CERTIFIED NURSE-MIDWIVES AND LICENSED MIDWIVES California Occupational Guide Number 555 Interest Area 13 1995
"Five nations with the lowest infant mortality rates
have 70 percent of all births attended by midwives."
California State Legislature, 1993
TRENDS
For the past 20 years California licensed only registered nurses (RNs) to be midwives. Recent legislation created a second category called Licensed Midwives. These midwives are not required to be RNs. The Licensing Division of the Medical Board of California began certifying Licensed Midwives September 1995.
THE JOB
CERTIFIED NURSE-MIDWIVES AND LICENSED MIDWIFES deliver babies of normal, spontaneous birth. They provide primary care for women and their babies during pregnancy, labor, delivery, and after birth. Prenatal care, labor and delivery management, postpartum, and infant care are at the very heart of their work. A 16th century Aztec representation of a Mother giving birth To do their work, they examine pregnant women and identify any health problems, provide gynecological care (such as Pap smears), and screen for normal pregnancies using laboratory and other diagnostic tests. They counsel about nutritional, behavioral, and environmental effects on pregnancy; provide physical and emotional support during labor; and assist normal, spontaneous deliveries. After birth, they assess the baby's health and nutritional needs and teach mothers self and infant care techniques such as breast feeding and the importance of child/parent bonding.
Both Licensed Midwives and Certified Nurse-Midwives (CNMs) are supervised by a doctor. However, this does not mean that the supervising doctor is present during deliveries.
California Legislation (Senate Bill {SB} 255, 1995) which allows Certified
Nurse-Midwives to admit their patients into hospitals and to deliver babies
in collaboration with a doctor is pending. This legislation changes the
existing law that requires doctors to supervise CNMs and admit the expectant
mother into the hospital.
WORKING CONDITIONS
CNMs work wherever women are receiving health care. About 90 percent are salaried by physicians groups, hospitals, HMOs, community clinics and educational institutions. Most CNMs now attend deliveries in hospitals, but some 11 percent are attending women at home. In 1993 CNMs attended 42,888 deliveries (7.3 percent of all births in California). In addition to providing health education and prenatal, postpartum, and newborn care, they also do menopausal services, family planning visits, and act as first assistants at cesarean section births. Although almost all practicing midwives attend home births now, newly Licensed Midwives may have the same diverse conditions as those described for CNMs.
The work itself is associated with long hours and irregular schedules. The satisfaction of caring for child bearing women and pioneering a model of care-giving more than compensate for workplace irregularities.
EMPLOYMENT OUTLOOK
Critical shortages of qualified care for expectant mothers exist in some areas, indicating that opportunities should grow steadily in midwifery. Some counties have only one obstetrician; a few counties have none. This under-representation was noted by the California State Legislature in the Licensed Midwifery Practice Act of 1993, stating that each woman has a fundamental right to receive proper prenatal care.
The California Nurse-Midwives Association (CNMA) expects demand for Certified Nurse-Midwives to grow because of managed health care policies shortening post delivery hospital stays and the spiraling costs of doctor assisted deliveries. California has only five approved nurse-midwifery programs -- three in the southern part of the State and two in San Francisco. Certified Nurse-Midwives may soon be in short supply.
The California Board of Registered Nurses reports that only 850 CNMs are licensed in the State. According to the CNMA, only 700 of them are currently practicing.
Despite legislation creating the new category of Licensed Midwife, California has no training programs to prepare aspiring midwives for licensing requirements. The demand for workers could soon be far greater than the supply of Licensed Midwives.
Beginning Licensed Midwives may have difficulty finding a doctor willing to supervise their practice. Medical malpractice insurance may be hard to obtain.
WAGES, HOURS, AND FRINGE BENEFITS
According to the California Association of Midwives, midwife gross income (fees) varies between $1,200 and $2,500 per delivery. Midwives average between 40 and 50 deliveries per year. It is important to note that all business expenses, including medical malpractice insurance, must be paid out of gross earnings.
No formal salary survey for Certified Nurse-Midwives is currently available. Beginning salaries should be comparable to the nurse practitioner salary -- $26,000 to $50,000 annually. Top salaries for experienced CNMs can be above $80,000. Earnings can be $100,000 or more annually for those in private practice.
Midwives are on call to attend deliveries which can happen at any hour, any day. Prenatal examinations and checkups and follow-up after birth can be scheduled for normal work hours.
Most CNMs employed by doctors, hospitals, or clinics receive paid vacation and sick leave, retirement benefits, and medical, dental, and vision insurance.
ENTRANCE REQUIREMENTS AND TRAINING
Who are Midwives?
Certified Nurse-Midwives -- registered nurses who have completed an
additional course of midwifery training (from nine months to two years) at
an accredited school, passed an American College of Nurse-Midwives (ACNM)
certification exam, and received a license from the California Board of
Registered Nurses.
Licensed Direct Entry Midwives -- Midwives who have met California
requirements for midwifery licensing and received a license from the
Medical Board of California Licensing Division.
Midwives need one of three requirements to be eligible to take the Board
licensing exam:
-- Graduation from a three year midwifery education program approved by
the Board, or
-- Proof of sufficient medical and clinical knowledge to pass the Board
exam by successfully challenging courses (pass written and oral
assessments)of an approved midwifery education program, or
-- Licensure as Midwives by another state whose standards are equivalent
to California standards.
Newcomers to the Licensed Midwife career will begin as apprentices to practicing Licensed Midwives until training programs are set up in California. Contact the California Association of Midwives for help in locating a practicing Licensed Midwife in your area.
The American College of Certified Nurse-Midwives establishes the educational and training requirement for CNMs. Applicants must be licensed RNs. For more detailed information about licensing and licensing alternative requirements for CNMs, contact the Board of Registered Nurses.
Certain personal traits are critical for this work: a real love for the work and a caring attitude are the most important. These professionals need the ability to interact on an extremely personal level with all clients, inspire confidence, make accurate decisions rapidly, and take appropriate action as changes occur. As patient advocates, they need excellent communication skills to successfully interact with other professionals on their medical team. They also need both physical and emotional stamina to do their work.
ADVANCEMENT
CNMs may use their administrative skills to direct a nurse-midwifery program in a hospital or clinic or go into private practice. Some combine their midwifery career with teaching at university nursing or public health schools or do related clinical research.
Practicing midwives who are not CNMs operate a private practice and measure success and advancement in terms of a growing practice and recognition in their field. Newly Licensed Midwives may have most of the same career development opportunities as CNMs.
FINDING THE JOB
Certified Nurse-Midwives network through their professional associations and apply directly to hospitals, clinics, physician groups, and birthing centers. Recent graduates obtain job leads from their school placement service.
Practicing midwives usually establish their own practice or practice with a partner. Many expand their practice through contacts made while teaching child birth sessions and conducting educational seminars. Newly Licensed Midwives may have expanded opportunities working for hospital, clinics, and doctor offices.
ADDITIONAL SOURCES OF INFORMATION
For detailed licensing and training information contact:
California Board of Registered Nurses P.O. Box 944210 Sacramento, CA 94244-2100 (916) 322-3350
Medical Board of California Affiliated Healing Arts Program 1426 Howe Avenue, Suite 56 Sacramento, CA 95825-3236 (916)263-2496
California Association of Midwives P.O. Box 417854 Sacramento, CA 95841 (800) 829-5791
California Nurse-Midwives Association 9852 Katella Avenue, Suite 351 Anaheim, CA 92804 (800) 900-2662 Fax (714 )456-7224
RELATED OCCUPATIONAL GUIDES
Registered Nurse and Nurse Practitioners No. 29 Licensed Vocational Nurses No. 313
OCCUPATIONAL CODE REFERENCES
DOT (Dictionary of Occupational Titles, 4th ed., Rev. 1) Nurse Midwife 075.264-014
OES (Occupational Employment Statistics) System Registered Nurses 325020
Source: State of California, Employment Development Department,
Labor Market Information Division, Information Services Group,
(916) 262-2162.
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