How to Become a Certified Nurse Midwife (CNM)

A Certified Nurse-Midwife (CNM) is a type of advanced practice registered nurse (APRN) that provides healthcare to women throughout the entire course of their lives. This may include family planning, gynecological checkups, and prenatal care.

Although their approach is somewhat different, CNMs, in many ways, offer similar care to that of an OB/GYN doctor. Midwife vs nurse midwife differences include varying scopes of practice, duties, and responsibilities.

Certified Nurse-Midwife Fast Facts

• Education Requirements: MSN or DNP
• How long does it take to become a certified nurse-midwife? 6-8 years 
• Salary: The average nurse-midwife salary is $122,450 per year

What do nurse midwives do? CNMs are focused on women’s health care. Common CNM duties include delivering babies, providing prenatal and postpartum care, assisting obstetricians, and performing routine check-ups for pregnant patients.

>> Related: Certified Nurse Midwife Meaning

One of their most important roles is helping mothers give birth to their babies safely and naturally. They help patients manage their labor and monitor both the moms and babies during the delivery to ensure safety. In some cases, they work under the supervision of, or in collaboration with, physicians during C-section births. 

According to the American College of Nurse-Midwives, 76% of CNMs identify reproductive care, and 49% identify primary care as the main responsibilities in their full-time positions. This includes things like:

• Annual exams
• Writing prescriptions
• Basic nutrition counseling
• Patient education
• Reproductive health visits

Also worth noting is that as of 2019, almost 89% of births attended by midwives took place in hospitals, with the rest happening in birth centers or homes.  

Like most healthcare professionals, being a CNM means working nontraditional hours, and being “on call” to respond to patients who go into labor. CNMs typically work in private practices alongside obstetricians, in hospitals, or in birthing centers.

>> Show Me Online Nurse Midwifery Programs

Where Do Certified Nurse Midwives Work?

Nurse midwives work in various facilities, including:

• Hospitals
• Birthing centers
• Women’s health clinics
• Private practices
• Community health centers
• Colleges and universities

Certified Nurse Midwife Scope of Practice

The scope of practice for CNMs can vary slightly depending on state regulations, but in general, their scope of practice includes the following:

• Prenatal care
• Labor and delivery
• Postpartum care
• Gynecological care, such as performing routine examinations, providing contraceptive counseling, and reproductive care
• Family planning,  and
• Health education

It's important to note that while CNMs are trained to handle normal, low-risk pregnancies and births, they work collaboratively with obstetricians and other healthcare professionals to ensure appropriate care is provided when complications arise. The specific scope of practice for CNMs may vary depending on the state regulations and individual hospital policies where they practice.

Nurse-Midwife vs Labor and Delivery Nurse: What's the Difference?

Nurse-midwives differ from labor and delivery nurses in many ways.

1. L&D nurses are Registered Nurses who are trained to monitor patient vital signs and take care of mothers who are in labor. But when the time for delivery comes, they call in the doctor. 
2. CNMs are advanced nurse practitioners, meaning they must earn an advanced degree, a special certification, and training to practice.

>> Related: Doula vs Midwife: What's the Difference?

According to the Bureau of Labor Statistics (BLS), the mean average certified nurse midwife salary is $120,880 as of May 2022.

CNM Salary Range

The lowest 10 percent earned less than $77,510, and the highest 10 percent earned more than $171,230. 

Nurse Midwife Salary by Years of Experience

Midwives have the ability to earn increased pay with increased years of experience. According to paycale.com, midwives can earn the following: 

• Less than 1 year of experience - $92,536
• 1 to 4 years of experience - $94,066
• 5 to 9 years of experience - $98,410
• 10 to 19 years of experience - $119,831
• 20 years or more of experience - $110,000

Highest Paying States for Nurse-Midwives

The BLS lists the top 5 highest paying states for CNMs as the following:

>> Show Me Online Nurse Midwifery Programs

Becoming a Certified Nurse-Midwife takes multiple steps and includes earning an advanced degree. As of 2010, a graduate degree is the minimum requirement for entry to midwifery practice as a CNM. In other words, it can take several years to achieve your goal of becoming a CNM. 

Here’s what your educational path will look like:

1. Become a Registered Nurse

Before you can become a CNM, you must become an RN. That requires graduating from a program of study that is approved by your State Nursing Board, either a bachelor’s degree or associate degree program. Upon completion, you have to pass the NCLEX-RN in order to begin practicing.

2. Gain Experience

Many graduate-level nursing programs require one or more years of nursing experience in order to gain admission. 

3. Earn a Master’s or Doctoral Degree in Nurse-Midwifery

Most APRN programs prefer candidates who have a bachelor’s degree in nursing, according to the BLS. Therefore, if you became an RN via an associate degree program, you will most likely have to seek out a bridge program that will allow you to go straight into a master’s program. Depending on the program (and whether or not you’re starting out with a bachelor’s degree), it can take two or more years to complete your degree.

4. Earn Your Certified Nurse-Midwife (CNM) Certification

This certification is offered by the American Midwifery Certification Board, and you’ll have to pass its national qualifying exam. Once this is achieved, you will be licensed to practice in all 50 states plus the District of Columbia and US territories.

These are the top 5 best CNM programs, check out our full list of the best programs here: Best midwifery schools.

1. Vanderbilt University, Nashville, TN

Vanderbilt’s midwifery program is located next door to their University Medical Center, which is also one of the top medical centers in the nation. They boast a rigorous midwifery program and one of the largest nurse-midwifery programs in the US.

2. Oregon Health and Science University, Portland, OR

Oregon Health and Science University (OHSU) in Portland, Oregon, is located between the Pacific Ocean and the Cascade mountain range. Many Nurse-Midwifery students appreciate the geographical beauty of the area and the fact that the state has a solid reproductive and maternity care reputation. Nurse-midwives are present in nearly 20% of all births in the Portland area!

The OHSU Nurse-Midwifery program has taught students for over 30 years between the university hospital and surrounding clinics. Students learn by attending many of the births at the OHSU hospital. 

3. University of Michigan, Ann Arbor, MI

The University of Michigan (UM)  at Ann Arbor, Michigan, offers two options for nurses who want to be nurse-midwives:

• A Nurse-Midwifery-MSN
• A Nurse-Midwifery-DNP

4. University of Pennsylvania, Philadelphia, PA

The UPenn midwifery program offers unique clinical education opportunities offered through the school and the most current research in the field. Some of the skills they say they teach that may not be available through other programs include procedures such as OB ultrasonography, IUD insertion, and endometrial biopsies, to name a few. 

5. East Carolina University, North Carolina

East Carolina University in North Carolina has a nurse-midwifery program to prepare registered nurses to become competent practitioners of nurse-midwifery and become Certified Nurse-Midwives (CNMs).

>> Top Certified Nurse Midwife Programs

Today, just about 10 percent of US births are attended by midwives. According to the BLS, there were 8,200 midwives practicing in the United States in 2022. 

The BLS predicts the employment of CNMs is projected to grow by 6 percent by 2031 from 2022-2032. There will be a need for an additional 500 CNMs per year by 2032.

>> Show Me Online Nurse Midwifery Programs

Recertification by the American Midwifery Certification Board is required every five years.  CNMs have two main certificate maintenance options:

Option 1 requires CNMs to complete three modules over a 5 year period and submit proof of 20 hours of relevant continuing education. One module must be completed in EACH of the three areas of practice: Antepartum and Primary Care of the Pregnant Woman; Intrapartum, Postpartum, and Newborn; and Gynecology and Primary Care for the Well-Woman. 

Option 2 allows a CNM to retake the certification exam as another means to demonstrate continued competence in midwifery practice.

Embarking on a CNM career is exciting, but challenging. To learn more about the profession, it’s a great idea to explore the career resources and information that professional organizations have to offer. Here are two to look into if you’re an aspiring CNM:

• The American College of Nurse-Midwives
• The Midwives Alliance of North America (MANA) 
• You can also see if your state has an association, such as the New York State Association of Licensed Midwives.

>> Show Me Online Nurse Midwifery Programs

Because of the nature of a CNMs expertise, finding work shouldn’t be a challenge no matter where you live. Add to that the fact that the demand for nurses overall is strong as much of the workforce is reaching retirement age.  

CNMs are also not limited to hospitals, as many run their own private practices, or work in groups with OB/GYNs.

Take a look at some current openings for nurse jobs in your area to get an idea of the positions available. 

• What degree does a nurse-midwife need?

  • Nurse-Midwives need either an MSN or DNP degree and they also need to pass the certification exam offered by the American Midwifery Certification Board.

• Where can nurse-midwives work?

  • Certified Nurse-Midwives can work in a variety of locations including, hospitals, private practices, international medical relief organizations, concierge services, birthing centers, health clinics, or home birth services.

• What is the difference between a midwife and a certified nurse-midwife?

  • The term midwife is used for direct entry into the profession. A midwife does not have any training in nursing and does not hold an advanced practice degree in nursing. While some of the training is similar, a Certified Nurse-Midwife has more education and experience than a traditional midwife. 

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