How to Become a Nurse Midwife (CNM)

By: Holli Sowerby, EdD, RN

Last Updated: Dec 26, 2018

The birth of a child is one of the most exciting events in life, and the presence of a nurse midwife can make the experience especially meaningful. Nurse midwives (also called certified nurse midwives, or CNMs) are registered nurses with advanced training in women’s health. While they’re best known for delivering babies, they also provide a full range of care services for women of childbearing age.

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CNMs are recognized health practitioners in all 50 states. The profession is governed by state-level scope-of-practice laws, which spell out the specific functions a CNM may perform independently as well as the functions that must be supervised by a physician. In most places, CNMs can independently care for women who are at low risk for pregnancy complications. When the risk is higher, the CNM may treat the patient as part of her healthcare team.

CNMs offer an alternative childbearing experience focused on the needs and desires of the patient and family. Midwifery practice emphasizes natural, intervention-free care when possible. CNMs encourage women and family members to be active participants in the pregnancy and birth. Many women feel that using a midwife provides a more fulfilling birth experience.

Most midwives choose the field out of genuine compassion for families and children. CNMs often develop long-term relationships with patients as they care for them through multiple pregnancies and births. Another fulfilling aspect of the job is its freedom; unlike registered nurses (RNs), CNMs have considerable autonomy to make care decisions and manage their own practices.

Workplace Details

The two largest employers of CNMs are physician offices (47 percent) and hospitals (28 percent). CNMs also work in birthing centers, government organizations, and colleges and universities. Some states allow CNMs to run their own private practices.

Overtime is the norm for CNMs; 89 percent report working more than 40 hours a week. In office-based practices, they generally work daytime hours with some evenings on-call. Hospital-based CNMs work irregular shifts, including evenings, weekends, and holidays.

Contrary to popular belief, CNMs usually deliver babies in hospitals (although they may occasional travel to patient’s homes for a low-risk delivery).

Like other health care professionals, CNMs are exposed to occupational hazards like dangerous drugs and contagious disease. These risks can be minimized by following safety procedures and using protective clothing and equipment.

Hover over any state to explore local income and job growth data.

According to the US Bureau of Labor Statistics, the median annual salary for nurse midwives is $99,770. The lowest-paid 10 percent earn less than $66,660, and the highest-paid 10 percent earn more than $142,510.

Salaries vary with work setting and geographic location. Hospital-based nurse midwives generally earn more than those in outpatient settings and academia. In addition, CNM salaries tend to be higher on the West Coast, in the upper Midwest, and in the Northeast.

In a word, job prospects for nurse midwives are excellent. According to the Bureau of Labor Statistics, employment of CNMs is expected to grow by 31 percent between 2014 and 2024, which is much faster than the rate for all occupations.

Growth of the midwifery profession is largely driven by increasing demand for health care services. Recently enacted federal health reform laws expanded insurance coverage to millions of Americans. Growth has also been spurred by new scope of practice regulations that allow nurse midwives to take on roles traditionally performed by physicians. Finally, the growing shortage of primary care physicians means CNMs are in demand to provide well-woman care.

Job prospects should be especially good in areas with physician shortages, particularly inner city and rural areas.

High school students interested in a career in nurse midwifery should take a rigorous college preparatory curriculum, including math, science, English, and foreign language courses.

College students can prepare by completing the prerequisite courses for graduate midwifery programs, including biology, microbiology, chemistry, human anatomy, and physiology. A bachelor’s degree in nursing (BSN) is typically required in order to gain admission to midwifery graduate programs. However, there are also bridging programs for students who hold an associate degree, a diploma in nursing or a bachelor’s degree in a related field.

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RN licensure is a prerequisite for admission to most graduate nurse midwifery programs. Many nurse midwifery graduate programs additionally require candidates to have two to four years of experience working as an RN in a women’s health-related field.

To become certified as a nurse midwife, candidates must earn a master’s degree (or higher) from a program recognized by the Accreditation Commission for Midwifery Education. Many universities offer accredited graduate degree programs in nurse-midwifery, which typically last three years and include both classroom and clinical components. Topics covered include anatomy, physiology, pharmacology and practical skills like patient assessment and medical procedures. Program graduates are qualified to sit for a licensing exam, and the CNM certification is recognized throughout the United States.

Several organizations certify nurse midwifes, but the American Midwifery Certification Board is the most widely recognized and respected. AMCB certification is a prerequisite for licensure in many states and is also required by many employers. To become CNM-certified through AMCB, candidates must:

• Hold an active RN license
• Demonstrate completion of an ACME-approved training program
• Pass a computer-based knowledge exam
• Recertify every 5 years

CNMs are legally recognized to practice in every state and in the District of Columbia. For detailed licensure requirements in your state, contact your state board of nursing.

It’s quite a long road to become a CNM, and for many people, achieving this level of practice is a goal in itself. A significant number of nurse midwives eventually earn doctorates in nursing, which qualifies them to teach at the university level and conduct research in the field.

Earning a CNM credential also opens up opportunities in consulting, healthcare management and public policy development. Where permitted by law, many CNMs move in to private practices, giving themselves considerable autonomy.

There are several different degree paths you might take in order to become a nurse midwife. Most nurse midwifery programs admit students who have already earned a bachelor’s degree - a BA or BS in a field outside nursing, or a BSN (Bachelor of Science in Nursing). Certain programs only admit BSNs who have qualified as registered nurses. For most students, the BSN-RN offers the most direct path to certification as a nurse midwife.

However, you can become a CNM whether you begin your career with a BSN, a bachelor’s degree in a different field, an associate degree (AD) in nursing, or a degree in practical nursing (PN). Many nursing schools offer “bridge” or “ladder” programs that allow working nurses to earn successively higher degrees; for instance, a CNA can earn a PN degree, and an LPN can earn an associate degree or BSN. RN-to-BSN programs are most common of all, providing a curricular bridge between associate’s degree and BSN training for certified RNs. And if you are already an advanced practice nurse, adding a post-graduate certificate in nurse midwifery will allow you to sit for the CNM-qualifying exam.

Note that if you’re presently an AD-RN, you could consider applying to an RN-to-BSN/CNM program. A program like this would allow you to complete your baccalaureate degree and transition seamlessly to master’s-level midwifery training. According to the American College of Nurse-Midwives, there are currently 11 university nursing programs in the U.S. that offer this training option to RNs with associate degrees.

Whichever route you choose, be sure to select nationally accredited degree programs; if you don’t, you will run into problems finding employment and continuing your studies. Your state’s Nursing Commission or Nursing Board publishes a list of approved nursing education programs, so look for accreditation from the CCNE (Collegiate Council of Nursing Education) or ACEN (Accreditation Commission for Education in Nursing). A smart approach is to check webpages run by the graduate programs that interest you, and find out what accreditation they look for in students’ BSN or associate degree programs.

A bachelor’s (baccalaureate) degree is the gateway to graduate education and most forms of advanced-practice certification in nursing; this degree opens pathways to teaching, managerial and clinical leadership positions. Many hospitals prefer to hire BSN-RNs, offering incentives for AD-RNs to acquire a BSN.

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In a traditional BSN program, your studies in nursing science are integrated with the well-rounded liberal arts curriculum of a four-year university degree. You’ll take courses in the arts, humanities and social sciences, as well as a series of life-science classes - biology, chemistry, and statistics - that provide the foundation for your nursing specialty. In general, students begin their nursing specialty courses in their second year.

Your coursework will likely include:

If you have a bachelor’s or higher degree in a different field, you may have alternatives to earning a traditional BSN. You could look for an accelerated BSN (ABSN) degree program; there are also many master’s-level nursing education programs geared toward bachelor’s-prepared students from other fields. These intensive three-year programs incorporate the training you need to qualify as an RN and a CNM. Sometimes these programs will be advertised as accelerated BSN/accelerated MSN options (ABSN/AMSN); sometimes you will find them described as BA/BS to RN/CNM programs.

Bachelor’s-prepared nurses (BSN-RNs) who want to qualify as a CNM have a few different training options, most commonly the master’s degree (MN or MSN) in nurse midwifery. Bachelor’s-prepared students who are not nurses should consider a master’s program that offers a BA/BS-to-RN/CNM option (3 years’ study).

A master’s program in midwifery incorporates coursework with relevance to many areas of advanced-practice nursing, as well as courses that have special application to midwifery: labor and delivery, lactation, breastfeeding, and other health issues surrounding birth. Your studies might include courses like:

There are alternatives to earning an MN/MSN in nurse midwifery. For instance, you can look for a BSN-to-DNP (doctor of nursing practice) program with a midwifery specialty. If you’re already an APRN with different specialty, and you want to obtain CNM licensure, you can obtain a post-graduate certificate in midwifery from most schools that offer MSN nurse midwifery programs.

• The American Midwifery Certification Board (AMCB) offers continuing certification for midwives and nurse midwives. Until 2010, the CNM represented a lifetime certification for practicing midwives, but now this certification must be renewed at least once every 5 years.
• The American Registry for Diagnostic Medical Sonography (ARDMS) now offers an ultrasound certificate examination for professional midwives. For more about this new certification, visit the American College of Nurse-Midwives.
• Continuing education opportunities give professional midwives exposure to the newest concepts in their field, including new healthcare research. Opportunities include live and distance-learning courses.