Return to Learn > Continuing Education > Ultrasound Education

ACNM Ultrasound Education

ARDMS Midwife Sonography Exam Update:
Midwives are encouraged to consider obtaining an ARDMS Midwife Sonography Certificate when adding ultrasound as an expansion to their clinical practice. The Midwife Sonography examination assesses the knowledge, skills, and abilities in the areas of the female reproductive system as well as the fetus in the first, second, and third trimesters of pregnancy. By earning the Midwife Sonography Certificate, midwives gain a critical edge in promoting public safety in women’s point-of-care ultrasound.

For more information specific to the exam please visit: https://www.ardms.org/get-certified/midwifery/

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

??Ellen Margles, CNM
Ellen Margles, CNM
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.

ARDMS Ultrasound Education and Certification

Beginning in 2013, ACNM worked with the American Registry of Diagnostic Medical Sonographers (ARDMS), to develop a means for CNM/CMs to be able to become certified in Point of Care (POC) bedside ultrasound examinations. The first Midwife Sonography Examination was given by the ARDMS in 2017. 

Midwives are increasingly adding ultrasound as a skill to their practice. The reasons are many, e.g. to be able to make bedside diagnoses that matter in overall care of the women in their care. As more midwives are covering triage in L&D, the skills for assessing fetal presentation, placental location and biophysical profiles. Others are utilizing ultrasound for identification of IUD placement and first trimester assessment of gestational age and well being of the pregnancy. Dating in the second trimester is helpful for late registrants and for supervision of fetal growth. It is also important to have the skill to assess cervical length and integrity. Multiple approaches to gaining education in ultrasound follows. Also of great interest to many is the Midwifery Sonography Examination to obtain certification in scanning.

Of particular importance are new national guidelines written specifically for midwives and the use of ultrasound as a Point of Care (POC) bedside care diagnostic tool. ACNM has recently updated it’s Position Statement, "Ultrasound in Midwifery Practice."

The American Institute of Ultrasound in Medicine (AIUM) partnered with ACNM and the American College of Obstetricians and Gynecologists (ACOG) as well as other organizations to publish “AIUM Practice Parameters for the Performance of Limited Obstetric Ultrasound by Advanced Clinical Providers,” as well as “Training Guidelines for Advanced Clinical Providers in Women’s Health Performing and Interpreting Limited Obstetric Ultrasound."

Application Dates for
      Midwife Sonography Examination    

Administration Dates for
     Midwife Sonography Examination      

April 12,2022-June 22, 2022
July 5-August 4, 2022

Ultrasound Education

How can you get the education you need for practice as well as the 12 credit hours in ObGyn ultrasound to take the certification exam? ACNM has partnered with Pegasus Lectures, Inc. to provide several online lectures to meet the ARDMS requirements and to provide the credit hours you need (http://pegasuslecturesmediacen... are a number of other organizations and publications that now provide information, online lecture, classroom lecture and/or hands on scanning that will meet the specific requirements for this exam.

Educational Resources:

InnovatED ultrasound Midwives' Course - https://www.innovatedultrasound.com/midwivescourses

Pegasus - https://pegasuslectures.com/midwifesonography.php

Professional Education Center - https://www.proedcenter.com/ultrasound-training2.html

Sonosession - http://sonosession.com

Thomas Jefferson University  - http://www.jefferson.edu/university/jmc/departments/radiology.jurei/cme_courswes/limited_ultrasound.html

Ultrasound for Midwives http://www.UltrasoundforMidwives.com

University of Colorado  - https://www.regonline.com/builder/site/Default.aspx?EventID=1775001

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. 

Menihan, C.A., (2019) Ultrasound for Advanced Practitioners in Pregnancy and Women’s Health.
Jones & Bartlett: Burlington, MA

Shepherd, G.W. & Gaston, J. B. (2018).  Introduction to Ob-Gyn Ultrasound for the Medical Practitioner. Sonosession: Asheville, NC.


ACOG (2009, Reaffirmed in 2014). Ultrasonography in pregnancy. Practice Bulletin 101, retrieved from http://www.acog.org/~/media/Practice%20Bulletins/Committee%20on%20Practice%20Bulletins%20--%20Obstetrics/pb101.pdf?dmc=1&ts=20140828T1112546585

Abuhamad A. Ultrasound in Obstetrics & Gynecology: A Practical Approach. Accessed at: https://www.evms.edu/obstetrics_and_gynecology/ultrasound_ebook/

Dowdy, D. (2016). Keepsake Ultrasound: Taking Another Look. Journal of Radiology Nursing, 35(2), 119-132.

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.

Shaw-Battista, 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 Midwifery. http://newmexico.midwife.org/i... Midwife Sonography Examination

What do you need to do to become certified?

  • Hold an active CM or CNM Certification
  • Submit 12 ARDMS-accepted CMEs or education hours in OB/Gyn ultrasound earned within 5 calendar years of application submission
  (ACNM CEUs related to ultrasound are acceptable.)


  • Pay the $300 application fee
  • Submit the required documentation within 21 days of applying

Schedule the Exam

through RDMS.org

Prepare for the Exam Review the content outline at

PearsonVue Center - ARDMS.org/MW



Sit for the Exam

2 hrs, 100 questions


Must be completed within 2 years of passing the written exam

Submit documentation demonstrating successful performance
Completion of 8 cases across defined domains through direct observational assessments.


Submit documentation demonstrating successful performance completion of 8 cases across defined domains through a combination of direct observational assessments and simulation.
3 of the 8 cases may be through simulation.

the written exam was passed more than 6 months ago,
5 New ARDMS-accepted CMEs or education hours in OB/Gyn ultrasound are required

Receive your Midwife ARDMS Sonography Certificate
within 4 - 6 weeks of successfully completing the practical examination

To learn more about the details of the examination, both written and practical components, go to http://ardms.org/get-certified/midwifery/Pages/midwife.aspx

This exam is designed to meet the needs of midwives caring for women at the bedside (Point of Care). There is no intent to require skills to be a full-scope OB/Gyn ultrasonographer. Conversely, there is a range of knowledge that is required to produce and interpret quality images in appropriate clinical situations. Following is a summary of the topics and percentages of the exam related to the topic. These are the topics that have been considered essential by ACNM https://www.aium.org/resources/guidelines/LimitedOB_Providers.pdf, ARDMS http://ardms.org/get-certified/midwifery/Pages/midwife.aspx and the American Institute of Ultrasound in Medicine which has been supported by the American College of Obstetricians and Gynecologists https://www.aium.org/resources/guidelines/LimitedOB_Providers.pdf .

Midwife Focused Sonography Content Outline

Focused gynecologic ultrasound exams 14%

  • Assess and record uterine position and measurement of depth, width and length
  • Assess both adnexa
  • Identify endometrial fluid
  • Measure the endometrium in the anteroposterior dimension
  • Assess the posterior and anterior cul-de-sacs
  • Identify intrauterine device (IUD) position
  • Identify ovarian cysts/masses
  • Perform exams for assisted reproduction techniques (e.g. follicular measurements, etc)
  • Use transabdominal scans and transvaginal scans in gynecologic patients, i.e. indications for using transabdominal vs. transvaginal scans
Focused first trimester OB exams   19%

  • Identify the double decidual sac sign
  • Identify the yolk sac
  • Measure gestational sac using the mean sac diameter
  • Measure the crown rump length
  • Identify signs of a failed pregnancy (e.g., anembryonic gestation, enlarged or echogenic yolk sac, embryonic or fetal demise)
  • Identify an ectopic pregnancy
  • Correlate human chorionic gonadotropin (hCG) with abnormal pregnancies (e.g. ectopic, hydatiform mole, other)
  • Use transabdominal and transvaginal transducers as indicated
Focused second and third trimester OB exams 35%

  • Establish fetal lie and presentation
  • Document placental location
  • Identify multiple gestations
  • Assess amniotic fluid volume
  • Perform biophysical profiles
  • Measure the biparietal diameter (BPD)
  • Measure the head circumference
  • Measure the abdominal circumference
  • Measure the fetal femur length
  • Measure cervical length
  • Identify components on an incompetent cervix
  • Assess for causes of bleeding
  • Identify fetal demise
  • Perform exams on high risk pregnancies (e.g., amniotic fluid index for biophysical profile surveillanced exams)
  • Identify specific components of the ultrasound exam as indicated by maternal/fetal complications
Protocols 13%

  • Determine necessity of maternal bladder filling based on the indication of the exam
  • Obtain pertinent clinical history as part of the exam
  • Check the results of a previous ultrasound exam
  • Inform a physician of findings that may be of an emergent nature
  • Refer patient when necessary based on finding from the focused ultrasound exam
Using the ultrasound system                       19%

  • Use knowledge of sound reflection as it relates to variations in tissue density
  • Adjust display depth based on the exam being performed
  • Adjust overall gain
  • Adjust the focal zone
  • Adjust time gain compensation (TGC)
  • Choose a specific transducer frequency based on the area being scanned
  • Use a curved linear ray transducer
  • Use a transvaginal transducer
  • Clean and disinfect transducers in accordance with manufacturer’s guidance
  • Modify the exam based on artifacts
  • Modify the exam based on the displayed mechanical index and the thermal index on the fetus
  • Practice the ALARA (as low as reasonably achievable) principle
  • Recognize the mechanisms for potential biologic effects
  • Document embryonic and/or fetal cardiac activity using M-mode
                                    Modified from http://ardms.org/get-certified/midwifery/Pages/midwife.aspx

                                    For more specific information regarding the practical exam, please go to:


Background: Expansion of Midwifery Practice to Include Ultrasound

The 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 Midwifery (ACNM, 2011).

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."

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.

In 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

The 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.

Task Force Members

Kristen Ostrem-Niemcewicz (Task Force Chair), FACNM, CNM, DNP
Thomas Chappel, CNM, MSN
Terri Clark, CNM, PhD, FACNM
Diana Dowdy, CNM, FACNM
Carolyn L. Gegor, CNM, MS, FACNM
Ira Kantrowitz-Gordon, CNM, PhD
Faith Harris, CNM, APN, MSN
Anthony Lathrop, CNM, PhD, RDMS
Cydney Afriat Menihan, CNM, RDMS
Vanessa Robbins-North, MSN, CNM, WHNP
Kathy Watkins CNM MSN
Venay Uecke CNM, MSN
American College of Nurse-Midwives
8403 Colesville Rd. Ste. 1230 Silver Spring, MD 20910
Phone: 240.485.1800 Fax: 240.485.1818
All rights reserved