A certified nurse-midwife, or CNM, is an advanced practice registered nurse (APRN) specializing in family planning, labor, delivery, and care of the newborn. CNMs provide reproductive care to women and their partners and also treat sexually transmitted infections. A CNM has a master’s degree or higher in addition to being an RN (registered nurse). CNMs practice in clinics, birth centers, hospitals, public health offices, and patients’ homes.
What Does a Certified Nurse-Midwife Do?
A certified nurse-midwife (CNM) provides care focused on improving the health of women and their newborns. This branch of medicine is referred to as obstetrics (childbirth and care of women giving birth) and gynecology (female reproductive health). In the United States, physicians also offer this care as part of primary care services or as specialty care. CNM’s scope of practice varies by state, from complete independence to some supervision or ongoing collaboration with a physician. A CNM provides nursing-based care with additional expertise in these skills:
Gathering patients’ medical and personal histories
Performing annual physical exams, including gynecological exams
Ordering and interpreting tests from patient samples like urine or blood
Creating plans of care for labor and delivery with patients
Providing prenatal care to expectant mothers
Monitoring women and fetuses during labor
Delivering babies and responding to complications
Collaborating with other providers in emergency situations
Caring for healthy newborns in the first 28 days of life
Assessing and caring for mothers after birth
Providing family planning services
Treating sexually transmitted infections with prescription medications
Working with physicians and other professionals to care for patients
Certified nurse-midwives are passionate about caring for women and families. Successful CNMs are great at connecting with patients, communicating with coworkers, and handling critical situations. CNMs are also knowledgeable about the cultural traditions surrounding childbirth and are able to respectfully incorporate patients’ wishes into patient-centered plans of care.
CNMs are also required to complete ongoing education and recertification throughout their careers. Shadowing other providers, skills demonstrations, in-person classes, online lectures, and computer-based testing are all possible examples of continuing education. Each state has its own requirements for the number of hours of education required per year. Failure to complete certain classes or failure to obtain enough hours would make a CNM ineligible to practice. CNMs may be responsible for registering for and reporting their own continuing education hours to their state’s board.
How Much Does a Certified Nurse-Midwife Make Per Year?
The annual mean wage of certified nurse-midwives in the U.S. ranges from $71,580 to $153,310. CNMs in California reported the highest annual mean wage of $169,530, which is an hourly mean wage of $81.50.
Certified nurse-midwives are most commonly employed within offices of physicians, general medical and surgical hospitals, and outpatient care centers. The annual salary will vary by place of employment, scope of practice, and geographical location. It is suggested that you perform extensive research on the state in which you wish to practice to determine where you can have the most responsibilities as a CNM and where you can receive a salary that will fit your needs. General medical and surgical hospitals are the second-most common place of employment for CNMs; these facilities paid an annual mean wage of $129,960.
While California, West Virginia, and Hawaii have the highest annual mean wages for CNMs, some states do not have any data available. Gaps in data reporting, low CNM utilization in some areas, and varying scopes of practice create potential challenges for CNMs in deciding where to practice.
The CNM profession is expected to grow by 38% between 2022 and 2032, which is slightly higher than the average for all jobs. Ongoing changes in scope of practice laws for all advanced practice nurses and an increased need for care providers in medically underserved areas will create more job opportunities in some states. Additionally, some women are increasingly seeking care from CNMs and considering home births in the U.S.
Where and When Do Certified Nurse-Midwives Work?
CNMs may be most commonly employed by offices of physicians, but many CNMs will also care for their patients at a hospital, birth center, or at a patient’s home during delivery. CNMs work within a group of providers and, at times, will be expected to care for patients usually seen by other providers. Patients have emergencies and may go into labor at any time. CNMs’ schedules and teamwork reflect those possibilities.
Work schedules can be a combination of hours in different locations. For example, a CNM may have clinic hours, birth center shifts to care for laboring patients, and possibly on-call hours. Due to the often unplanned nature of labor and delivery, CNMs can expect to work evenings, nights, weekends, and holidays on a rotating basis. Like many healthcare systems, CNMs rely on and communicate with other providers within their network to care for patients around the clock.
CNMs interested in pursuing independent practice will seek employment in one of the many states offering independence to CNMs. In other states and some territories, CNMs are required to follow a written agreement that defines their scope of practice under a physician.
How Do I Become a Certified Nurse-Midwife?
A certified nurse-midwife is first a certified registered nurse (RN) with a Bachelor of Science in Nursing (BSN). Then, hopeful CNMs complete either a master’s or doctorate degree in nurse-midwifery. Some programs allow a bachelor’s degree in another field. A Master of Science in Nursing (MSN) with a focus on nurse-midwifery can be completed in two to three years. A Doctor of Nursing Practice (DNP) program with a nurse-midwifery track generally lasts three years. DNP graduates will have obtained the highest degree possible, making them arguably the most competitive and most prepared for changing legislation affecting advanced practice nurses. Competitive nurse-midwifery candidates have experience caring for women across the lifespan, including during labor and delivery. Not all programs require experience as an RN, but applicants must have an active RN license in the same state as their program prior to beginning classes. Many programs offer distance learning or a hybrid format, which requires a limited amount of time on campus.
Completion of either the MSN or DNP option enables students to take the national certification exam. Certification is required in all 50 states. This computer-based test has 175 questions and is given by the American Midwifery Certification Board (AMCB). It currently costs $500 to take the exam. After passing the AMCB exam and becoming a certified nurse-midwife, the next step is to apply for licensing in the state where you wish to practice. Each state has its own requirements, but many require proof of RN license, transcripts, AMCB results, a background check, and a fee.
What Are the Benefits of Being a Certified Nurse-Midwife?
A career as a CNM provides opportunities to educate and support patients in some of their most vulnerable moments. Patients look to their CNMs for guidance and education during critical times. CNMs are able to develop connections with families and watch them grow. Delivering babies is a unique specialty in healthcare and arguably the oldest. A CNM is passionate about honoring the cultural expectations of their patients. CNMs find satisfaction in guiding their patients using skills gained through education and experience.
What is the Difference Between Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives?
The American Midwifery Certification Board provides testing for certified nurse-midwives and certified midwives (CMs). CMs must complete a bachelor’s degree or higher and a midwifery education program but are not required to have an RN license. CMs are only recognized in Delaware, Maine, New Jersey, New York, and Rhode Island.
Certified professional midwives (CPMs) are certified by the North American Registry of Midwives (NARM). Becoming a CPM requires a high school diploma, working with a NARM-registered preceptor for two to five years, and completing a written exam. During the student’s time with the preceptor, the student must learn the core competencies of NARM and attend a minimum of 55 births. CPMs are recognized to practice in 31 states and usually work in non-hospital settings. CNMs and CMs are also eligible to complete NARM certification, though this is not required by any state.
What Are Other Advanced Practice Registered Nurse (APRN) Careers?
In addition to CNMs, three other types of APRN providers practice in the U.S. Advanced practice nurses in these roles have earned at least a master’s degree and have specialized to care for specific patient populations. They are certified to assess, diagnose, prescribe, and treat patients at various levels based on state regulations.
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