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The 5 Steps to Becoming a Midwife in 2020
Adobe Stock/ Mangostar
Heather K Adams
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  • A midwife is trained health care professional, birth partner and maternity coach who helps healthy women navigate pregnancy, childbirth and motherhood.
  • The are four different kinds of midwives: a lay midwife, a certified professional midwife, a certified midwife and a certified nurse-midwife.
  • To become one, you need to complete your education, pass the national certification exam and find a mentor.

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The tradition of midwifery goes back millennia. Women have been helping other women through childbirth for thousands of years. But midwives are present not only at births — they also walk with their clients through the course of their pregnancies to help them stay healthy and feel prepared for their upcoming labor. 

Many midwives continue to be engaged as a care provider for women's issues even after their patients have given birth. It's a career that attracts people who are passionate about seeing women through these very emotional milestones in their lives. 

If you're interested in learning how to become a midwife yourself, read on to learn more about what you'll be doing, who you'll be doing it for and just what kind of education and training you need in order to become a midwife.

What does a midwife do?

A midwife is part trained health care professional, part birth partner and part coach who helps healthy women navigate pregnancy, childbirth and beyond. Women who want to work with a midwife normally don't want much hospital care during their pregnancies, so C-sections and labor inductions are rare. Much more common are births that happen in the comfort of a client's home or at a birthing center, because most moms-to-be who hire a midwife don't like the idea of delivering their baby in the more clinical setting of a hospital environment. 

A midwife will act as the medical authority during the labor regardless of where childbirth takes place. She also consults with women during the course of their pregnancy, monitoring client and baby's overall health and acting as a kind of counselor for any pregnancy or birth-related concerns as well. You'll work closely with clients and need to be available emotionally as well as physically.

Whether you decide to work at or with a hospital or birthing center, exclusively oversee home births or perform a mix thereof will be up to you. Keep in mind that some midwives do keep clients well beyond the birth or births of their children. A midwife may provide continued gynecological services for her clients as well as offer family planning advice and counseling on the care of newborns for nervous first-time moms. Some midwives are able to write out prescriptions, but state restrictions may limit what kinds of midwives can do this and what medicines they can prescribe.

Who chooses to work with a midwife?

The aura around midwifery is that of having a natural and holistic approach to pregnancy, childbirth and childcare. A woman who engages with a midwife will still probably see her personal physician during the course of her pregnancy, but the emphasis will be on the more traditional partner or consulting role of the midwife. 

These expectant moms are generally quite informed on topics of pregnancy and prenatal and postpartum care or want to be and expect to take an active role in maintaining their health and wellness. Learning how to become a midwife will include assessing which clients are right for you to work with. 

Personality is, of course, important, since both you and your client want to "click," but as a midwife you'll also want women who are considered lower risk and who also want as much of a "natural" birth (with little to no medications during labor) as possible. 

What kinds of midwives are there?

1. Lay midwife.

 A lay midwife has little to no professional training via midwife programs and may not have any certifications, either. This is generally someone with enough practical experience to use the label of midwife, without an actual medical background. Lay midwives may come up studying and practicing under the eye of a professional midwife and learn the trade that way. 

2. Certified professional midwife (CPM).

A CPM is a midwife who isn't a nurse but who does have training and clinical (medical, not just personal) experience with childbirth. CPMs can perform home births or assist during labor in hospital or birth center settings. A CPM must pass the national exam in order to become a certified midwife.

3. Certified midwife (CM).

A midwife who, again, isn't a nurse but who does have a bachelor's degree in a related health field. CMs must also complete midwife programs from accredited agencies and pass the national exam.

4. Certified nurse-midwife (CNM).

A certified nurse-midwife is a registered nurse, has completed a nurse-midwifery education program from an accredited agency and has also passed the national exam. While lay midwives, CPMs and CMs face state-to-state restrictions when it comes to setting up a personal practice CNMs are able to practice anywhere in the United States.

5 steps to becoming a midwife

1. Choose which kind of midwife you'd like to be.

Because there are different kinds of midwives, each with its own path toward certification, deciding which is right for you is the first step. If you live in an area where midwifery is popular enough to support a number of professionals in your area, assisting one or more of them and becoming a lay midwife may make sense as the right place for you to start. If you want to make a career of being a midwife, then planning to continue your education and work toward becoming a CNM may be best.

Keep in mind that few states actually allow CMs and CPMs to practice legally, so where you live or are going to live may be one of the largest factors in what kind of midwife you ultimately choose to become. And while all midwives provide care to their clients during pregnancy, childbirth and postpartum, CNMs and CMs also often consult for gynecological care throughout the course of a woman's life. CPMs and lay midwives usually focus their practices specifically on pregnancy, birth and related care.

2. Complete your education.

  • Certified professional midwife: Becoming a certified professional midwife may involve attending an accredited midwife degree program and doing an apprenticeship (most midwives actually serve an apprenticeship in some form; more on that below). If you've been working as a lay midwife, with no formal education but plenty of on-the-ground experience, this background will serve you well should you choose to attend a midwife degree program. A lay midwife may, however, also undergo an evaluation by a certified professional who could grant you CPM status based on the level of that experience and knowledge, letting you bypass the actual coursework.
  • Certified midwife: Becoming a certified midwife requires completing a bachelor's degree in a health-related field. Nursing is the obvious and most practical field in which to get a degree, especially if you plan to move onto the graduate-level studies of midwifery that a CNM must complete. Once you have that degree, you'll need to complete a midwife program from the American College of Nurse-Midwives (ACNM) Accreditation Commission for Midwifery Education. 
  • Certified nurse-midwife: Like the certified midwife, the path to becoming a certified nurse-midwife begins with an undergraduate degree and ends with completing the graduate midwife program. Beyond nursing, this graduate program will involve coursework in chemistry, biology, sociology and women's studies and continuing your nursing education. It's a lot of work to take on, but once you complete the program, you'll not only be a CNM but will also have a master's degree. You can then pursue a Doctor of Nursing Practice (DNP) after that if you'd like.

3. Pass the national certification exam.

The last hurdle for midwives of any "level" is to become officially certified by the American Midwifery Certification Board (AMCB). You must pass this exam to become licensed to practice midwifery in any fashion (except as a lay midwife). Remember, however, that just because you pass this exam doesn't mean you'll legally be allowed to set up in any state or region you choose. Be sure to stay up to date on which states and areas allow what kinds of midwives to practice and what other restrictions or legal hurdles you may have to deal with before you take on clients.

4. Find a mentor to apprentice under.

Finding an apprenticeship can be difficult depending on where you live and how many other practicing midwives there are around you. Networking through personal contacts and through your certification programs and agencies will offer you a little more help in finding the right person for you to serve under. The right fit really is important, so don't rush into committing to someone. You're going to be serving under this midwife, learning what she knows about everything from working with clients to managing her business, for quite some time. Most apprenticeships last at least a year, but some are even longer. You may also find an opportunity to apprentice at a birthing center, learning from and working with multiple midwives and professionals at once, but that isn't as common as the traditional one-on-one arrangement.

5. Keep up with the required continuing education.

Completing additional education requirements is necessary for maintaining your certifications as a midwife at all levels, save as a lay midwife. You'll need to complete a set amount of continuing education units (CEUs) every three to five years, depending on your certifications or level. You'll have to retake the certification exam at that time to remain in good standing as well. In this way, you'll stay up to date in your field and also have regular opportunities to grow your experience, interests and knowledge base. And if you're ever interested in taking on your own apprentice, going back to your school or program can be a great way to make connections with new midwives just starting out.

How much does a midwife make a year?

The potential income for midwives varies considerably based on your level of education and certification (as well as where you live and how popular the practice of midwifery is in that area). Some certified nurse-midwives may, in fact, rack up as many as six figures in a given year. But CNMs have completed both nursing school and attained a master's degree, which accounts for their ability to garner the highest wages in the field, making anywhere from $80,000-$95,000 or more a year. 

The income of most midwives is much more modest. For midwives who are self-employed and work with private clients more than hospitals, the average incomes are between $25,000-$50,000 a year. Because midwives usually charge a few thousand dollars per client or birth, this means maintaining an average client load of two to four births a month. Being able to have that many clients consistently will, again, depend very much on where you live and the demand for your services in that area. However, the fees you can reasonably charge for your services will increase as you gain experience in the field.

What is a midwife's work schedule?

In a word: nontraditional. Babies don't always come on time after all, so part of learning how to become a midwife will be learning to adapt to and juggle a less-regulated work schedule. When it comes to actual childbirth, you'll be on call 24 hours a day and need to be ready to attend a birth as soon as you get the call. The lifestyle of a working midwife means being okay with fitting in your social and personal life around your professional obligations. Childbirth can last from hours to days, but the midwife still needs to be present the whole time to continually monitor the health and well-being of both mom and baby. You'll be the one making the call if your client or her child seems to be in distress and needs to be taken to the hospital. 

A career and a calling

Learning how to become a midwife and pursuing that career path is perfect for anyone who loves the idea of working exclusively with expectant mothers and women wanting to consult on gynecological and reproductive issues. Reproductive health and wellness, prenatal and postpartum care, labor and delivery all fall under the midwife's purview. You'll participate in at-home births as well as births at hospitals, birthing centers or other private facilities. 

Many people begin a career in nursing before they decide to pursue midwifery, but even if you have zero experience or background in healthcare, you can still find a program and a career path that's right for you. Becoming a midwife can be a very fulfilling career and is in fact often touted by midwives themselves as being as much a calling as it is a job.

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