What is a Certified Nurse Midwife?
Definition of a CNM
A Certified Nurse Midwife (CNM) is an APRN who provides a full range of primary healthcare services to women from puberty & adolescence through to menopause & old age. Although their main areas of interest are:
- Pregnancy & antenatal care
- Labor & delivery
- Postpartum care & care of normal newborns
CNMs are also responsible for:
- Preconception counseling
- Reproductive health (e.g. preventing or treating STDs)
- Gynecologic & family planning services
- Nutrition counseling
- Parent education
- Family care
In many ways, they act as a woman’s primary healthcare provider.
When it comes to their scope of practice, CNMs can be remarkably independent. They help with uncomplicated births, perform specific interventions (e.g. IUD insertion, amniotomy, repair of perineal lacerations, etc.), and serve as assistants to obstetricians & gynecologists in complex cases (e.g. breech births, fetal distress, etc.). They have prescriptive authority in all 50 states, and are able to conduct physical exams, order tests, diagnose diseases, and recommend treatments & therapies.
CNMs are trained to practice in a variety of settings, both urban and rural. Typical places of employment include:
- Regional medical centers
- Freestanding birth centers
- OB-GYN clinics
- Private practices & medical offices
- Family care practices
- Rural clinics
- Correctional facilities
- Military bases
Note: If you’re interested in providing 360º of care to women & families, you might wish to consider dual certification in an NP role: CNM/Women’s Health Nurse Practitioner (WHNP) or CNM/Family Nurse Practitioner (FNP) are the two most popular options.
Certified Nurse Midwife vs. Other Specialties
CNM vs. CM vs. CPM
Since you’re on an RN to MSN site, we assume you’re planning to go down the CNM route! But we wanted to let you know how it compares to the two other midwifery credentials out there:
- Certified Nurse Midwife (CNM): CNMs have earned an RN license, graduated from an ACME-accredited CNM graduate program, passed the AMCB’s national CNM certification exam, and become licensed to practice as CNMs in their state. It’s a well-regarded qualification—CNMs are licensed, independent healthcare providers with skills in nursing and midwifery, as well as prescriptive authority in 50 states. Medicaid reimbursement for CNM care is mandatory in all states. Most states also mandate private insurance reimbursement for CNM services.
- Certified Midwife (CM): CMs are folks who have a background in a health-related field other than nursing (i.e. they don’t have an RN license). They have completed science & health courses and related health skills training, graduated from an ACME-accredited midwifery graduate program, and passed the AMCB’s national CM certification exam. During the graduate program, CMs receive the same clinical training as CNMs. According to ACNM, CMs are only authorized to practice in Delaware, Missouri, New Jersey, New York, and Rhode Island; they only have prescriptive authority in New York and Rhode Island.
- Certified Professional Midwife (CPM): The CPM is a midwifery credential that requires knowledge about—and experience in—out-of-hospital settings. CPM certification does not require an academic degree—instead, it is based on demonstrated competency in specified areas of knowledge & skills. To become a CPM, applicants must complete NARM’s Portfolio Evaluation Process OR graduate from a MEAC-accredited midwifery education program OR be an AMCB-certified CNM/CM with at least 10 community-based birth experiences OR have completed an equivalent state licensure program. All CPM candidates have to pass the NARM written exam.
Most CPMs attend births in homes and birth centers, so CNMs who want to specialize in natural/low-intervention labor & delivery sometimes decide to pursue the credential. A lot of mothers speak glowingly about working with CPMs.
Having said that, although the majority of CNMs end up attending births in hospitals, they are trained to practice in all kinds of settings. Plus, if you choose an RN to MSN CNM program that includes clinical rotations in birth centers, home visits & rural care, you may get substantial experience in natural delivery. Talk to current CNM/CPMs to decide whether it’s worth the effort to earn both.
Note: Torn between the CPM and the CNM? The ACNM has a helpful comparison chart of all 3 midwifery credentials. You’ll also find a lot of nursing message boards that cover the debate.
CNM vs. WHNP (Women’s Health Nurse Practitioner)
Thinking about your options as an APRN in women’s healthcare? Noticing a lot of similarities in the definitions of the CNM and WHNP?
You are not alone! A lot RNs struggle to decide between the WHNP and the CNM. Our guide to RN to MSN WHNP Programs outlines the pros & cons of each path.
Note: Remember, too, that you always have the option to pursue both certifications.
RN to MSN Certified Nurse Midwife Programs
RN to MSN CNM: Overview
RN to MSN CNM programs are designed for working RNs who have a diploma or an associate’s degree (e.g. ASN/ADN) and want to pursue an MSN or MS to become a certified nurse midwife. A number of these programs will help you earn a BS or BSN on your way toward achieving the master’s degree! Better yet, there are also RN to MSN CNM programs for RNs with a bachelor’s degree in a field other than nursing.
Our directory includes ACME-accredited programs in three major categories:
- CNM Specialty: This is the standard offering for most universities—an RN to MSN CNM degree that focuses solely on nurse midwifery.
- Dual Focus: A few “dual focus” programs in our directory will prepare you for both CNM and NP certification. The most popular combinations are CNM/FNP (Family Nurse Practitioner) and CNM/WHNP (Women’s Health Nurse Practitioner). These programs may take a little longer to complete.
- CNM Specialty with NP Post-Master’s Certificate Option: Some universities in our directory also offer post-master’s certificates. You can earn your CNM degree and then decide if you want to take a few more courses to prepare for NP certification.
RN to MSN CNM: Admissions
RN to MSN Certified Nurse Midwives programs often have the same prerequisites as NP programs, but you’ll notice that the entry bar is set a little higher. For example, schools may wish to see:
- A diploma or associate’s degree in nursing (unless you have a bachelor’s in another field)—if you have a bachelor’s degree in another discipline, you will usually need to submit a clinical practice portfolio
- A current RN license
- A baseline undergraduate GPA (usually 3.0)—if your GPA isn’t very high above 3.0, some schools may also ask for GRE/MAT scores
- At least one year of relevant RN clinical experience
- Letters of professional reference/recommendation
Don’t have any prior experience with labor & delivery or obstetrics? Not to worry—admissions officers are often willing to consider folks with significant experience in related fields. Before you apply, you might wish to:
- Take childbirth education classes
- Volunteer as a doula
- Complete relevant training courses (e.g. fetal heart rate monitoring)
- Attend “strip rounds” on an obstetric unit
- Serve as a lactation/breastfeeding consultant
If they like the look of your application, many schools will want to bring you to campus for an informational session & personal interview. We’ve also found a few programs that ask CNM applicants to pursue Neonatal Resuscitation Program (NRP) certification.
RN to MSN CNM: Undergraduate Phase
One important factor to consider is the total time commitment. In RN to MSN CNM programs, you must earn good grades on certain undergraduate courses (e.g. community health, research & evidence, patient safety, etc.) before the university will allow you to move up to a master’s degree. Some RN to MSN programs may also include a transitional practicum or health assessment lab.
Examine the program description to see how long the undergraduate phase will take (e.g. 4-5 courses over one year). In some cases, you may be able to transfer previous undergraduate coursework (e.g. statistics) or submit a professional portfolio for credit.
RN to MSN CNM: MSN Curriculum
Once you’ve made it to the graduate level, standard MSN or MS degrees take around 1-3 years to complete. Schools of Nursing like to customize their CNM degrees, so every program has its unique quirks. However, as a general rule, you’ll be required to tackle:
- Foundation Courses: CNM programs almost always start with a “Nursing Core”—foundation courses in advanced practice issues (e.g. evidence-based practice, leadership, health promotion, health policy, and ethics) and three mandatory courses in advanced pharmacology, advanced physiology/pathophysiology, and advanced health assessment.
- Hard-Core Science Courses: Although this isn’t true of all CNM programs, Schools of Nursing sometimes like to add subjects such as genetics, biostatistics, and reproductive anatomy & physiology.
- Midwifery Specialty Courses: In addition to a course on the role of the CNM, you’ll cover all 4 bases of midwifery: primary care of women through the lifespan; antepartal care (e.g. pregnancy & fetal evaluation); interpartum and postpartum care (e.g. labor & delivery and post-delivery); and newborn care. You’ll often be taking these courses in tandem with clinical rotations.
- Midwifery Research Project: Again, this won’t be true of all CNM programs, but we’ve seen some curricula that include a research-based master’s project or evidence-based practice project.
As you can see, it’s a challenging program with a lot of rigorous courses. You may be able to choose one elective, but a lot of RN to MSN CNM programs have a fixed curriculum with no deviations.
RN to MSN CNM: MSN Clinical Hours / Practicums
CNM programs don’t mess around when it comes to clinical rotations!
- Unlike NP programs (~600-800 clinical hours) and CNS programs (~500 clinical hours), nurse midwifery programs often require students to complete a minimum of 700-900 clinical hours.
- This is because CNMs have an enormous responsibility when it comes to their patients, and schools want graduates to be prepared for every eventuality. In addition, even just one normal childbirth experience can last for many hours.
When it comes to worksites, schools will want you to gain clinical experience caring for well women (e.g. reproductive health, gynecology & menopause); women in the antepartum, intrapartum, and postpartum periods; and newborns. That means you may end up doing rotations in:
- Primary care settings
- Hospitals & inpatient settings
- Outpatient & specialty clinics
- Out-of-hospital settings (e.g. home visits, travel to rural areas, etc.)
During rotations, you could be providing preconception care & family planning services, helping women through pregnancy, assisting in labor & delivery, advising on breastfeeding, assessing newborns, and handling common health issues.
Note: Dual focus programs (e.g. CNM/FNP) will usually have the same midwifery clinical practicums, but they’ll add more rotations in the NP specialty (e.g. primary healthcare of the family).
Online RN to MSN Certified Nurse Midwife Programs
Are Online RN to MSN CNM Programs Available?
Yes. A small number of ACME-accredited schools in our directory offer Online RN to MSN Certified Nurse Midwife degrees. Here’s how a typical online CNM program plays out:
- Undergraduate Phase: Just like an on-campus degree, you will have to earn good grades in upper-level undergraduate courses before you can proceed to the MS or MSN. Unless they involve labs, you should be able to complete these courses online. A lot of RNs continue to work during this time period.
- Graduate Phase: In most programs, you’ll be able to take standard MS or MSN courses online. But you must complete a set number of clinical hours in order to graduate. You’ll be allowed to do CNM practicums in your own community. However, you may be expected to find the site and a preceptor who is willing to supervise you. Many RNs end up on a part-time schedule (or even stop working) during clinical rotations because of the heavy workload.
In addition to clinical rotations, Schools of Nursing often like to include on-campus components in an online RN to MSN CNM program. For example:
- Frontier Nursing University has developed a skills-intensive experience called “Clinical Bound” that takes place on its Kentucky campus. CNM students must complete it before they start their first clinical practicum.
- Bethel University’s online CNM program includes three on-campus intensives, lasting about three days each.
- George Washington University’s partner program with Shenandoah University includes a Campus Learning and Skills Intensive (CLASI) and two in-depth clinical training sessions (antepartal, primary care, and perinatal skills) at the Shenandoah campus.
We think these kinds of intensives are great, especially in a hands-on, technical field like midwifery. But they will involve travel time & extra costs. Draw up a full budget of expenses before you commit to a distance learning program.
Note: You’ll also find a lot of “hybrid” or “blended” RN to MSN CNM programs that combine on-campus courses and online classes. If you live near a strong School of Nursing, these are worth considering.
Online RN to MSN CNM Programs & State Licensure
Sound the warning, bang the drums! Before you fall in love with an online RN to MSN CNM program, check with your State Licensing Agency/Board for Nurse Midwives and the program coordinator about state licensure requirements. Certified nurse midwives are governed by specific rules and regulations regarding clinical learning experiences. You need to make certain that all your online degree components will meet the state’s licensing criteria.
Schools tend to talk about this issue up-front, usually in the online program’s FAQ section or a “State Authorization/Regulation” page. For example:
- In its Program Details, Bethel University notes that the program fulfills CNM licensure requirements in the state of Minnesota, but “if you want to obtain this license in a state other than Minnesota, you’ll need to check that state’s requirements for licensure.”
- In its Accreditation & State Authorization section, Frontier Nursing University states that “applicants should contact the licensing boards in their state of residence, or any state in which they may reside in the future, to determine whether the program meets state requirements for licensure.”
- In its State Authorization page, George Washington University notes that folks from certain states simply can’t apply. For example, as of 2018, GW Nursing wasn’t accepting online students from Alabama, Louisiana, or North Dakota.
If you have questions, don’t be afraid to ask the program coordinator for help.
Certified Nurse Midwife Certification
Overview of CNM Certification
To become a CNM, you will need to earn a graduate degree from an ACME-accredited program. You will then be eligible to take the national CNM exam from the American Midwifery Certification Board (AMCB).
Most State Licensing Agencies/Boards for Nurse Midwives will ask to see proof of AMCB certification before they’ll grant you a state CNM license and practice privileges. Certified nurse midwives are legally recognized to practice (as APRNs) in all 50 states and the District of Columbia.
Good RN to MSN CNM programs will clearly state that they are ACME-accredited and ready to prepare you for the AMCB exam. They will also talk openly about their pass rates. For example:
- In 2017, Bethel University noted that the pass rates on the AMCB exam were 85% for first-time test takers and 100% overall for subsequent tries.
- In 2018, Vanderbilt University stated that its cumulative pass rate for students taking their first AMCB certification exam was 95%.
Note: Get your CNM certification done as soon as you can after graduation! Applicants have 24 months from the date of graduate program completion to pass the exam. You can sit for the exam a maximum of 4 times.
The CNM is offered by the American Midwifery Certification Board (AMCB). To gain it, you must:
- Hold a current, active RN license.
- Graduate with a master’s (e.g. MS or MSN) or a doctoral degree (e.g. DNP) from a nurse midwifery education program accredited by ACNM Accreditation Commission for Midwifery Education (ACME).
- Tackle graduate-level coursework in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology.
- Complete clinical hours under the supervision of an AMCB-certified CNM/CM or an APRN. Clinical skills must meet ACNM’s Core Competencies for Basic Midwifery Education and include management of primary care for women throughout the lifespan (including reproductive health care, pregnancy, and birth); care of the normal newborn; and management of sexually transmitted infections in male partners.
- Take & pass AMCB’s CNM exam.
- Keep your certification & licensure up-to-date through continuing education. The certification period lasts 5 years.
Certified Nurse Midwife Jobs
Certified Nurse Midwife Careers
As we mentioned in the CNM definition, CNMs are qualified to work in a whole heap of places. Hospitals, birth centers, and OB-GYN clinics are always popular choices, but you could expand your horizons to include community work in foreign countries, midwife advocacy, and involvement in state policy. Whatever you decide, we recommend you:
- Research the Role Beforehand: Try to shadow a CNM in your area of interest (e.g. birth center work). Talk to current CNMs about their graduate experience and the job hunt. Examine local CNM job descriptions to see what’s available in your area.
- Choose a Job-Focused Degree: Does the School of Nursing offer career counseling, career development workshops, and job fairs? Does it help you organize clinical practicums? Do the courses focus on real-world applications & scenarios? What’s the alumni employment rate? What do alumni say about the program? Remember that CNMs usually list their alma mater & degree on LinkedIn!
- Match the CNM Program to Your Area of Interest: For example, a city university attached to a regional medical center may be famous for midwifery clinical training in hospital settings or affiliated clinics. A rural university with a history of community-based care may include a fair amount of training in home births, natural labor, and independent practice. Ask around.
We should also add that although the majority of CNMs end up attending births in hospitals, the circumstances will depend upon the job. For example:
- As a CNM employed in a private OB-GYN practice, you might always attend births at your local community hospital.
- As a CNM at a birth center, you could end up splitting your time between home births, center births, and more complex births at a collaborative hospital.
- As a CNM in a large maternal center, you might serve as expert back-up to independent midwives providing home birth services.
Certified Nurse Midwife Job Openings
- ACNM: Midwife Jobs.
- Indeed: Certified Nurse Midwife Jobs; Certified Nurse Midwife (CNM) Jobs.
- Monster: Nurse Midwife Jobs.
- LinkedIn: Midwife Jobs.
Certified Nurse Midwife Salaries
Glassdoor’s page on Certified Nurse Midwife Salaries and Payscale’s page on Certified Nurse Midwife Salaries will give you current salary figures for CNMs. In 2018, average CNM salaries ranged from $91,000-$117,000.
You can compare these numbers to the Bureau of Labor Statistics (BLS), which provides annual occupational statistics for Nurse Midwives. Here you’ll find a list of industries with the highest levels & concentration of CNM employment, as well as detailed salary data. Outpatient centers tend to pay the best:
- In 2017, the average mean wage for CNMs in Outpatient Care Centers was $123,150 ($59.21 per hour).
- In 2017, the average mean wage for CNMs in General Medical and Surgical Hospitals was $108,840 ($52.33 per hour).
- In 2017, the average mean wage for CNMs in Offices of Physicians was $103,270 ($49.65 per hour).
Even better, BLS’s national CNM maps will show you states & metro areas with the highest level of employment and the best wages for nurse midwives.
As you might expect, big states like New York, California, Georgia, and Florida have the highest levels of CNM employment, but smaller states (e.g. New Mexico, Alaska, Maryland, Vermont) often have the highest concentrations. In 2017, CNMs in West Virginia and Wisconsin had some of the best wages for CNMs in the country!
Certified Nurse Midwife Resources
CNM Certification Bodies
CNM Professional Associations
- American Association of Birth Centers (AABC)
- Accreditation Commission for Midwifery Education (ACME)
- American College of Nurse-Midwives (ACNM)
- American College of Obstetricians and Gynecologists (ACOG)
- International Childbirth Education Association (ICEA)
- International Confederation of Midwives (ICM)
- Midwifery Education Accreditation Council (MEAC)
- Midwives Alliance of North America (MANA)
- National Association of Certified Professional Midwives (NACPM)
- North American Registry of Midwives (NARM)
CNM Conferences & Events
CNM Useful Resources
- ACNM: Midwifery Graduate Programs
- ACNM: Midwifery Graduate Programs: Fully Distance
- ACNM: Midwife Jobs
- ACNM: Patient Safety & Quality Improvement
- Alliance for Innovation on Maternal Health (AIM)
- Childbirth Connection
- Council on Patient Safety in Women’s Health Care
- Global Library of Women’s Medicine (GLOWM)
- MANA: List of State Licensing Agencies/Boards for Nurse Midwives
- National Coalition for Sexual Health (NCSH): Provider Tools
- NICHD National Child & Maternal Health Education Program
- NIH: PregSource Research Project
The Master of Science in Nurse-Midwifery at Bethel University requires students to complete 57 credits and 750 hours of clinical rounds. Specialized courses cover women's health, antenatal care, intrapartum and postpartum care, fetal evaluation, and newborn care. Students also complete four practicum experiences in nurse-midwifery and a clinical integration providing care for women across the lifespan in a variety of settings. Classes for this degree are offered online, and students are required to come to St. Paul, Minnesota, for one week of on-campus intensives each year. Full-time students complete the degree in two years, and part-time students complete it in three years. Bethel uses a cohort format and students progress through the program as a group. The university describes the program as rigorous and recommends that students not work full-time while pursuing this degree. Classes start in the fall, and no classes are scheduled during the summers.
The Stony Brook University School of Nursing has a master's level nurse-midwifery program that requires students to complete 54 credits. Nearly half of those credits are in clinical courses covering primary care of women and midwifery. Students also complete classes in the nursing core, research, and advanced pharmacology, physiology, and health assessment. Classes for this degree are delivered online, and there are some onsite requirements. Graduates of this program are prepared to take the exam to become a Certified Nurse Midwife. For Stony Brook's most recent graduating nurse-midwifery class, 88% of graduates passed the CNM exam on their first try and the rest passed on subsequent attempts. Every graduate of that class is working as a midwife. The university also reports a 100% graduation rate for part-time students in this program.
The Vanderbilt School of Nursing has two options for nurses interested in nurse-midwifery. Students can earn an MSN in nurse-midwifery or pursue a dual focus in nurse-midwifery and Family Nurse Practitioner. The nurse-midwifery program requires 53 credits and 945 hours of clinical rotations. The dual focus program requires at least 65 credits and 1,365 clinical hours. Nurse-midwifery classes are held on campus and students must live in the Nashville area for the first two semesters of the specialty year. After that, where a student lives may vary depending on where the student is performing nurse-midwife clinical rounds. FNP classes use a modified distance learning format that mixes online classwork with blocks of time, including weekends, when students must be on campus. The School of Nursing matches students with a qualified preceptor and rotates students through a variety of clinical settings.
Shenandoah University has a Master of Science in Nurse-Midwifery that uses a hybrid format for some classes. Core classes require students to attend face-to-face at the main campus in Winchester, Virginia, one or two days per week. Once students enter the specialty classes in the program, some course modules are available online with in-person class meetings scheduled in concentrated blocks of time. During the specialty year, students are usually required to be on campus for one week in the fall semester and another in the spring. Students are also required to complete at least 720 hours of clinical practice working with a preceptor. Students may be able to complete clinical hours in their home community. Full-time students complete core courses in their first year and part-time students complete them in two years. Nurse-midwifery courses take another year for full-time students.