Key Responsibilities and Required Skills for Midwife

🎯 Role Definition

A Midwife provides autonomous and collaborative care for women and newborns across the antenatal, intrapartum, postpartum, and well-woman lifespan. This role centers on evidence-based midwifery practice, clinical assessment, labor management, complication identification and escalation, patient-centered education, and interprofessional teamwork with obstetricians, pediatricians, nurses, and community health providers. The midwife advocates for physiologic birth while ensuring safety through appropriate use of diagnostics, interventions, and referrals.

Responsibilities emphasize: prenatal risk assessment and health optimization, management of spontaneous labor and normal births (including VBAC when appropriate), intrapartum monitoring, postpartum care and lactation support, newborn assessment and initial stabilization, documentation and quality improvement, patient education and shared decision-making, and adherence to professional, state, and institutional standards.

📈 Career Progression

Typical Career Path

Entry Point From:

Registered Nurse (RN) with maternity/labor & delivery experience
Graduate of an accredited Midwifery program (MSN-CNM, CPM, CM)
Nurse Practitioner or Clinical Nurse with obstetrics rotation

Advancement To:

Lead Midwife / Clinical Lead, Midwifery Services
Nurse Manager / Director of Maternal & Newborn Services
Clinical Educator or Faculty in Midwifery Programs
Advanced Practice Leadership (e.g., Chief Nursing Officer, Director of Women’s Health)

Lateral Moves:

Perinatal or Lactation Consultant
Community Health Midwife or Home Birth Midwife
Public Health Maternal & Child Health Specialist

Core Responsibilities

Primary Functions

Provide comprehensive prenatal care including history-taking, physical and pelvic examinations, routine screening and diagnostic testing (labs, ultrasound referrals), individualized risk assessment, and development of an evidence-based antenatal care plan that supports physiologic pregnancy and recognizes complications early.
Manage normal labor and birth from admission through delivery and immediate postpartum period: conduct ongoing maternal and fetal assessments, interpret fetal heart rate tracings and contractions, perform cervical exams, support progress of labor with non-pharmacologic and pharmacologic measures as appropriate, and assist vaginal deliveries.
Provide postpartum assessments and care for mother and newborn, including evaluation of uterine involution, hemorrhage risk, wound healing, pain management, mood screening for postpartum depression, contraceptive counseling, and individualized discharge planning.
Perform newborn assessment immediately after birth and during early postpartum: Apgar scoring, thermoregulation, feeding assessment, identification of congenital or transitional conditions, and initiation of newborn stabilization and neonatal resuscitation when required (NRP).
Identify maternal and fetal complications early (pre-eclampsia, hemorrhage, fetal growth restriction, placental abnormalities, prolonged labor, chorioamnionitis) and implement emergency protocols, escalate care and facilitate timely transfer/referral to obstetricians, anesthesiology, or tertiary centers.
Prescribe, administer and manage medications within scope and institutional policy (analgesia, oxytocics, antibiotics, prenatal vitamins), interpret laboratory results and imaging, and adjust clinical plans based on evolving clinical data.
Develop, document, and maintain accurate clinical records including prenatal visit notes, labor and delivery records, postpartum care documentation, prescriptions and referral orders using electronic medical records (EMR) systems.
Provide patient-centered education and counseling on prenatal health, labor and birth options, birth planning, breastfeeding and lactation support, newborn care, contraception and family planning, and preparation for parenting and postpartum recovery.
Lead and participate in multidisciplinary rounds and care coordination meetings to ensure seamless transitions between outpatient, inpatient, and community services and to align care plans with obstetric, pediatric, anesthesia and social work colleagues.
Support and supervise nursing staff, student midwives, and trainees in clinical settings, offering direct teaching, skills coaching and competency assessment for safe labor, birth and postpartum care.
Facilitate shared decision-making and informed consent conversations with pregnant people and families, balancing physiologic birth promotion with transparent discussion of risks, alternatives and indications for interventions such as induction, augmentation and cesarean delivery.
Provide perinatal mental health screening, initial counseling, and referral to behavioral health services when concerns such as anxiety, depression, or trauma are identified.
Counsel and manage patients seeking vaginal birth after cesarean (VBAC) by assessing eligibility, communicating risks/benefits, and providing supportive intrapartum monitoring and care when VBAC is undertaken.
Perform minor procedures within midwifery scope such as episiotomy repair, suturing of perineal lacerations, catheterization, IUD insertion/removal and placement of contraceptive devices as permitted by licensure and institutional policy.
Lead quality improvement initiatives and participate in morbidity and mortality reviews, perinatal safety committees and audits to reduce adverse outcomes and improve patient experience and clinical outcomes.
Maintain current certifications and licensure (e.g., CNM/CM, RN licensure, NRP, BLS/ACLS) and comply with state regulatory requirements, credentialing and privileging processes.
Provide community and outpatient midwifery services including prenatal clinics, well-woman visits, contraceptive counseling, home visits, and postpartum home-based follow-up when part of service model.
Collaborate with public health, social work and community resources to address social determinants of health that affect pregnancy outcomes (housing, nutrition, substance use, intimate partner violence) and make appropriate referrals and care plans.
Participate in program development and policy creation to expand midwifery-led models of care, outpatient group prenatal care or birth center services, supporting accessibility, equity and culturally safe care.
Ensure infection prevention, aseptic techniques and safe handling of biological samples, maintain compliance with institutional protocols for patient privacy and documentation (HIPAA or local equivalent).
Use patient satisfaction data and clinical metrics to inform service improvements, contribute to performance dashboards and meet institutional KPIs for maternal-newborn outcomes.
Provide telehealth prenatal and postpartum visits as part of hybrid care models, utilizing virtual assessment protocols, remote monitoring data and appropriate escalation procedures when in-person assessment is indicated.
Participate in on-call rotations to provide labor and delivery coverage, triage incoming patients, coordinate transfers and provide emergent obstetric decision-making during off-hours.
Teach and lead antenatal education classes (labor preparation, breastfeeding, newborn care) to expectant families, fostering empowerment and improving birth literacy and postpartum adaptation.

Secondary Functions

Contribute to multidisciplinary education sessions, in-service trainings and community outreach events to promote maternal-child health and midwifery services.
Assist with data collection for clinical research, registries and evidence-based practice projects to advance midwifery outcomes and institutional protocols.
Support administrative tasks such as scheduling, referral coordination and authorization for diagnostic testing in collaboration with clinic staff.
Mentor and precept students and new clinicians, provide feedback on clinical skills and professional development plans.
Participate in community partnerships for perinatal health initiatives, breastfeeding support groups and home visiting programs aimed at improving access and equity.
Maintain inventory of delivery and emergency supplies, ensure equipment (resuscitation, monitoring) is functional and report needs to clinical leadership.
Help create and update patient educational materials and web content to reflect current best practices and institutional care pathways.
Engage in performance improvement projects focused on reducing cesarean rates, optimizing postpartum care pathways, and improving breastfeeding initiation and continuation.
Support billing and coding accuracy by documenting services and diagnoses in accordance with payer and institutional requirements.

Required Skills & Competencies

Hard Skills (Technical)

Evidence-based obstetric and gynecologic assessment (antenatal, intrapartum, postpartum) with strong clinical reasoning and differential diagnosis.
Proficient in fetal monitoring: intermittent auscultation, electronic fetal heart rate interpretation, and intrapartum monitoring protocols.
Neonatal assessment and stabilization skills including NRP (Neonatal Resuscitation Program) techniques and newborn transition management.
Skilled in management of normal spontaneous birth, assisted vaginal birth (where applicable), and readiness to manage obstetric emergencies (postpartum hemorrhage, shoulder dystocia).
Medication management and prescribing within scope (oxytocin, analgesics, antibiotics, magnesium sulfate protocols awareness), plus ability to interpret labs and order diagnostics.
Competent in suturing and repair of perineal lacerations, episiotomy repair, catheterization, and basic office procedures (IUD insertion, contraceptive implant counseling).
Electronic Medical Record (EMR) fluency for charting, ordering, and documentation (e.g., Epic, Cerner, Athena).
Proficiency with telehealth platforms for virtual prenatal and postpartum visits and remote patient monitoring.
Quality improvement and safety methodologies (PDSA cycles, root cause analysis) and experience with perinatal metrics reporting.
Basic ultrasound skills for fetal position and growth assessment (if scope/allows) or ability to coordinate and interpret imaging results with radiology/OB.

Soft Skills

Excellent interpersonal communication and counseling skills to build trust, explain complex clinical information and facilitate shared decision-making.
Calm, decisive leadership in high-stress or emergency situations with demonstrated triage and escalation judgment.
Cultural humility and sensitivity with ability to provide trauma-informed, equitable care to diverse populations.
Team collaboration and conflict resolution skills for effective multidisciplinary coordination (obstetrics, pediatrics, anesthesia, nursing).
Strong organizational skills and time management to balance clinic, on-call, and documentation responsibilities.
Teaching and mentoring aptitude for educating patients, families, students and junior staff.
Empathy, advocacy, and patient-centered approach that supports autonomy and informed choices.
Analytical mindset for interpreting clinical data, trends and applying evidence to individualized care plans.
Resilience and adaptability to evolving clinical guidelines and changing care models.
Attention to detail and commitment to compliance with regulatory, safety and documentation standards.

Education & Experience

Educational Background

Minimum Education:

Masters of Science in Nursing (MSN) with accredited Midwifery program (CNM) or accredited direct-entry midwifery credential (CM/CPM) plus state licensure OR
Bachelor of Science in Nursing (BSN) with completion of accredited midwifery graduate program

Preferred Education:

Postgraduate certifications (e.g., Fetal Monitoring, Lactation Consultant certification) or Doctor of Nursing Practice (DNP) with a focus in midwifery/obstetrics
Additional training in perinatal mental health, maternal-fetal medicine collaborations or public health

Relevant Fields of Study:

Midwifery
Nursing (Obstetric focus)
Women’s Health / Reproductive Health
Public Health / Maternal and Child Health

Experience Requirements

Typical Experience Range:

1–5 years clinical experience in labor & delivery, antepartum, postpartum, or community midwifery settings for entry CNM roles; 3–7+ years recommended for senior/lead positions.

Preferred:

At least 2 years of direct labor & delivery experience (triage, delivery room, postpartum)
Demonstrated experience with on-call coverage and emergency obstetric management
Experience working in hospital, birth center or community birth settings with established referral pathways

Licensure & Certifications:

Active Registered Nurse (RN) license where applicable and state Midwifery credentialing (CNM/CM/LM) as required
Current Neonatal Resuscitation Program (NRP) certification and Basic Life Support (BLS); Advanced Cardiac Life Support (ACLS) preferred or as required by employer
Fulfillment of institutional privileging and credentialing requirements; malpractice coverage as required

Clinical performance is evaluated on safety metrics, maternal-newborn outcomes, patient satisfaction, adherence to evidence-based protocols, and contribution to team-based care and quality initiatives.