rapport by seeing the same patients on a regular basis. OB offices can vary in how they utilize the midwife. In some offices the midwife sees her own patient load, which varies from pregnant patients to those who just need an annual exam. In other offices, the midwife solely works with pregnant women and women in labor and the physician sees any patients who are sick, need hormone replacement therapy, or need surgery. There are also entire midwife practices owned and managed by midwives. They may contract the services of a physician who serves in a consultation role, and who is there to perform any necessary surgeries, but the midwives see the patients on a day-to-day basis. Midwives are typically employed at medical centers in obstetric and gynecology units, obstetrician/gynecologists offices or at community health clinics. There are only six states that require midwives to work under a physician, the others allow these professionals to work independently. This means in most states nurse-midwives can start their own practices.

Do nurse-midwives only see pregnant women?

There is a common misconception that nurse-midwives are only able to see and work with pregnant women and women in labor. However, nurse-midwives can work in a very similar capacity as an obstetrician/gynecologist in that they’re able to perform annual pap smears, infection checks, as well as all the duties that relate to pregnant and laboring women. In some job positions, nurse-midwives may not provide the full scope of care for which they are trained. For example, some midwives may work at women's health clinics where they only provide gynecological care. Others may work in practices where they only provide prenatal care.

Learn more about the midwife degree.

How do OBs and midwives work together?

This can vary greatly depending on the type of financial arrangements involved. Some midwives are employed by physicians whereas others have their own practices and use physicians only to consult with as necessary. Oftentimes midwives and physicians work together as a team under a larger health care corporation.

In terms of clinical care, a midwife is completely responsible for the care of her clients. If the client develops certain medical complications that are beyond the scope of the midwife's practice, she will consult with a physician in the same way that a family doctor would consult with a cardiologist if one of her patients developed a complication outside the scope of her practice.

What is within a nurse-midwife’s realm of practice?

All midwives practice according to the Standards of Practice that are established by the profession. States do not regulate specific procedures that a nurse-midwife can perform; however, specific hospitals may differ in their credentialing procedures.

Typically nurse-midwives can perform most of the day-to-day duties an obstetrician or gynecologist does, such as pap smears, infection checks, breast examinations, monitoring pregnant women and assisting in the delivery of babies under normal circumstances. In special situations the midwife may need to consult with or collaborate with an obstetrician, such as when the woman is in preterm labor, has high blood pressure, or needs operative assistance, such as forceps, vacuum extraction, or cesarean section. Nurse-midwives can also perform the duties that go along with the delivery including cutting and repairing episiotomies if necessary, and repairing any lacerations. They are also able to perform ultrasounds with the proper training.

In addition to the day-to-day functions and deliveries a nurse-midwife can perform, they are also trained to insert intrauterine devices as part of their basic education. Also, a nurse-midwife may perform the duties of first assistant to a physician during a cesarean section if they have received additional education to do so. They are also able to assist the physician with tubal ligations and hysterectomies.

A nurse-midwife’s prescriptive authority varies among states, although they have basic prescriptive authority in every state. In some states they must practice under a physician to write prescriptions and can still only write for certain types, such as being able to prescribe birth control pills but not narcotics.

Learn more about how to become a certified midwife.

Nurse-midwives cannot see male patients, except to treat partners of women who have sexually transmitted infections. Licensed family practitioners are able to work with both men and women, whereas with a degree in midwifery or women’s health the scope is limited to women and newborns. Midwives can see babies up to their first month of life if they so choose to have this as part of their practice. If trained, they can also perform infant circumcisions.