Day in the Life of a Certified Nurse-Midwife (CNM): Two Experts Share Their Perspectives

Meet the Experts

Mary R. Franklin, DNP, CNM, FACNM

Dr. Mary Franklin is an Assistant Professor at Case Western Reserve University’s Frances Payne Bolton School of Nursing, where she is also Director of the Nurse Midwifery Program. She received her BSN, MSN, and DNP from Case Western Reserve University. Dr. Franklin’s teaching responsibilities include maternity and newborn nursing, informatics, and well woman gynecology courses.

Dr. Franklin has received the Most Outstanding Nurse Midwife Award from the Northeast Ohio Chapter of the American College of Nurse-Midwives; the Ohio Exemplary Midwife Award from the Ohio Chapters of the ACNM; and the Clinical Star Award from the ACNM. She became a Fellow of the ACNM in 2021.

Karen Jefferson, DM, CM, FACNM

Dr. Karen Jefferson is the Director of Midwifery Practice and Education for the American College of Nurse-Midwives, the professional association for Certified Nurse-Midwives and Certified Midwives. She is adjunct faculty at Thomas Jefferson University, where she was formerly the Program Coordinator for the Doctorate in Midwifery program.

For 17 years, she co-owned a private midwifery practice in New York City, attending births at home. A State University of New York-Downstate graduate, Dr. Jefferson is a former member of the board of directors of the ACNM and the past president of the New York State Association of Licensed Midwives. Her advocacy work helped pass two major midwifery bills in NY, and she is now working to support licensure for Certified Midwives in all 50 states. Her scholarly focus is on strengthening midwifery associations as well as changing public policy surrounding licensure and regulation of midwives in the U.S.

The Work of the Certified Nurse-Midwife (CNM) and Certified Midwife (CM)

“For CNMs and CMs in practice, the typical day will depend on the setting,” Dr. Franklin says. “Midwives who are providing care in the office will typically have a set schedule of patients and predictable hours. Midwives who are providing intrapartum care may have predictable hours or may be on call to attend patients in the labor and birth setting. Some midwives work in only the office or birth setting in a given week, while others may have a mixed schedule of office and birth setting work in the same week.”

The majority of midwives in America work in hospitals, but they can also work in birth centers, in private practice, in other health clinics, or in facilitating home births. Midwives may see prenatal patients and gynecology patients, perform postpartum visits, attend childbirths, provide well-woman care, or offer health screenings. The client-centered approach that midwives take has been shown to lead to a more efficient use of health system resources, including fewer unnecessary and potentially harmful interventions, and improved patient satisfaction and health outcomes.

“The best way to practice midwifery care needs time,” Dr. Jefferson says. “There are productivity constraints, depending on the setting, but we try to schedule longer visits, so there’s time for people to ask questions. The heart of midwifery is relationship-building, and that extra time allows us to establish relationships with people.”

Top Advocacy Issues for Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs)

Maternal and neonatal mortality is a major issue in the U.S., but the overall numbers can obscure an even more alarming statistic: maternal mortality rates are twice as high for Black women in America. Stronger support for access to postpartum care, paid maternity leave, and midwifery education can help.

“Reducing maternal and neonatal mortality, particularly for individuals of color, is a main focus of health policy work for CNMs/CMs,” Dr. Franklin says. “To address the health disparities in maternal and neonatal mortality, we need to educate and support more midwives of color. Outcomes for vulnerable populations are better when caregivers are representative of their clients, and increasing the numbers of midwives of color is a strong initiative in the CNM/CM community.”

Today, midwifery education doesn’t enjoy the same federal benefits that medical education does. Graduate Medical Education (GME) funding exceeds $15 billion per year, and that money helps support hospitals in training medical residents, but it doesn’t extend to midwives or midwifery education programs.

“The lack of federal funding for midwifery education is a pressing advocacy issue,” Dr. Jefferson says. “We’re competing with residents and medical students for births in hospitals, and the hospital almost always chooses the medical resident, because they get paid to educate them.”

The Midwives for Maximizing Optimal Maternity Services (MOMS) Act, first proposed in 2019 and on the 2021 legislative agenda, would begin to rectify this disparity. The act would authorize two federal funding streams to support basic and graduate nursing and midwifery education and training programs, with a specific focus on support for clinical preceptors and designated funding to increase racial and ethnic representation within midwifery programs.

ACNM sees the act as a critical step in addressing the health disparities that disproportionately affect Black women and women of color.

“The demand for midwives is strong and is expected to continue,” Dr. Franklin says. “CNMs/CMs can provide sexual, reproductive, primary, and perinatal health care in a variety of settings to a variety of populations. And we are working to increase the diversity of CNMs and CMs with the goal of having a more diverse workforce that can more effectively address the issues facing vulnerable populations.”

The Future for Certified Nurse-Midwives (CNM) and Certified Midwives (CMs)

One emerging trend in midwifery is non-hospital births. While most births in America still occur in hospitals, the Covid-19 pandemic saw an increased interest in community births, either in birth centers or in homes. This has created the opportunity to collect more evidence of the safe and satisfying care that midwives provide in community settings.

Regardless of the setting, the future of midwifery rests in its critical role of addressing maternal and neonatal mortality rates. State and federal policy in the U.S. would do well to better empower the profession. Expanded insurance coverage, full scope of practice in every state, greater licensure recognition, better educational funding, and increased access to midwife-led care would increase the overall health of American women, parents, and children.

Midwifery, as a profession, will continue to support equitable, ethical, and accessible healthcare. It’s a field that’s predicated upon a compassionate partnership between practitioner and patient, and an individualized approach that prioritizes watchful waiting and non-intervention in the absence of complications. For both Dr. Jefferson and Dr. Franklin, midwifery is a challenging but rewarding profession.

“The most rewarding part of midwifery is the ability to make a difference in a patient’s life,” Dr. Franklin says. “That could include providing a positive first pelvic exam experience for a young woman, facilitating a patient to have exactly the type of birthing experience they want, or providing advice and support that helps a patient through a crucial or difficult time.”

“The best part about being a midwife is developing relationships with so many people throughout their life,” Dr. Jefferson says. “And having the privilege of being with people, especially first-time parents, at that moment when they become a family—nothing, to me, surpasses that.”