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ACNM Ultrasound Education

Ellen Margles, CNM

Prepare for your Ultrasound Exam with the Midwife Sonography ExamSim by ACNM and Pegasus Lectures, Inc.!

The ExamSim provides simulation of the ARDMS Midwife Sonography examination with interactive test-taking, three timed full length exams, a patented algorithm to help the user determine their level of preparedness to sit for the exam, and more! 

By using this invaluable ExamSim tool to prepare for your Midwife Sonography Exam, you will have studied the key concepts, focused on your areas of weakness, and used your valuable study time efficiently and effectively.
After the eligibility requirements have been met and your application has been approved, you can take the computer-based examination. The Midwife Sonography examination is only offered during select periods of the year. See schedule below.

Application Dates for
      Midwife Sonography Examination    

Administration Dates for
     Midwife Sonography Examination      

December 5, 2018 - February 20, 2019

March 6, 2019 - April 3, 2019

Updated eligibility requirements were developed that accurately reflect midwifery scope of practice which should enable more midwives to become eligible to take the exam. With more midwives taking the exam, we're confident the exam process will meet national certification standards for the midwifery community. ACNM members can review the updated eligibility requirements, certification process, testing locations, and sign up for exam reminders at

  • Visit for information and resources ACNM has available to help you prepare for the examination, including updates about workshops, exam simulations and other materials.
  • Sign-up for the ultrasound Pegasus education programs at ACNM's ultrasound education partner has an online exam simulation program, a comprehensive, modular eCourse to teach ultrasound principles, and it offers hands-on training.


Expansion of midwifery practice to include

scope of midwifery practice may be expanded beyond the core competencies to
incorporate additional skills and procedures that improve care for women and
their families. The performance of ultrasound examinations is one skill which
can be integrated into midwifery care according the expansion of practice
guidelines outlined in Standard VIII of the Standards for the Practice of

In 1996, ACNM
published the first clinical bulletin providing guidelines for midwives who
expressed an interest in incorporating third trimester ultrasound examinations
into their clinical practice. The document was retired in 2009 yet clinical
practice has changed in that many midwives are now adding all trimesters of
ultrasound examination and gynecologic ultrasound to their clinical practice
(ACNM Survey, 2010). ACNM published an updated position statement in 2012
titled "Midwives: Performance
of Ultrasound in Clinical Practice
." The statement reviews scope of practice, expansion of
practice beyond the core competencies, avenues for practice expansion,
reimbursement, licensing and regulation. The statement posits "With appropriate
additional training as outlined by ACNM, AIUM, ACOG or AWHONN, midwives may
perform ultrasound examinations within the scope of midwifery practice. It is
not necessary for midwives to achieve competency in all types of ultrasound;
they may tailor their education and training to the specific type of ultrasound
examination(s) they wish to perform."

National guidelines

Expanded guidelines
for the performance of all types of obstetric ultrasounds have been published
and updates maintained by three professional organizations: The American Institute of Ultrasound in Medicine (AIUM), the American College of Obstetricians and
(ACOG), and
the Association of Women's Health, Obstetric, and
Neonatal Nursing
(AWHONN).  ACNM is working with AIUM to develop joint guidelines.

Membership Survey

In August of 2013, a
survey was presented to all ACNM members to determine clinician demand. The
results of the survey validated a call for action as evidenced in the following:

  • 91% of respondents agreed that there is a need for the development of a credential/certificate examination in women's health ultrasound.
  • 95% of those in favor of a credential/certificate believe that improved patient care would be the biggest benefit to the midwife community.

  • 83% of respondents said they would be interested in obtaining a credential/certificate examination in women's health ultrasound.
  • Of these, only 9% felt that their current level of knowledge would be sufficient to take a credentialing/certification examination in ultrasound.

2013, the ACNM Board of Directors approved the formation of a joint task force
with the American Registry for Diagnostic Medical Sonography (ARDMS) to explore
how best to support midwives' ability to become credentialed and reimbursed for
performing ultrasound. Key members of ACNM worked collaboratively with ARDMS to
develop a midwife specific test with leadership from Cydney Menihan CNM, RDMS
and Diana Dowdy CNM, RDMS.

Ultrasound Education
Task Force

ACNM Board of directors charged a newly formed task force to develop didactic
and clinical education opportunities for midwives across the nation. Content
objectives for didactic and clinical courses were developed and disseminated.
An affiliation between Pegasus Lectures and ACNM was
developed to offer midwives on-line didactic education and test review courses.

Didactic content

ACNM encourages an
ultrasound educational component that includes the following:

  1. Physics and instrumentation relevant to type of exam to be performed (e.g., physics of ultrasound, proper use of machine and transducer selection, ALARA principle).
  2. Required elements and components as described by AIUM for a specific exam to be performed (e.g., imaging parameters for each trimester).
  3. Required anatomic landmarks defined by AIUM pertinent to type of exam to be performed (e.g., landmarks for biometry).
  4. Indications for exam (e.g., indications for POC versus the Standard Examination).
  5. Clinical implications of normal and abnormal findings (e.g., documentation, communication, consultation).
  6. Ultrasound safety (e.g., output, frequency, length of exams).
  7. Components of a complete ultrasound report (e.g., orientation of image, documentation).
  8. Client education (e.g., explanation of procedure, communication of results).
  9. Additional didactic content can be specific to type of sonograms to be performed (e.g., first-trimester dating vs. cervical length).
Clinical component:

the completion of the clinical component, each midwife will be able to perform
OB/GYN ultrasounds by successfully visualizing each anatomic structure and
obtaining the necessary measurements in the following areas: physics and
instrumentation relevant to the exam being performed. Task force member Anthony
Lathrop adapted a rubric for members to document hands-on competency achievement
and include in their ultrasound education portfolio. A complimentary copy of
this rubric is available on ACNM Store.

Clinical instruction will include,

  1. Required elements and components as described by AWHONN, ACOG or AIUM for the type of exam to be performed.
  2. The required anatomic landmarks as described by ACOG or AIUM pertinent to the type of exam to be performed.
  3. Indications for type(s) of exam(s) being performed.
  4. Clinical implications of normal and abnormal findings,
  5. Ultrasound safety.
  6. Components of a complete ultrasound report.
  7. Patient education.8. Process of informed consent regarding the scope and limitations of the various ultrasounds performed.
  8. Process of informed consent regarding the scope and limitations of the various ultrasounds performed.
Other educational venues have
adopted midwifery specific learning objectives:

InnovatED ultrasound Midwives' Course -

Gulf Coast Ultrasound -

Professional Education Center -

Sonosession -

Thomas Jefferson University -

University of Colorado -

Task Force Members

Thomas Chappel,CNM, MSN, Clarendon
Health Systems, Manning, South Carolina

Terri Clark, CNM, PhD, FACNM, Graduate
Nurse-Midwifery Track Lead, Seattle University

Carolyn Gegor, CNM,
MS, FACNM, Former Program Director, Midwifery Program, Georgetown University

Kantrowitz-Gordon, CNM, PhD, Program Director, University of Washington

Faith Harris, CNM, APN, MSN Advocate
Health Care, Chicago Illinios

Ann Konkoly, CNM,MSN University Hospitals, Cleveland, Ohio

Anthony Lathrop,
CNM, PhD, RDMS, Indiana University Health

Cydney Afriat
Menihan, CNM, RDMS, (ex-officio advisor to the task force), past-chair,
Perinatal Productions

Sarah Morrow, CNM, MSN, Three Lower
Counties Community Services, Salisbury, MD

Robbins-North, MSN, CNM, WHNP, 31st Medical Group, Aviano, Italy

Watkins CNM MSN, Family Birth Center, Great Falls, MT

Ostrem-Niemcewicz (Task Force Chair), CNM, DNP University of New Mexico

Venay Uecke CNM, MSN Gallup
Indian Medical Center, Gallup New Mexico

Staff Liaisons

Elizabeth Hill-Karbowski, Director of MPEGO, 240.485.1840


Textbooks available on SHOP ACNM

Gill, K (2013). Davies: Ultrasound
in Obstetrics and Gynecology. A practitioners Guide. 4th ed.

Miele, F. (Director). (2016). Introducing
Ultrasound into your practice: Why and How to Prepare

Menihan, C. & Kopel, E. (2014).
Point-of-Care Assessment in Pregnancy and Women's Health: Electronic Fetal
Monitoring and Sonography.

Introducing Ultrasound into your practice: Why and How to Prepare, f

Shepherd, G.W. & Gaston, J. B. (2016).  The Complete Ultrasound Guide for Nurse
Midwives. Sonocations: New Paltz, NY.

Resources to guide practice

ACNM (2012) Position
Statement:Midwives' Performance of Ultrasound in Clinical Practice,
retrieved from

ACNM (2011)Standards for
the Practice of Midwifery, retrieved from

ACOG (2009; Reaffirmed in 2014).Ultrasonography
in pregnancy. Practice Bulletin 101, retrieved from

AIUM (2013) AIUM Practice
Guideline for the Performance of Obstetric Ultrasound Examinations,
retrieved from

AIUM (2018) AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers retrieved from

AIUM (2018) Training Guidelines for Advanced Clinical Providers in Women's Health Performing and Interpreting Limited Obstetric Ultrasound retrieved from


Dowdy, D. (2016). Keepsake
Ultrasound: Taking Another Look. Journal of Radiology Nursing, 35(2),

Lathrop, A., & Blackburn, M.
(2011). Learner Portfolios and Hands‐On
Workshop to Facilitate and Evaluate Nurses' Learning in Obstetric Ultrasound. Journal
of Obstetric, Gynecologic, & Neonatal Nursing, 40(5), 654-661.

Menihan, C. A. (2000). Limited
sonography in collaborative midwifery practice. Journal of Midwifery &
Women's Health, 45(6), 508-516.

J., Young‐Lin, N., Bearman, S., Dau, K., & Vargas, J. (2015).
Interprofessional Obstetric Ultrasound Education: Successful Development of
Online Learning Modules; Case‐Based Seminars; and Skills Labs for
Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees. Journal
of Midwifery & Women's Health, 60(6), 727-734.


The ACNM New Mexico
Affiliate has developed a toolkit to guide members on expanding their
practice following Standard VIII of the ACNM Standards for the Practice of

Older documents

ACNM (1996).Limited
Obstetrical Ultrasound in the Third Trimester(Clinical Bulletin No.
1) Washington, D.C.

ACNM (2010) Position
Statement:Midwives' Performance of Ultrasound in Clinical Practice,
retrieved from


American College of Nurse-Midwives.
8403 Colesville Rd, Suite 1550 | Silver Spring MD 20910
Phone: 240-485-1800 | Fax: 240-485-1818
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