The North American Registry of Midwives (NARM) Exam
Many women decide to have their children at home, instead of in a hospital. A doctor and nurse will not necessarily assist in these home births. Instead, women hire midwives to assist with their pregnancy and the birthing process. How can these women be certain they are hiring a competent professional? They seek out certified midwives.
Becoming certified is completely different than earning a license. Licenses are required while certification is usually voluntary. Midwives who decide to become certified submit themselves to a rigorous review process by an independent industry leading organization. Their education and experience credentials are carefully reviewed. They must pass a nationwide certification exam. Then, they must commit to continuing their education. Women can be assured that when they hire a certified midwife they are hiring an individual who can competently and safely treat them and their baby.
There are two types of certification a midwife can earn. The Certified Professional Midwife (CPM) credential, awarded by the North American Registry of Midwives, is for midwives who may not be nurses. The Certified Nurse-Midwife (CNM) and Certified Midwife (CM) certification, awarded by the American Midwifery Certification Board, is for midwives who may or may not have nursing experience. All certifications are equally recognized in the industry.
Passing a certified midwives exam will be a requirement for each certification. Midwives will need to pass the NARM Written Exam to earn the CPM credential. To earn a CNM or CM credential, midwives will need to pass the National Certification Examination in Nurse-Midwifery and Midwifery. Although the exams these organizations offer are different, the content and topic material is very similar. Both exams test knowledge and skills that are essential to perform (at the minimum) entry-level tasks.
NARM Written Exam
The NARM Written Exam is the last step in becoming a Certified Professional Midwife. The exam, offered 3 times a year, consists of 350 multiple choice questions. Exam questions are divided into 7 key categories:
- Labor, Birth, and Immediate Postpartum (35%)
- Prenatal (25%)
- Postpartum (15%)
- Maternal Healthcare Assessment (10%)
- Well Baby Care (5%)
- Midwifery Counseling, Education, and Communication (5%)
- General Healthcare Skills (5%)
Exam scores will be reported as pass or fail. The passing score does vary and is determined by the statistical process known as reverse Angoff. Each question is worth one point. Skipped questions will be treated as an incorrect answer. So, do your best to guess on questions you are unsure of. Scores are available 3 – 4 weeks after the testing date. If you fail the exam, you will receive a report detailing how you performed in the 7 key categories. There is no limit to the number of times you can retake the NARM Written Exam.
National Certification Examination in Nurse-Midwifery and Midwifery
The National Certification Examination in Nurse-Midwifery and Midwifery is administered by the American Midwifery Certification Board. It is a requirement to earn a CNM or CM credential. The 4 hour exam consists of 175 multiple choice questions. Questions are designed to test your clinical judgment, knowledge, and understanding of normal phenomena and deviations in the following categories.
- Intrapartum (25% - 35%)
- Antepartum (15% - 25%)
- Well Woman / Gyn (15% - 20%)
- Primary Care (12% - 16%)
- Newborn (10% - 15%)
- Postpartum (5% - 10%)
- Professional Issues (Up to 5%)
There will be a few pretest questions scattered throughout the exam. However, you will never know which questions count towards your score. Your overall score will be based on the number of questions you answered correctly. Guessing is encouraged because there is no penalty.
This exam is taken on the computer, so your scores will automatically be available. You will receive either a pass or fail score. It is possible to fail one category and still pass the exam. If you fail, you will receive a detailed report showing your performance in each of the categories. However, you only have 4 chances to pass this exam before you have to enroll in a series of continuing education programs.
Registering and Taking the National Certification Examination for Nurse-Midwifery and Midwifery
Midwives must register with the American Midwifery Certification Board (AMCB) in order to sit for this exam. AMCB has developed certain criteria that midwives must meet before they are allowed to take the National Certification Examination for Nurse-Midwifery and Midwifery. These criteria ensure that only midwives with a strong educational background are allowed to become certified.
Before you submit your application, you will need to decide which type of certification you are trying to earn. Midwives, who are also registered nurses, will need to apply for the CNM (Certified Nurse-Midwife). All others will need to apply for the CM (Certified Midwife).
Applicants who are considering earning a CNM credential must meet the following requirements:
- Have a current U.S. Registered Nurse license
- Have a graduate degree and complete the midwifery program requirements at an ACME accredited school
- Have verification that they successfully completed the nurse-midwifery part of the program
Applicants who are considering earning a CM credential will have to meet the same requirements, with one exception. They do not need to hold a nursing license. When you submit your application, you will also be required to pay a registration fee. This fee is non-refundable and does not guarantee that you will become certified. You must pass the exam to earn that designation.
Scheduling Your Exam Appointment
AMCB administers the exam through Applied Measurement Professionals (AMP) testing centers. The exam is offered 6 days a week, Monday – Saturday at designated times. You must pre-register in order to sit for the exam. This is not the only exam the testing center administers. So, make sure to schedule your appointment as soon as possible. That way you schedule an appointment that bests fits your schedule. If you need to reschedule, you must contact AMP at least 2 business days before your appointment to avoid paying an additional registration fee.
Retaking the Exam
Not everyone passes this exam on their first attempt. So, AMCB will let you take the exam 4 times. All 4 attempts need to be completed within 24 months of completing the educational requirements. If you still have not passed after 4 attempts, you will have to complete the education requirements once again.
You must wait at least 30 days after your initial exam before you can register to retake the exam. This waiting period allows you to study and focus on the areas you struggled with. All other retake attempts cannot be scheduled until 90 days after your last attempt. You will be charged a fee each time you retake the exam.
What to Expect on Test Day
You need to arrive to the testing center at least 15 – 30 minutes before your scheduled appointment time. AMP will not admit candidates who are more than 15 minutes late. These candidates will have to reschedule and pay another registration fee. All test-takers will be required to provide 2 forms of identification. The first form of identification must be government issued (driver’s license, passport, or military identification) and have your photo and signature on it. Temporary government identification cards will not be accepted. The 2nd form of identification can be a signed credit card, student or employee identification card, or Social Security card.
Cell phones, pagers, watches, PDA’s, wallets, keys, purses, hats, backpacks, and briefcases are not allowed inside the testing room. AMP will provide a small locker where you can store these items. Before you are seated, you will be asked to turn your pockets inside out. The center wants to make sure you are not trying to smuggle in any cheat sheet notes.
Once you are seated at the computer, you will be asked to provide your identification number from your registration papers. Then, a photo will be taken of you. This photo will remain on the computer during the entire test. If you ask to get up and step outside, your photo will be matched to make sure you are who you claim to be.
There is an option of taking a brief tutorial before the actual exam begins. This will help you become a little more comfortable with the test. You can exit the tutorial at any time and begin the actual test. Staff members will not be able to answer any questions specific to this exam. However, they can assist you if you experience any type of issue with the computer.
Renewing Your Certified Professional Midwife Certification
When you pass the NARM Written Examination, you officially become a Certified Professional Midwife (CPM). Your certification status only lasts for 3 years. Patients must be assured that they are receiving the most up-to-date treatment and procedures. So, NARM requires each CPM to undergo a series of continuing education programs in order to keep a certification current.
Each CPM must complete at least 30 continuing education contact hours during their three year certification period. You should not try to complete all 30 hours during the last few months of your certification. These hours should be spread out over your 3 year period. A contact hour is awarded for every 55 minutes of continuing education you complete. You can receive 0.5 contact hours if you complete between 30 and 55 minutes of continuing education. If you attend continuing education that lasts less than 30 minutes, you will not receive credit.
Every candidate will be required to fulfill the following mandatory requirements:
- Complete 5 contact hours in peer review (attending peer review workshops or actively participate in a peer review),
- Hold a current Adult CPR certificate
- Hold a current neonatal resuscitation certificate or infant CPR certificate
- Attest to understanding practice guidelines, consent policies, and emergency care forms and processes
Then, a candidate will be able to choose from 2 distinct recertification paths. One recertification path is not superior to the other path. The path you choose will be based on your personal preference. Each path will require a registration fee.
The first option allows you to fulfill the mandatory requirements and retake the NARM Written Examination. If you choose this option, you must make sure you have enough time to retake the exam and submit your recertification application before the deadline. Remember, the exam is only given 3 times each year. You will not receive the exact same exam you took during the initial certification process. So, you will need to spend time studying.
The second option allows you to fulfill the mandatory requirements and complete 25 contact hours from a mixture of NARM defined categories. It is important to keep documentation for each continuing education program you complete. Although NARM does not require you to submit this documentation, they do perform random audits. You can choose from the following categories:
- Category 1 (up to 25 contact hours) – Complete programs accredited through Lamaze International, ICEA, BRN, ACOG, ACNM, OR MEAC.
- Category 2 (up to 10 contact hours) – Complete unaccredited coursework in women’s health or midwifery topics. Choose topics that could easily fall into the 7 main categories on the NARM Written Examination.
- Category 3 (up to 15 contact hours) – Involvement in research about the field of women’s health or midwifery. Make sure to keep copies of research reports, documentation, and a list of researchers or participants. NARM may ask to review this information to verify you were involved in the research.
- Category 4 (up to 5 contact hours) – Complete a life experience or self-study project on women’s health or midwifery. NARM has a specific form that must be completed to document these projects.
- Category 5 (up to 5 contact hours per position) – Act as a NARM subject matter expert, write NARM examination questions, serve as a NARM QE, or work on NARM’s Accountability Process
- Category 6 (up to 10 contact hours) - Earn one contact hour for every 10 MANA statistics forms you file.
If your certification has expired, you can declare inactive status. Inactive status must be declared within 90 days of your certification expiring. You will still receive industry news and NARM updates. However, you will no longer be able to use your CPM credential. NARM will still keep you in their database. Potential clients will be able to see that you were once certified, but have let your status slip to “inactive.”
To renew expired certifications, you will need to sit for the NARM Written Examination again. A new application will need to be submitted along with another CPM application fee. Once the application has been approved, you will be able to take the exam. Additional requirements will include completing the 30 continuing education hours, attending at least 5 births, holding adult and infant CPR certificates, and paying a reactivation fee.
The National Certification Examination in Nurse-Midwifery and Midwifery
The National Certification Examination in Nurse-Midwifery and Midwifery was developed by the American Midwifery Certification Board (AMCB). The exam measures key concepts midwives must master in order to safely and effectively treat women and their babies. Passing the exam is required to achieve either Certified Nurse-Midwife (CNM) of Certified Midwife (CM) status.
The exam is made up of 175 multiple choice questions. However, all of the questions will not count towards your actual score. Some questions will be “pretest questions” and will not count. You will never know which questions do or do not count towards your score. Each question will have 3 or 4 answer choices. There is only one best answer you can pick from. You will be given 4 hours to complete the exam.
Exam questions are designed to measure a variety of issues that midwives encounter on a daily basis. A firm knowledge of both normal and deviation phenomena are required in order to earn a passing score. Your coursework will provide you with the education needed to pass. However, you will need to spend some time preparing for the exam.
The exam covers 7 key content areas. Questions will not be grouped by specific content area or level of difficulty. Do not panic if you encounter a few difficult questions. You can return to them if time permits at the end of the exam. Here is a look at the key content areas and topics you could receive questions on.
- Intrapartum Care (25% - 35%) – labor assessment (vital signs, physical examination, fetal status), fetal monitoring (palpitation, auscultation, uterine, fetal heart rate), labor pain management options (anesthetic, analgesia, nonpharmacological), perineum management, delivery conduct (occiput anterior and posterior, umbilical cord), third stage of labor (placenta separation), fourth stage of labor (hemorrhages, laceration repair)
- Antepartum Care (15% - 25%) - pregnancy diagnosis (lab tests, ultrasound, indicators, options), gestational ages, determining date of birth, pregnancy counseling (nutrition, emotions, discomfort, health promotion), family education
- Well Woman / Gynecology (15% - 20%) – family planning (contraception devices, methods, options), peril-menopausal period, postmenopausal period (hormone replacement therapy, alternative therapies)
- Primary Care (12% - 16%) – pharmacology, physiology, well woman assessment, health promotion (STD’s, substance abuse, immunizations, breast health, exercise, nutrition), lab tests and lab procedures (serum tests, pap smears), deviations from normal, pregnancy assessment (weight, vital signs, Leopold maneuvers, fetal heart rate)
- Newborn Care (10% - 15%) – newborn assessment (APGAR score, reflexes, stimulation, suction), nutrition (bottle, breastfeeding), eye prophylaxis, family education, immunizations
- Postpartum (5% - 10%) – postpartum assessment, lactation, postpartum period (uterine involution, nutrition, family planning, exercise), infant to parent relationship, 6 week postpartum physical exam
- Professional Issues (Up to 5%) – legal (birth certificates, malpractice, liabilities), standards of care, WHO Baby Friendly Hospital Initiative, health care system and midwifery practice
The exam is scored as either pass or fail. To pass, you will need to answer about 65% - 70% of the exam questions correctly. Points are awarded based on the number of questions you answer correctly. Skipped questions will be counted as incorrect. So, it’s in your best interest to guess and answer each question. This exam is only offered on the computer. However, you will be able to review any questions and change answers until the time clock expires. You do not necessarily need to pass each content area in order to pass the overall exam.
You will know your score immediately after you finish the exam. If you end up failing, you will receive a breakdown of your performance in each content area. Your performance on specific questions will not be provided. The breakdown should help you prepare if you decide to retake the exam. If you feel that your scores are not correct, you can appeal. You must submit your request in writing to AMCB within 12 months of taking the exam and pay a small fee.
Once you pass the exam, you will become a CNM or CM, depending on your credentials. Within 8 weeks of passing the exam, you will receive a certification package. This package includes one free “primary source verification” letter. Your certification will be valid for 5 years.
NARM Written Examination Content and Scoring
The North American Registry of Midwives (NARM) awards Certified Professional Midwife (CPM) status to candidates who have proven that they are competent, practicing professionals. Passing the NARM Written Examination is the final critical step in their certification process. CPM status is awarded to international candidates too. However, only candidates residing in the United States are required to take the written exam.
The NARM Written Examination is the result of an extensive job analysis study. A survey was sent out to thousands of practicing midwives asking them to identify key knowledge and skills that are essential in their day to day practice. The exam is structured around these key areas. The curriculum in many midwifery schools also revolves around the same key areas. So, your education will adequately prepare you for the exam. However, you still need to spend plenty of time reviewing and studying before you take the written exam.
The exam consists of 350 multiple choice questions. Each question will only have one correct best answer choice. If you choose more than one answer or leave it blank, it will be counted as an incorrect answer. The exam is broken out into 2, 4 hour periods.
Exam content focuses on 7 key content areas. The more relevant the content area, the more questions you will receive. Here is a look at some of the key topics these content areas will measure.
- Labor, Birth, and Immediate Postpartum (123 questions) – maternal relaxation, pain management, stages of labor, recognizing labor complications (abnormal fetal heart rate, cord prolapse, breech birth), multiple births, Gaskin maneuver, McRobert’s position, meconium fluids, maternal exhaustion, hemorrhaging, APGAR scores, newborn physical exam
- Prenatal (88 questions) – conducting prenatal physical and emotional exam (blood pressure, weight gain, sleep patterns, energy levels, hemoglobin, blood glucose levels, edema, fetal growth, fetal heart rate), prenatal education (nutrition, cramps, discomfort), prenatal record keeping, prenatal complications (breech, preterm labor, stress, pregnancy induced hypertension), post-date pregnancy
- Postpartum (54 questions) – postpartum evaluation (up to 8 weeks), birth certificate, family education and counseling, breastfeeding, emotional readjustment, postpartum depression, jaundice
- Maternal Health Care Assessment (35 questions) – collecting health, reproductive, and family records (medical conditions, toxin exposure, surgical history, substance abuse, nutrition, exercise), performing physical exam (vital signs, cardio, vascular, muscular, skeletal, kidney pain)
- Midwifery Counseling, Education, and Communication (17 questions) – individualized care, client confidentiality, family based counseling and education, birth site options, Kegel exercises, referrals to other health agencies, cultural sensitivities
- General Healthcare Skills (17 questions) – sterilization procedures, shock management, knowledge of pharmacological agents (lidocaine, oxygen, IV fluids, RhoGam, Pictocin, Vitamin K, methergine), alternative treatments, ultrasounds, instruments and equipment (Amni-hook, Delee mouth and suction device, syringes, clamps, gestational wheel), lab work (urine test, cultures, blood screening tests)
- Well Baby Care (16 questions) – performing well baby care exam (up to 6 weeks), hearing screenings, colic, thrush, metabolic screening, integrate baby and family, assess newborn activity and responses
Scores are reported as either pass or fail. NARM uses the reverse Angoff process to determine what the passing score will be for a particular exam. This process is used to ensure that a pass score earned on one version of the exam is comparable to a pass score earned on another version of the exam. You will need to answer 70% - 75% of the questions correctly to earn a passing score.
Each exam question will be worth one point. Do not skip over difficult questions or content areas you are not sure of. Skipped questions will be treated the same as incorrectly answered questions, impacting your score. Incorrect answers are not weighted heavier than correct answers. It is possible to do poorly in one content area and still pass the NARM Written Examination.
Scores are sent out 3 to 4 weeks after the exam date. If you are taking the exam as part of a licensing requirement, scores will only be sent to the licensing agency. The agency should then forward you a copy of the score report. Reports will indicate whether you passed or failed the exam. If you failed, you will also receive a breakdown of your performance in the main content areas. You will not see the actual questions that you missed. If you passed, you will not receive this breakdown.
Taking the NARM Written Examination
The NARM Written Examination, developed by the North American Registry of Midwives (NARM), is given just 3 times a year. Midwives must meet certain eligibility requirements in order to take this paper based exam. These requirements were established to assure patients that they are being treated by a competent professional. All requirements must be completed before taking the exam.
There are a variety of avenues you can take to become a Certified Professional Midwife (CPM). Some states will require you to earn this certification as part of the licensing process. Some midwives may just want to earn one more credential to add to their portfolio. Eligible applicants include:
- Graduates (entry-level, experienced, or internationally educated midwives) from NARM’s Portfolio Evaluation Process
- Hold a current Certified Nurse-Midwife (CNM) or Certified Midwife (CM) credential from the American Midwifery Certification Board (AMCB)
- Graduate from a Midwifery Education Accreditation Council (MEAC) approved program
- Hold a license from a state or province to practice as a midwife. The educational component of these licenses will be evaluated by NARM.
Once you have met the eligibility requirements, you can submit your application to NARM. A registration fee will also be required. Carefully follow the application’s instructions. NARM will return applications if there are any questions, which can delay the registration process.
You are able to submit applications throughout the year, but you should time your submission to the testing day you are considering. Candidates who are applying as an entry-level, experienced, or internationally educated midwife must submit their applications at least 4 months before their desired testing date. All other candidates need to submit their application at least 2 months before their desired testing date.
After your application has been approved, you will receive an Intent Form from NARM listing the locations and dates of future exams. The NARM written examination must be taken within 1 year of receiving the Intent Form. You are able to request a 6 month extension at no cost. If you fail to take the exam, your registration fee will not be refunded.
To register for the exam, you will need to send the Intent Form to the NARM Test Department at least 4 weeks before the actual exam date. They will then send you a Written Examination Admission Letter. This letter will let you know the time and place of the exam. You should receive this about 2 weeks before the exam.
What to Expect the Day of the Exam
Plan on arriving to the testing location at least 30 minutes before the exam begins. This should give you ample time to complete the check-in process and get settled. You will need to bring 3 items to the exam: a government issued identification card (driver’s license, passport, or state identification card), your admission letter, and a small photograph of yourself.
Testing locations require a small photograph for security purposes. This is a long exam and people will need to be excused to take a break. Photographs will be matched up to ensure nobody switched places with an expert test taker. The photo should be a head and shoulders shot. Make sure it was recently taken. Testing staff members will scrutinize the picture if your features have changed significantly. The photo must be stapled to the Admission Letter.
The NARM Written Examination is a pencil and paper exam. So, you will receive a testing booklet and answer sheet. Only answers recorded on the answer sheet will be counted. Your testing booklet will never be reviewed. Make sure to clearly fill in your answers. The sheet is graded by a machine, so light marks will not be picked up.
Retaking the NARM Written Examination
Not everyone passes the NARM Written Examination on their first attempt. You are able to retake the exam. However, you will need to retake the entire exam, not just the content areas you failed. If you fail to pass the exam within 3 years of submitting your application, you will need to gain more supervised experience before you can retake it again. You must provide documentation that you have actively participated in 10 supervised births over the last 3 years. NARM will randomly audit candidates to make sure they have met this requirement.
Last Updated: 06/09/2014