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The Latent Phase: Navigating the Midwifery Certification Exam

By Stephanie Tillman, CNM, MSN

Every once in a while, my emotions take over. The daily grind outweighs the beauty of individual interactions, and I (silently, or actually) yell out, “I just want to be a midwife!”

Well, guess how that happens? Every midwife first takes the certification exam.

There is the rational preparation of studying, practice questions, a good night’s sleep, and maintaining one’s normal routine the morning of the exam. Perhaps the difference with the certification exam is that for so many, midwifery became the ultimate, the second career long aspired – or maybe it’s the absolute certainty of an upcoming long career of beautiful work. This exam feels, emotionally and logistically, like far more of a lifetime event than other exams.

Silver lining of this whole thing? Each student midwife has already studied for this exam with each moment caring for women, each birth, each day in class or session with an experienced midwife.

The nagging bits are all those facts that just won’t stick, the surprises we never learned during school or years of experience, and the knowledge that, despite all our preparation, the first year of practice will command continued learning. The exam is only the beginning of realizing what we don’t know.

Like with labor and birth, is there comfort in knowing that many before you have travailed, sweated and grunted, ultimately succeeded, and celebrated afterward? During my exam preparation, I discovered volumes of information I did not know. On top of that, the list of “what to study” (also known as the list of “what to know as a midwife”) seemed positively inhumane. And yet, midwives somehow tap into that knowledge every day. Despite feeling overwhelmed, each study session began with a mantra: “I will join the ranks. I will be a midwife.” So, I started to organize myself. Like a woman in labor, I’m glad my words of comfort are catching y’all early!

My experience with the exam may be helpful to some – I am not too far removed from the experience. But I also checked in with my graduating class and midwives on Facebook and Twitter to find out what others had to say. I assure everyone currently studying that we recent graduates send you oodles of positive vibes, memory cells, and intuition. You can absolutely do this! Below is a list of our collective best advice – the links are mostly to Amazon for ease of ordering, but always check at your local bookstore and with your local midwife counterparts to access their resources!

  • Practice questions. Hundreds of them. This is the bread and butter of exam prep, hands down.
  • If I discovered, in practice questions or their answer choices, facts or concepts I had not yet mastered, I created a separate list for “still need to study.”
  • I rotated continuing to challenge myself with practice questions, studying information I thought I already knew, and systematically tackling the “still need to study” list.
  • Read midwifery memoirs. Those are LOADED with fantastic wisdom and intuition about what to do in certain situations. The books I read through during my final semester were Carol Leonard’s Lady’s Hands, Lion’s Heart and Into These Hands, edited by Geraldine Simkins.
  • I mixed academic texts with each topic. Varney’s Midwifery was my mainstay, largely supplemented with Linda Wheeler’s Nurse-Midwifery Handbook for obstetric info, and Schuiling and Likis’ Women’s Gynecologic Health for gynecologic info. I picked one topic and read about it in all 2 or 3 resources, and felt good to go.
  • I also loved using my CNM Exam Prep iPhone app for practice questions on-the-go. The Certified Nurse Midwife Exam Prep from Upward Mobility is available for the iPhone and iPad. I used this in every spare moment.

What did other people say?

  • “Don’t get too worked up about the exam, trust that what you've studied/experienced has, in fact, taught you something, and that you can think through the problems presented. And take care of yourself while studying (sleep, good food, exercise)!” Absolutely!
  • “I studied the Green Book (ACNM Exam Prep Workbook) only.” Friends with whom I studied had some great information and practice questions from this book.
  • “The Green Book, old study guides, and the Midwifery / Women’s Health Nurse Practitioner Certification Review Guide.” I never had my hands on this guide, but saw many classmates with it!

Some people also attend the Exam Prep Workshop at the ACNM Annual Meeting, which can be incredibly helpful. Whether you are at the beginning or end of your studying, this workshop can give you structure and strategies to think through questions and answers.

Now, from this list, how the heck would one ever figure out what books to get, where to start studying, and how to make sense of it all? Here’s my final pointer: start with what you have. The exam itself is expensive, so check whether the resources you already have are still encouraging your own learning before purchasing new resources. If you need new material and do not already have access to practice questions, consider splitting a shopping list with classmates and rotating books. Never undervalue the notes, PowerPoints, and go-to resources you use on the daily.

Get all of the paperwork in order so last-minute tasks won’t weigh you down close to exam time, when you’ll really be cramming. Check with your academic program to see when your certification letters will be submitted, and the earliest date by which you can take the exam; I recommend taking it as soon as possible after completing your academic program. This capitalizes not only on the freshness of the information in your mind, but also advances the timeline by which you can apply for a job and necessary licenses and begin working as a midwife. Visit the American Midwifery Certification Board (AMCB) website to obtain the full list of requirements before exam time.

Take some deep breaths, reach out to graduates of the program before you for advice, and seek solace in knowing that midwives before you have succeeded, and so will you. And if you have exam fatigue one or multiple times, take a walk to the bathroom! Like with labor, find a mantra you can grab on to that focuses on the positive:

I can do this! I know how to care for women and families! I will be a midwife!

For all those midwives who have already taken the exam: we’d love to hear your tips! Let us know what worked for you during your exam review process. Leave a comment on this post or the ACNM or Feminist Midwife Facebook pages to give your feedback!

Stephanie Tillman is a recently-graduated Nurse-Midwife now practicing full-scope midwifery in the urban United States, at a Federally Qualified Health Center (FQHC) and as a member of the National Health Service Corps (NHSC). With a background in global health and experience in international clinical care, the impact of public health and the broader profession of midwifery are present in all her thoughts and works. Stephanie's blog, Feminist Midwife, discusses issues related to women, health, and care. Find out more at and follow her on Twitter at @feministmidwife.

Posted By Barbra Elenbaas | 1/24/2013 1:09:43 PM



Any opinions expressed in this blog are those of the individual participant(s) and do not necessarily reflect the views of the American College of Nurse-Midwives. ACNM is not responsible for accuracy of any of the information provided by guest bloggers and/or members via the Comments section. We welcome all feedback – including comments, ideas and suggestions. We also welcome civil, friendly debates. However, any and all content that is deemed inflammatory or rude will not be posted.


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