Oh snowy Alaska – you are so pretty. The babes and I went to a little town called Girdwood last week to go to the outdoor zoo (yes…. outdoor zoo, in 0 degree weather, in January – you read all of that correctly). The full moon over the mountains and town was too pretty to pass up! It almost looks like a postcard to me. It is a cold but majestic place! Onto midwifery things…

I’d like to do a small mini series on the state of midwifery in the United States and the obstacles ahead for the profession. This is not meant to start a spirited debate, but to bring to light facts and numbers that speak for themselves. It is only when we all acknowledge the facts that we can truly start working towards a common goal. I find that most people don’t have a good idea of where midwifery stands in the United States, or more importantly, where midwifery has the potential to go!

The ACNM (American College of Nurse Midwives) and the ACME (Accreditation for Midwifery Education) recently published a report titled “Midwifery Education Trends Report – 2019” in fall 2019. The report highlighted the current state of the road to midwifery and also the long road ahead. If you’re curious, there were also reports published in 2011, 2013, and 2015 – access them here. Let’s dig right in…

How many delivering providers work in the United States?

As of August 2019, the number of CNMs (certified nurse midwives) and CMs (certified midwives) was 12,655 and 111, respectively. In contrast, there were 33,624 OB/GYNs in 2010. That’s 3 times as many OB/GYNs as midwives. For comparison, OB/GYNs compromise only 5% of the 661,400 physicians in the United States (American College of Nurse Midwives [ACNM] & Accreditation for Midwifery Education [ACME], 2019). At the time of this writing, I wasn’t able to find a current number for practicing CPMs (certified professional midwives) in the United States but was able to confirm with the North American Registry of Midwives (NARM, Debbie Pulley) that they have issued a total of 3,693 certifications since the credential was certified in 1994. Ms. Pulley was unable to say how many CPMs are actively practicing.

How do we make more midwives?

Alas, that is a multi-faceted answer. Let’s start with the good news. According to the report, there are more than 500 CNM/CMs passing the midwifery exam each year! It’s hard to say how many of these individuals are going directly into practice, but the numbers are moving in the right direction. Additionally, NARM certifies a few hundred CPMs each year.

First, the pipeline into midwifery is a bit of a bumpy road. What does that mean? To start, midwifery schools are not easily accessible and many states don’t even offer a midwifery program. See the picture below. The report summarizes the main idea: “Despite the compelling need for more midwives to enter the workforce, there has been no growth in the number of ACME accredited midwifery education programs between 2009 and 2018” (ACNM & ACME, p. 5, 2019). For my own training, I moved to another state to attend my midwifery program (see more about my journey here). Additionally, some midwives pursue the path of CPM (read more about their path here). Second, maximizing student enrollment in the available midwifery programs continues to be a problem. Let’s take 2018 for example. In 2018, approximately 2,000 individuals applied for candidacy into a midwifery program; approximately 1,000 individuals were accepted; and 123 spots were unfilled. (ACNM & ACME, 2019). The average for vacant program spots from 2014 to 2018 was: 135 students a year (ACNM & ACME, 2019). Over a ten year period, that’s almost 1,000 midwives that could have started midwifery school! Why are these spots open? The report cites these reasons:

“Midwifery education program directors provided ACME with reasons for not reaching capacity which included insufficient qualified applicants, limited clinical sites and preceptors, and
applicants accepting positions in other midwifery programs” (ACNM & ACME, p. 6, 2019).

The good news is that some programs are moving to a distance format – a change that helps capture individuals that are not able to move to a physical campus. Midwives practice in all 50 states – but just because midwives practice in a state, doesn’t mean finding a preceptor is easy.

As cited in “Midwifery Education Trends Report – 2019“, finding preceptors and clinical sites is part of the problem:

“Midwifery program directors consistently indicate that they could increase graduation rates if more clinical sites and preceptors were available for midwifery students” (ACNM & ACME, p. 10, 2019).

Regardless of the barriers, the number of graduates is slowly but surely increasing each year.

What’s the predicted economic outlook for midwives?

The future is bright! As cited in the report: “According to the Bureau of Labor Statistics, the overall employment of nurse midwives is projected to grow 26% between 2018 and 2028, much faster than the average for all occupations. As of May 2018, the Bureau reported the mean annual wage of a certified nurse-midwife at $103,774 annually” (ACNM & ACME, p. 10, 2019). The median annual salary for a CPM is estimated at $54,201 (source).

How can we help make more midwives?

The report states that “direct funding for midwifery education has been identified by the ACNM as the number one priority for growing the midwifery workforce” (ACNM & ACME, p. 10, 2019). The remaining recommendations are:

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Did you read the report? What did you think? Did you know there were so many midwives in the United States? How do you think we can make more midwives?

Still have questions about the differences between the different types of midwives? Read this chart here.

How do we put these recommendations into practice? What can everyone do to help? Stay tuned for Part 2!

Jamie

References:

American College of Nurse Midwives & Accreditation for Midwifery Education. (2019). “Midwifery Education Trends Report – 2019“, 1-13.