Not only has the practice of nurse-midwifery been shown to reduce the number of neonates born with low birth weight, the American College of Nurse-Midwives (ACNM) has documented numerous other benefits, including fewer costly and invasive procedures like episiotomies and C-sections.
The practice of nurse-midwifery has had the net effect of reducing health care costs during pregnancy, delivery and beyond, and has helped increase access to high-quality obstetric and gynecologic care.
Though most certified nurse-midwives in Maryland work in obstetric units of major hospitals, CNMs attend virtually all births that take place outside of the hospital setting in birthing centers and in the home. In 2018, approximately 11-13.69% of births in Maryland were attended by midwives, according to the U.S. Department of Health & Human Services, Centers for Disease Control and Prevention and the National Center for Health Statistics.
Additionally, according to the U.S. Department of Labor’s Employment and Training Administration, the occupation is expected to grow 26.7% from 2018 to 2028 in the state of Maryland.
The growing interest in a gentler, less-invasive approach to childbirth coupled with the low number of CNMs currently licensed to practice in Maryland is creating new opportunities for nurse-midwives interested in establishing independent women’s health clinics and partner practices that cater to the unique needs of women and expectant mothers.
Working within hospitals, clinics, and birth centers throughout Maryland, CNMs are dedicated to providing women-centered healthcare services at all stages of life and pregnancy. CNMs in Maryland independently manage clients and collaborate with licensed physicians to provide comprehensive healthcare services to women and expectant mothers.
Steps to Becoming a Certified Nurse-Midwife in Maryland
Becoming a nurse-midwife in Maryland requires RNs with licenses in good standing to meet the education and certification requirements for advanced practice registered nurse (APRN) licensure through the Maryland Board of Nursing. RNs in Maryland interested in becoming nurse-midwives must complete the following steps to attain APRN licensure and recognition as a certified nurse-midwife in the state:
Step 1. Earn a Qualifying Master’s Degree in Nurse-Midwifery
Becoming a nurse-midwife in Maryland starts by earning a master’s or higher degree in nurse-midwifery through a program that has been recognized by the Accreditation Commission for Midwifery Education (ACME).
Graduate Program Options and Dual Specialty Tracks
Since there are so few schools that offer nurse-midwife programs at conventional campus locations around the nation, flexible online programs that accommodate the schedules of working RNs have become common. While there are no graduate-level nurse-midwife programs housed in schools with campus locations in Maryland, aspiring nurse-midwives may enroll in one of several ACME-accredited online master’s programs in nurse-midwifery available to residents of the state.
RNs apply to different programs based on their past education. Bachelor’s prepared RNs may apply to conventional MSN and MS programs with a focus in nurse midwifery or a dual focus in nurse midwifery and women’s health. RNs who only hold an associate’s degree may complete an RN-to-MSN bridge program with a focus in nurse-midwifery to earn both a BSN and MSN in one accelerated program. Admission requirements to both types of programs are often strict, evaluating students’ undergraduate GPA, GRE score, letters of recommendation and more.
An increasing number of aspiring CNMs are electing to pursue dual specialty tracks structured as Nurse-Midwife/Women’s Health Nurse Practitioner (NM/WHNP) master’s programs. Graduates of these programs would be able to earn board certification as a women’s health nurse practitioner (WHNP-BC) in addition to their certified nurse-midwife (CNM) credential.
Program Structure and Components
Upon admission to a master’s program in nurse-midwifery, students will encounter both didactic and clinical coursework designed to provide a full spectrum of knowledge in the field.
Didactic coursework, which typically consists of between 40-60 credits, would cover such topics as:
- Physiology & Pathophysiology
- Newborn Care
- Biostatistics for Health Care Providers
- Midwifery Care During Labor
- Pharmacology
- Midwifery Care During Pregnancy
- Ambulatory Care of Women
- Women’s Reproductive Healthcare
- Family Crisis Care
Clinical coursework takes place at a nearby hospital or birthing clinic and usually consists of between 700 and 1,000 hours of work, depending on the program. Online students work with program directors to make arrangement for placements in nearby clinical settings. Examples of locations that facilitate clinical sequences for nurse-midwife master’s students in Maryland include:
- Adventist HealthCare Shady Grove Medical Center in Rockville
- Anne Arundel Medical Center in Annapolis
- Family Childbirth and Children’s Center at Mercy Medical Hospital in Baltimore
- Holy Cross Hospital in Rockville
- Prince George’s Hospital Center in Cleverly
Step 2. Pass the National Nurse-Midwife Certification Examination
The final step to qualifying for advanced practice registered nurse licensure as a nurse-midwife in Maryland is to pass the Certified Nurse Midwife Exam offered by the American Midwifery Certification Board (AMCB). RNs who have earned their master’s degree in nurse midwifery may apply to take the exam by mailing their completed application form to the following address:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
The Certified Nurse Midwife Exam is a computerized test consisting of 175 multiple choice questions. Examinees have a four-hour time limit to complete the exam, which is offered in Maryland at AMP Testing Centers in the following H&R Block offices:
H&R Block Office
123-B Crain Highway North
Glen Burnie, MD 21061
H&R Block Office
8620 Liberty Rd
Randallstown, MD 21133
To help RNs prepare for the exam, the AMCB offers an online Candidate Handbook. The exam is divided into the following sections:
- Antepartum – 19-26 percent
- Intrapartum – 17-26 percent
- Postpartum – 15-18 percent
- Gynecology – 15-18 percent
- Women’s health and primary care – 8-16 percent
- Newborn – 7-16 percent
The exam is graded on a pass/fail basis. Upon passing, RNs will receive the Certificate in Nurse Midwifery (CNM) from the AMCB.
In addition to the Certified Nurse Midwife Exam, RNs who have completed a Nurse-Midwifery/Women’s Health Nurse Practitioner (NM/WHNP) dual-focus program may also choose to take the Women’s Health Care Nurse Practitioner (WHNP) Exam administered by the National Certification Corporation (NCC) to achieve WHNP-Board Certification.
Exam candidates may use the WHNP Candidate Guide to prepare for the exam. The 150-question multiple-choice test is divided into the following areas:
- Pharmacology – 5-10 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Obstetrics – 25-30 percent
- Gynecology – 35-40 percent
Examinees must complete the exam within three hours. The exam is scored on a pass/fail basis, as determined by the NCC. The exam is offered at the same Baltimore AMP Testing Center as the Certified Nurse Midwife Exam.
Step 3. Apply for Advanced Practice Licensure in Maryland as a Certified Nurse-Midwife
Upon successfully completing the Certified Nurse Midwife Exam, CNMs may begin the application process for advanced practice registered nurse (APRN) licensure with certified nurse-midwife recognition through the Maryland Board of Nursing.
To apply for APRN licensure as a certified nurse midwife, RNs must print and complete the Nurse Midwife Certification Application Form found on the Maryland Board of Nursing website. Along with their application, they must send the following to the Board:
- A copy of their active RN license
- Their American Midwifery Certification Board-issued certificate
- A CCA card, when applicable
- A $50 fee in the form of a check or money order made payable to the Maryland Board of Nursing
- Copies of two items that provide proof of residency, which may include a current driver’s license, a federal income tax return, a voter’s registration card, a W2 form from the U.S. Government, or a Military Form #2058
All materials must be sent to the following address:
ADVANCE PRACTICE DEPARTMENT MARYLAND BOARD OF NURSING
4140 PATTERSON AVENUE
BALTIMORE, MD 21215-2254
(410) 585-1926
Applicants who pass the NCC’s Women’s Health Care Nurse Practitioner Exam and receive the WHNP-BC credential may additionally elect for APRN licensure with WHNP recognition through the Maryland Board of Nursing by submitting the Nurse Practitioner Certification Application Form.
Step 4. Begin a Career as a Certified Nurse-Midwife in Maryland
In April of 2015, Maryland senators unanimously approved a bill that allows Certified Professional Midwives (CPMs) to assist women in home childbirth. The bill will not, however, allow CPMs to provide care to women with previous cesarean sections, a role reserved for Certified Nurse Midwives (CNMs).
CNMs work in a variety of settings ranging from Maryland’s largest hospitals to small medical practices, women’s clinics and birth centers. Additionally, many CNMs start their own practices, often in conjunction with other medical professionals.
The following are among the top employers of CNMs in Maryland:
- Adventist HealthCare Shady Grove Medical Center in Rockville
- Adventist HealthCare Washington Adventist Hospital in Takoma Park
- Anne Arundel Medical Center in Annapolis
- Bay Area Midwifery Center in Annapolis
- Better Birth Center in Bowie
- Birthright in Frederick
- Calvert Memorial Hospital in Frederick
- Family Childbirth and Children’s Center at Mercy Medical Hospital in Baltimore
- Greater Baltimore Medical Center – Labor and Delivery in Towson
- Holy Cross Hospital in Germantown, Silver Spring, and Rockville
- Laurel Regional Hospital in Laurel
- MedStar Franklin Square Medical Center in Baltimore
- MedStar Southern Maryland Hospital Center in Clinton
- Meritus Health Family Birthing Center in Hagerstown
- Prince George’s Hospital Center in Cleverly
- Riverside Midwifery, LLC in Buckeystown
- Saint Agnes Hospital in Baltimore
- Sinai Hospital in Baltimore
- Southern Maryland Women’s Healthcare, P.A in Leonardtown
- Special Beginnings Birth & Women’s Center in Annapolis
- Suburban Hospital in Bethesda
- The Johns Hopkins Hospital in Baltimore
- Union Hospital in Elkton
- University of Maryland Charles Regional Medical Center in La Plata
- University of Maryland Medical Center in Baltimore
A survey of job vacancies for certified nurse-midwives in Maryland in November 2015 revealed some of the opportunities available to CNMs in the state (shown for informational purposes only and does not constitute a job offer or the assurance of employment.):
- Nurse Midwife Hospitalist at Sinai Hospital in Baltimore
- WHNP/Nurse Practitioner/Certified Nurse Midwife/Women’s Health GYN Outpatient at Advanced Practice Solutions in Baltimore
- Staff Nurse – Midwife at Anne Arundel Medical Center in Annapolis
- Certified Nurse Midwife at University of Maryland St. Joseph Medical Center
Salaries for Certified Nurse-Midwives in Maryland
Nurse-midwives in Maryland earned an average annual salary of $118,240 according to 2019 U.S. Bureau of Labor Statistics data.
Salaries for nurse-midwives varied depending upon experience. Those just entering the field in 2019 earned an average of $85,750 annually in the 10th percentile. The same report stated that highly experienced nurse-midwives in Maryland earned an annual salary of $125,110 in the 75th percentile and $145,360 annually in the 90th percentile of earnings, respectively.
Maryland’s Legislation Recognizes State-wide Shortage of Nurse-Midwives
According to the Maryland Department of Health and Mental Hygiene, a new bill was introduced in 2012 that took a fresh look at the scarcity of licensed CNMs and brought attention to the demand for their services while proposing ways to increase employment opportunities all across Maryland.
Laura Herrera, Deputy Secretary for Public Health in Maryland, suggested further legislation to breakdown barriers in nurse-midwife training and licensure. This included a plan for expansion in the employment of nurse-midwives in major hospitals and non-hospital home-birth settings alike. This was a promising development for those entering the field in Maryland as newly licensed nurse-midwives, as well as seasoned practitioners in the state interested in exploring new career opportunities.
Nurse-Midwives in Baltimore-Columbia-Towson Area Enjoy Competitive Regional Salaries
While certified nurse-midwives are employed throughout the state of Maryland, most of them have settled in the Baltimore-Columbia-Towson region. This might be attributed to the area’s competitive salaries.
According to the U.S. Bureau of Labor Statistics, certified nurse-midwives in Baltimore-Columbia-Towson were shown to earn an average annual salary of $118,570 in 2019. Here are the additional salary breakdowns:
Baltimore-Columbia-Towson
- Average: $118,570
- Entry-Level: $84,830
- Experienced: $149,580
Washington-Arlington-Alexandria
- Average: $103,700
- Entry-Level: $64,870
- Experienced: $130,120
(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2019. Figures represent state data, not school-specific information. Job growth data provided by Projections Central, a resource funded by the U.S. Department of Labor’s Employment and Training Administration. Conditions in your area may vary. Information accessed March 2021.)