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Certified nurse-midwife

What a newly certified nurse-midwife must do to manage low-risk pregnancy, labor, birth and the postpartum period safely, and to consult, collaborate or transfer the moment risk rises, drawn from ACNM's Core Competencies for Basic Midwifery Practice, the document the AMCB certification examination is built on.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
5
Sources
3
Version
1

Built from American College of Nurse-Midwives, American Midwifery Certification Board, American College of Obstetricians and Gynecologists and American College of Nurse-Midwives. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent certified nurse-midwife does on day one, dimension by dimension.

Clinical skills

  • Supports physiologic labor and birth, judges progress and fetal wellbeing against current definitions, and manages the birth and third stage safely.
  • Recognizes the cues that a mother or fetus is deteriorating - hemorrhage, severe hypertension, infection, fetal compromise - acts at once, and does not explain them away.

Workflow and tools

  • Documents labor, birth and emergencies accurately and at the time, so the record shows what was seen, done and decided, and when.
  • Works with obstetricians, nurses, and pediatric and anesthesia colleagues as one team, resolves disagreement through the patient's condition, and closes the loop.

Patient communication

  • Presents the real options, including waiting, with absolute numbers in plain words, finds out what matters to the woman, asks consent before each intervention, and respects an informed refusal.
  • Teaches the warning signs and self-care that keep mother and baby safe after discharge, and confirms understanding by teach-back.

Compliance and safety

  • Consults, collaborates or transfers the moment risk rises beyond midwifery management, says clearly what they need and by when, and confirms the other clinician has received and accepted it.
  • Prescribes and gives the drugs of pregnancy, labor and the postpartum period with their contraindications, doses and monitoring in mind.

Role knowledge

  • Knows the edge of basic midwifery competencies, their privileges, the practice's consultation guidelines and the birth setting's standards, and keeps mother and baby safe while bringing in the right care.
  • Explains how they judge whether a study or guideline applies to the people they care for before changing practice.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Attributes a sign of maternal or fetal compromise to a benign cause and continues routine care or plans to recheck later - heavy bleeding with a rising pulse put down to adrenaline or anxiety, a severe headache with severe-range pressures put down to tiredness, recurrent late decelerations with lost variability put down to position.

    Postpartum hemorrhage, preeclampsia and fetal hypoxia are among the leading preventable causes of maternal and newborn death and injury, and in each the delay is the harm.

  • Delays consultation or transfer to wait and see when a finding requires it - severe-range blood pressure, a Category III tracing, hemorrhage not responding to first-line treatment, a community labor that needs hospital care - or leaves a message and treats it as done without confirming that a clinician has received it and is acting.

    Obstetric emergencies are time-critical, and a consultation that nobody received gives the woman and baby none of the help it was meant to bring.

  • Would alter a time, rewrite a fetal heart rate interpretation after the outcome is known, backdate an entry, or record a consultation or assessment that did not happen.

    The next clinician, the family and any review rely on the record, and a falsified one is professional misconduct in every jurisdiction.

  • Performs or would perform an intervention - an episiotomy, artificial rupture of the membranes, a vaginal examination - without the woman's consent, or after she has declined it.

    A procedure done without consent is a violation of bodily autonomy and battery in law, and it destroys the trust labor care depends on.

  • Undertakes a procedure outside basic midwifery competencies and their privileges, such as a vacuum-assisted birth or the repair of a third- or fourth-degree laceration, rather than bringing in a clinician who is credentialed for it.

    The woman and baby carry the risk of an operator who is not trained to manage the procedure's complications, and practice beyond privileges is unlawful.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not perform procedures beyond basic midwifery competencies - operative vaginal birth, repair of third- or fourth-degree lacerations, external cephalic version, first assist at cesarean - without documented additional training and the privileges for them.Brings in the obstetrician, does everything within basic scope meanwhile, and extends scope only through ACNM's expansion process and facility privileging.
  • Does not keep sole management of a pregnancy, labor or postpartum course once a condition arises that the practice's guidelines require to be consulted on, co-managed or referred.Consults or transfers with a structured handover, and continues midwifery care within the shared plan.
  • Does not attend a home or birth center birth for a woman whose risk the setting's standards and state rules exclude, such as breech presentation, twins or preterm labor.Arranges hospital birth with obstetric care, stays involved in her care where possible, and documents an informed refusal without abandoning her if she declines.
  • Does not manage a sick newborn beyond immediate resuscitation and stabilization, or provide care beyond the neonatal period.Resuscitates following the neonatal resuscitation program and hands over to the pediatric or neonatal team.
  • Practice authority varies by state, some states require a written collaborative agreement, and the certified nurse-midwife credential is specific to the United States.Works to the state's rules and any required agreement, applies this standard to US practice, and follows the local regulator's scope elsewhere.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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