How to Become a Nurse Midwife (Steps & Career Overview)

Certified nurse midwives (CNMs) are advanced practice registered nurses who carry far more responsibility and autonomy than other midwives. They guide patients through pregnancy, labor, and the postpartum period, and many also serve as primary care providers for women across the lifespan.

Demand is climbing. The Bureau of Labor Statistics projects CNM employment to grow about 11% from 2024 to 2034, faster than the average for all occupations. A nationwide shortage of maternity care providers is part of the reason. The American College of Nurse-Midwives reports that demand for midwifery services has risen steadily since 2005, and in 2020 CNMs attended roughly 10% of all U.S. births.

What a Certified Nurse Midwife Is

CNMs are a type of advanced practice registered nurse (APRN). They work in hospitals, birthing centers, physicians' offices, and private practices. Along with training as registered nurses, they hold a Master of Science in Nursing (MSN) with a midwifery specialization.

That graduate education sets them apart from other midwives, many of whom aren't registered nurses. Because of their degree and training, CNMs are licensed, independent providers in all 50 states and U.S. territories. Under federal law they count as primary care providers, which means they can write prescriptions, order and review lab tests, perform physical exams, and prescribe treatment.

There are several routes to the credential, but they all run through four steps:

1. Complete an accredited MSN program with a midwifery specialty.
2. Pass the national midwifery certification exam.
3. Apply for advanced practice state licensure as a certified midwife.
4. Maintain certification and licensure through continuing education.

What Nurse Midwives Do

Your daily work depends on where you practice. In a private practice you'll take on more than you would at a large hospital, but in general CNMs:

• Order and perform STD and other tests for prospective, expecting, and new parents
• Educate parents on breastfeeding, infant care, SIDS, and colic
• Prepare patients for labor and delivery
• Provide care for mothers and infants during and immediately after childbirth
• Administer low-intervention pain relief during labor
• Watch for complications that require physician intervention
• Provide postpartum care for mothers and infants

Many CNMs also serve as primary care providers for women, handling reproductive and general health services.

CNMs Versus Other Childbirth Specialists

Only physicians carry more authority during childbirth than a CNM. Here is how the main roles compare.

Obstetrician-Gynecologist (OB-GYN): Medical doctors who care for women from pregnancy through delivery, including high-risk pregnancies. They induce labor and perform C-sections.

Certified Nurse Midwife (CNM): Registered nurses with a graduate midwifery degree who attend births in hospitals and birthing centers. As primary care providers, they can do much of what physicians do, including prescribing.

Certified Midwife (CM): Holds a non-nursing undergraduate degree plus a graduate degree in midwifery, and isn't required to hold an RN license. CMs have the same scope of practice as CNMs and sit for the same certification exam, but only a handful of states recognize the credential.

Registered Midwives (RMs) and Licensed Midwives (LMs): Trained outside nursing. They primarily attend home births.

Certified Professional Midwife (CPM): Trains through an apprenticeship or midwifery school and cares for patients planning home births.

Doula: A childbirth support professional who completes a certification program and focuses on the emotional and physical needs of women during labor. Doulas don't provide medical care.

Childbirth Educator: Leads classes in hospitals, birthing centers, and community facilities but isn't present during birth.

Labor and Delivery Nurse: An RN who assists physicians or CNMs during delivery and helps with first breastfeeding.

Other specialists work with parents before, during, or after childbirth, including lactation consultants, postpartum physical therapists, prenatal fitness instructors, and new-parent counselors.

CNM Salaries

CNMs earn a median of $128,790 a year, according to the BLS (May 2024). That's well above the $93,600 median for registered nurses. Pay varies with setting, location, and experience.

How to Become a Certified Nurse Midwife

Before enrolling in a master's program, you'll usually need:

• A current, unrestricted RN license
• A year or more of work in a labor-and-delivery unit as an RN
• Satisfactory GRE scores (where required)

Accreditation

Confirm that any program you consider is accredited. Graduates of non-accredited midwifery programs can't sit for the CNM certification exam. The Accreditation Commission for Midwifery Education (ACME) accredits midwifery programs and verifies that they meet the standards needed to produce competent graduates.

Education Options

Your starting point determines your path to an MSN in midwifery. If you hold an Associate Degree in Nursing (ADN), an RN-to-MSN bridge program lets you skip earning a separate BSN. If you already hold a BSN, you can move straight into a master's program. Depending on your program and starting degree, the MSN takes two to four years.

Online, campus-based, and hybrid programs run nationwide, and many are built for working nurses with night and weekend courses. Whichever you choose, expect significant hands-on clinical training in a medical setting.

Financial Aid

Federal aid is the most common source. File the Free Application for Federal Student Aid (FAFSA) to be considered. Scholarships, grants, and private loans can fill the rest.

Certification

After earning your degree, take the American Midwifery Certification Board (AMCB) exam. The computer-based test runs 175 questions. You get four attempts and must pass within 24 months of completing your master's program. Candidates who don't pass within those limits must complete another accredited midwifery program before retesting.

Continuing Education

CNMs take continuing education throughout their careers to stay current. The American College of Nurse-Midwives offers courses approved by state boards. Requirements vary by state, so check with your board for the number of credits and how often you'll need them.

Career Paths

CNMs work inside and outside clinical settings. Those drawn to work beyond hospitals and birth centers can move into administration and public policy. If patient safety during labor matters to you, your clinical experience positions you to advocate for health initiatives.

Workplaces

Common employers include hospitals, physicians' offices, birthing centers, and medical centers. Some CNMs run private practices and offer home births. Your options depend on where you live and your experience.

Job Growth and Career Outlook

With maternity care providers in short supply, demand for CNMs keeps rising. The BLS projects about 11% growth from 2024 to 2034, faster than average.

If you want to move into leadership, teaching, or management, a Doctor of Nursing Practice (DNP) is the highest degree in the field and can qualify you for university faculty roles and senior positions, including work on maternal and newborn health worldwide.