A certified nurse midwife (CNM), as an advanced practice registered nurse (APRN), provides care throughout pregnancy, birth, and beyond. The acceptance of the nurse midwife model in women’s reproductive and gynecological healthcare has boosted employment prospects for CNMs.
CNMs work in a variety of practice settings including hospitals, community clinics, and birthing centers. While their primary role centers on women’s healthcare during pregnancy, birth, and the postpartum period, CNMs provide primary care, gynecological care, and family planning services for women throughout their reproductive years and menopause. Some CNM responsibilities are listed below:
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This list describes the various roles performed by CNMs in some of the most common workplace settings.
These CNMs work with obstetricians handling normal and surgical births. They assist with pain management and provide personal care to mothers and infants.
CNMs in this setting provide services to women with low-risk pregnancies seeking natural childbirth. They assist with vaginal births using nonmedical interventions and provide postnatal support.
These CNMs diagnose and treat gynecological conditions and monitor women during pregnancy. They may offer family planning and contraception counseling and treat sexually transmitted diseases.
A CNM must hold a graduate midwifery degree, a valid registered nurse (RN) license, and certification through the American Midwifery Certification Board (AMCB). This certification qualifies them to apply for licensure in any of the 50 states.
The direct-entry midwife designation includes both certified midwives (CMs) and certified professional midwives (CPMs). Unlike CNMs, direct-entry midwives may obtain certification without first becoming licensed nurses. While CMs may enter the field without nursing training, not all states allow them to practice. Most direct-entry midwives hold the CPM credential — the only certification that provides training for out-of-hospital deliveries.
Traditional midwives lack formal nursing education but have acquired training through direct experience. These unlicensed midwives, typically working with poor and/or rural populations, rely on their experience, knowledge of traditional (or folk) medicine, and the trust of the communities they serve. However, they might not have a legal right to practice midwifery, though this will depend on the state where they live and/or practice.
CNMs must earn both undergraduate and graduate degrees, acquire an RN license, and obtain national certification and licensure in the state where they intend to practice.
The average annual nurse midwife salary, as of May 2020, reached $115,540 with the highest paid making more than $136,000. The BLS projects the demand for nurse midwives to grow by 12% between 2019 and 2029. Midwives working with urban and rural populations will find the most opportunities. CNMs can expect the highest salaries in major metropolitan areas, where they can earn between $116,750 and $191,440 a year.
Several factors contribute to this favorable employment outlook. Hospitals and clinics hire nurse midwives to handle low-risk pregnancies and assist in nonsurgical births to lower costs and reduce complications. The demand for midwives has also grown as more women choose natural childbirth and birth center options.
| Top Paying States | Average Salary | Total Number of Certified Nurse Midwives |
|---|---|---|
| California | $159,590 | 1,010 |
| Utah | $133,680 | 90 |
| Mississippi | $127,960 | Data Not Available |
| New York | $125,780 | 460 |
| Minnesota | $123,600 | 230 |
| Top Paying Metropolitan Areas | Average Salary | Total Number of Certified Nurse Midwives |
|---|---|---|
| Los Angeles-Long Beach-Anaheim, California | $191,440 | 260 |
| Riverside-San Bernardino-Ontario, CA | $171,000 | 40 |
| San Jose-Sunnyvale-Santa Clara, CA | $167,870 | 50 |
| San Francisco-Oakland-Hayward, CA | $162,100 | 210 |
| Sacramento–Roseville–Arden-Arcade, CA | $157,100 | 90 |
| Industry | Average Salary |
|---|---|
| Local Government (excluding schools and hospitals) | $158,210 |
| Outpatient Care Centers | $142,010 |
| Offices of Physicians | $116,440 |
| General Medical and Surgical Hospitals | $111,420 |
| Colleges, Universities, and Professional Schools | $107,130 |
CNMs who typically work with mothers experiencing low-risk pregnancies may deliver babies in hospital and out-of-hospital settings such as home births and birthing centers. Nurse midwives do not induce labor and try to avoid pain medication during the birthing process. In hospital settings, they assist obstetrics and gynaecology (OB-GYN) doctors who manage both low-risk and high-risk pregnancies.
The nursing profession has begun to advocate for the DNP as the terminal degree for advanced practice nurses, including nurse midwives. Earning a DNP not only enhances career prospects in administrative and educational roles but also boosts salary. The nursing field recognizes the relationship between doctoral-level training and improved healthcare delivery, quality, and safety.
BSN graduates may earn a master’s in two years or less or a BSN-DNP in approximately 3-4 years. Those entering the field with only an RN can choose RN-to-MSN or RN-to-DNP programs that may take longer. Direct-entry programs for students with non-nursing undergraduate degrees may require between 2-4 years of study, including prerequisites and clinical requirements.
Nurse midwives acquire specialized nursing and technological training in reproductive and gynecological healthcare and the skills needed to provide primary care through pregnancy and childbirth. CNMs also need “soft skills” to work with diverse populations, or the ability to function in high-stress situations, strong communication skills, leadership qualities, and a caring and compassionate approach to patient care.
This professional organization represents CNMs and CMs in the United States. Members receive discounted registration fees to the annual ACNM meetings and a subscription to the Journal of Midwifery & Women's Health. The association promotes education, research, and networking through an online news site, weekly newsletters, and an online discussion forum.
Established in 1982, MANA provides resources for advocacy, research, and professional education for midwives from diverse backgrounds. The organization offers membership to midwives, students, and other healthcare providers and consumers. Benefits include liability insurance discounts, subscriptions to professional journals, and continuing education opportunities. MANA midwife members may join the Mother's Naturally registry.
AMCB, the leading national certification agency for the profession of midwifery, manages the certification program for nurse midwives who have graduate-level degrees accredited by the Accreditation Commission for Midwifery Education. The organization develops and administers the national certification examination, awards initial CNM and CM certificates, and administers the certification maintenance program for certificate renewal.
AWHONN supports RNs caring for women, newborns, and their families through research, education, and policy initiatives. The association, through its legislative action center, advocates for laws and regulation that improve healthcare for women and newborns and strengthens the nursing profession. Members benefit from professional development opportunities, awards and scholarships, podcasts, and collaborative industry and community partnerships.
Nicole Galan, RN, MSN is a registered nurse who started in a general medical/surgical care unit and then moved to infertility care where she worked for almost 10 years. She has also worked for over 13 years as a freelance writer specializing in consumer health sites and educational materials for nursing students. Galan currently works as a full-time freelancer and recently earned her master’s degree in nursing education from Capella University.
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