Certified nurse-midwives are experts in womancare, from adolescence through menopause and beyond. Whether they’re providing primary care to women in medically underserved rural areas or managing perinatal care in leading hospitals and medical centers in major metro areas, CNMs are satisfying the need for cost-effective, patient-centered, healthcare for women of all ages.
Certified nurse-midwives focus on ensuring patients have options and a level of control during pregnancy and throughout the childbearing process, offering a supportive environment that views birth as a normal physiological process. Many studies have revealed outstanding patient outcomes associated with CNMs, including lower cesarean birth rates, higher breastfeeding rates, and lower NICU admission rates.
Certified nurse-midwives often work with OB/GYN doctors; however, these APRNs also serve as independent practitioners, improving access to quality healthcare for women in community clinics, OB/GYN practices, nurse-midwife-run practices, hospitals, and private birthing centers.
While they may be best known for their work with perinatal patients (including the prenatal, delivery, and postpartum periods), they also satisfy family planning and gynecological needs, family planning and STD care for men, and newborn care (usually during the first 28 days of life).
Not to be confused with certified midwives, who are also educated through accredited programs and nationally certified to practice, CNMs are advanced practice registered nurses who have completed an accredited nurse-midwifery master’s program at minimum and have passed a national exam. While just fives states allow certified midwives to practice, all 50 states and Washington D.C. recognize CNMs.
On any given day, CNMs can be found counseling expecting mothers on birth plans…providing annual pelvic and breast exams…performing pap smears and other diagnostic tests…attending labor and delivery for low-intervention births…treating common infections, such as STDs…and educating patients on family planning options.
The State of Independent Practice Authority Among Certified Nurse-Midwives
Certified nurse-midwives who are able to practice as fully autonomous healthcare providers are highly valued, especially now with an aging OB/GYN workforce and shortages in maternity care, particularly in rural and medically underserved areas of the country. According to the American Congress of Obstetricians and Gynecologists, a shortage of nearly 9,000 OB/GYNs is expected by the end of 2020. And by 2050, this number is projected to swell to 22,000.
All 50 states and Washington D.C. recognize CNMs through state licensure. And while CNMs enjoy full practice autonomy and prescriptive authority in 28 states, there are still many states where these APRNs must practice in a collaborative or supervisory capacity with a partnering physician.
Nineteen states require CNMs to enter into a collaborative physician agreement, while the remaining four states – California, Nebraska, North Carolina, and Florida are the most restrictive, requiring CNMs to practice under direct physician supervision.
Education and Certification Requirements to Become a Certified Nurse-Midwife
To become a certified nurse-midwife, you’ll need to become nationally certified and state licensed, which requires, at a minimum, the completion of an MSN. However, in recent years, the MSN has given way to the DNP as a route to initial certification and licensure for many aspiring CNMs.
In addition to providing CNMs and other APRNs with more professional opportunities and, often times, larger paychecks, the DNP packs a punch when it comes to earning respect and recognition from the largely doctorate-prepared interdisciplinary healthcare team. This trend toward the DNP is also clear among colleges and universities, many of whom have increased their DNP offerings in recent years.
Today, DNP programs can be designed for students with various educational backgrounds:
- MSN-DNP: This traditional DNP program, which may be designed for APRNs and non-APRNs alike, takes about two years to complete and consists of about 36 credits.
- BSN-DNP: This entry-point is designed for BSN-prepared RNs and takes about three years to complete and consist of about 73 credits, combines the components of both the MSN and DNP into one, streamlined program.
- Direct-Entry DNP: This unique option is designed specifically for career changers -those students who have completed a bachelor’s degree in a non-nursing subject. The direct-entry DNP takes about four and a half years to complete; students earn their RN license, MSN, and DNP during this program.
The DNP includes all coursework and clinical experiences necessary to satisfy the AACN’s DNP Essentials and requirements for national certification. You can expect to complete about 500 clinical hours and a final DNP project as part of your DNP program. Some of the courses unique to a DNP-CNM program include:
- High-Risk Childbearing Family
- Normal Childbearing Family
- Management Women’s Complex Health Issues
- Management Fetus/Neonate in DYAD
Graduates qualify to take the national certification through the American Midwifery Certification Board (AMCB).
Salary Expectations for Certified Nurse-Midwives
According to a 2019 APRN Compensation Report, CNMs earned an average gross salary of $107,000 – much higher than the annual gross salary of $98,000 among women’s health nurse practitioners.
May 2019 statistics from the Bureau of Labor Statistics (BLS) reported an annual, average salary of $105,030 for CNMs, with the top 10% of these APRNs earning an average salary of $158,990.