Health Careers Spotlight:
Certified Nurse-Midwife

Certified Nurse-Midwives (CNMs) provide obstetric and gynecologic care to women of all ages. They perform gynecologic exams and Pap smears, prescribe medications and suggest birth control methods, deliver babies, perform the first newborn exam, and assist new mothers with breastfeeding, CNMs consult with a physician if complications arise during pregnancy or birth. CNMs also educate patients about reproductive health and family planning.

The demand for advanced practice nurses, which includes CNMs, is expected to continue to increase over the next decade and beyond, as the need and demand for effective health care increases. Demand is expected to be particularly high in rural, inner-city and other underserved areas.

Nurse midwives typically earn a starting salary of between $50,000 and $65,000 per year.

For those interested in a career as a certified nurse-midwife, high school course work should include an emphasis on math and science. A bachelors degree in nursing (BSN) and a registered nurse (RN) license are usually required before continuing on to advanced certification or a master's degree; however, there are nursing programs that enroll non-RNs with bachelor degrees in other areas of specialization. Master's programs generally take two years to complete.

For more information on a career as a certified nurse-midwife or another health career, please call 802-527-1474.

Amy Levi, CNM is the Director of the Claire M. Lintilhac Nurse-Midwifery Service at Fletcher Allen Health Care (FAHC). Amy received her undergraduate degree in Nursing from Widener University in Pennsylvania. In addition, Amy completed her Master of Science in Nursing, Doctor of Philosophy in Nursing, and received her Certificate in Nurse-Midwifery at the University of Pennsylvania. We recently spoke with Amy to discuss her experiences working in the field of Nurse-Midwifery.

Q How did you become interested in becoming a Certified Nurse-Midwife?
A I am very committed to women and their health and well-being. I also believe that the health of families is supported most effectively by supporting the health of women during pregnancy and childbearing.

Q How long have you been working in the Nursing field?
A I have been a women's health care practitioner since 1981, and a nurse-midwife since 1986.

Q What other career alternatives did you consider?
A Nothing else, really. I started out studying nutrition, and quickly realized that I wanted to have a different kind of contact with women and their families. "Midwife" means "with woman," and I was drawn to the opportunity to attend families during birth, and to become part of the growth of a new family. There is a tremendous amount of variety in what we do, and it is satisfying on so many levels: intellectually, emotionally, and spiritually.

Q Did any person influence your decision to become a Nurse-Midwife?
A I was probably influenced by the first midwife I ever met, who came to a college class I was in and talked about what she did. I then gave birth with a wonderful midwife in Arizona. After that experience, I knew what my life's work would be.

Q What personal needs are satisfied by your job?
A I love women, babies and families. I feel so incredibly fortunate to do something that I feel is important, and that is also so satisfying to me personally.

Q In what ways has being a Nurse-Midwife changed you as a person?
A Being a midwife requires tremendous amounts of patience, and I have been grateful for the opportunity to develop more patience since I have been a midwife! Also, I think my compassion has grown tremendously; being with families during such a vulnerable time in their lives has helped me realize how fortunate I have been in my life. Also, during birth, I am in complete awe of how courageous and powerful women can be.

Q If you didn't have to work, would you anyway? If not, what would you do?
A I am a midwife. Whether I am employed at the bedside, or teaching about childbirth and women's health, or developing policy to ensure the well-being of women and their families, I will always be a midwife. It has nothing to do with being paid for what I do... it is who I am.

Q Describe the demands of your job...
A I work about 50 to 60 hours per week; part of that is by choice, because I am committed to ensuring that I support my profession both at my work site, and by writing and advocating for midwifery in the educational and political arenas. Because midwifery is very people-oriented, it carries with it all the frustrations and joys of working closely with others, whether colleagues, coworkers or superiors.

Q What is a typical day for you?
A I'm not sure if any day is typical! I sometimes see patients in the office, sometimes cover the labor and delivery area, and sometimes teach, read or write.

Q Do you supervise the work of others?
A In my current position, I am the Practice Director, which means I coordinate the activities of the other midwives with whom I work. In the birthing area, we work closely with others who are in different roles, but it is not really a supervisory relationship.

Q What personal characteristics are desirable to be a good Nurse-Midwife?
A First and foremost, it is important to be a good listener. It is also important to be compassionate and patient. Midwives also must have the ability to tolerate the unknown and unexpected.

Q What special knowledge or skill does a person in this job need?
A In addition to the above, it is important to have a keen intellect and good dexterity.

Q What kinds of people do you work with? Coworkers, clients, patients...?
A All kinds of people!! One of the things I like best about what I do is the variety of people with whom I get to work; physicians, administrators, nurses, other health professionals, and patients of all kinds and from all walks of life.

Q What do you like best about your career and what aspects of being a Nurse-Midwife cause you the most frustration?
A I feel like I am making a positive contribution to people, and I get so much in return! Health care in the United States is in terrible disarray; interfacing with the disorganization of health care is frustrating. Other dissatisfactions come from the reality of needing to get paid for what I do!

Q What requirements exist, in addition to schooling - training, experience, certification, license to become a Nurse-Midwife?
A Following baccalaureate nursing education, there is an 18-24 month educational course in midwifery education that is often at the master's level. Graduates from accredited midwifery education programs can become certified by taking an exam to enable them to be licensed by the state in which they practice.

Q What are the career ladder possibilities in this field?
A The upward mobility in midwifery is in the direction of education, administration or public policy. There are midwives who are nursing school deans, state directors of maternal child health, and directors of obstetrical departments in the military.

Q Can a person specialize within the field of Nurse-Midwifery? Into what areas?
A Some midwives work exclusively in specific settings with specific populations of women; some midwives identify specialty skills that they pursue (such as colposcopy or lactation consultation).

Q What changes are occurring in this field?
A The need for midwives is always there, but health care politics and economics do not always promote the availability of positions. In many ways, midwives must still make a place for themselves at the table - hopefully that will start to improve as women assert their desire to have the option of midwifery care. I would love to have midwifery be the standard of women's health care in the United States as it is in so many other countries in the world! In Vermont, nurse-midwives perform about 19% of all vaginal births and physicians do the balance. In other developed countries, it is the opposite!

Q How does the economy impact this field?
A People will always be having babies! Because of the aging of professional nurses, we will need younger folks to continue for us.

Q Do you encounter any problems combining your job with your family life?
A Having to respond to a beeper is often very frustrating for family members... I have sometimes found it difficult to meet all of my family's needs while fulfilling my professional responsibilities.

Q What advice would you give someone who is planning to enter the Nurse-Midwifery field?
A Be patient with yourself and the process of becoming a midwife. Learn as much as you can along the way by spending time with women and their families - as a doula, childbirth educator and/or lactation consultant.