With the American Congress of Obstetricians and Gynecologists publishing projections that suggest a 25 percent shortage of OB-GYNs is imminent in the US by 2030, one clear solution to this impending healthcare crisis has emerged: Increase the number of certified nurse midwives licensed to practice in the United States.
This solution could very well change the face of maternity care and childbirth in the US for the better, as patients have long reported a high level of satisfaction, excellent outcomes, fewer invasive and expensive interventions, and lower overall costs while receiving nurse-midwife care.
Nurse-midwives are master’s-educated nursing professionals who have met the rigorous certification standards necessary to earn the Certified Nurse-Midwife (CNM) credential through the American Midwifery Certification Board (AMCB). Skilled in nursing, midwifery and women’s health issues, certified nurse-midwives provide safe, evidence-based general, gynecologic and obstetric care to women of all ages.
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Registered nurses interested in furthering their education to become certified nurse-midwives must successfully:
Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery
The Accreditation Commission for Midwifery Education (ACME) remains the sole accrediting agency for midwifery programs in the U.S. Graduates of ACME-accredited nurse-midwifery programs are eligible to take the nurse-midwife national certification examination administered by the American Midwifery Certification Board (AMCB), a requirement for advanced practice licensure as a certified nurse-midwife in all jurisdictions.
Program Options for Different Types of Graduate Students
All nurse-midwifery programs result in a graduate degree or post-graduate certificate. Depending on their current educational background, RNs may qualify to take the following ACME-accredited nurse-midwifery programs:
- Traditional MSN or MS Programs: RNs who possess a Bachelor of Science in Nursing (BSN) are eligible to enter nurse-midwifery programs structured as a Master of Science in Nursing (MSN) with a focus on nurse-midwifery or a Master of Science (MS) in Nurse-Midwifery.
- RN-to-MSN Bridge Programs: RNs that hold an associate’s degree in nursing would enroll in ACME-accredited RN-to-MSN bridge programs that confer both a BSN and an MSN with a focus in nurse-midwifery.
- Post-Graduate Certificate Programs: RNs or advanced practice registered nurses (APRN) who already possess a master’s degree in nursing may become a nurse-midwife by completing an ACME-accredited post-graduate certificate in nurse-midwifery.
Other options available to those pursuing graduate degrees in nurse-midwifery include:
- Partially or Fully Online Format: Many institutions offer ACME-accredited nurse-midwifery programs either partially or entirely online, with clinical rotations completed at approved sites near students’ homes. The distance learning option provides working RNs and those not in close proximity to an accredited nurse-midwifery program with a convenient alternative to campus-based programs.
- Dual Specialization: Many institutions have begun offering students the option of taking a dual specialization program. One of the most popular programs today is the nurse-midwifery/women’s health nurse practitioner program, which provides students with a more comprehensive course of study in women’s health. Graduates of these programs are eligible to become nationally certified and state licensed as both a Certified Nurse-Midwife (CNM) and a Women’s Health Nurse Practitioner, Board Certified (WHNP-BC).
A traditional MSN or MS in Nurse-Midwifery is about two years in length. Part-time programs are about three years in length. In addition to possessing an RN license and bachelor’s degree in nursing, candidates are often required to possess a minimum undergraduate GPA, minimum GRE scores, and letters of recommendation for admission.
Nurse-midwife graduate programs prepare RNs to provide quality care to women throughout the lifespan through didactic coursework and immersive clinical rotations. Students of nurse-midwifery programs participate in a full range of clinical experiences in settings like birth centers and hospitals. The clinical component of a nurse-midwifery program may be as long as 1,000 hours, while didactic coursework typically consists of 40-60 credit hours.
All ACME-accredited nurse-midwife master’s programs consist of core coursework in these topics:
- Advanced Pathophysiology
- Clinical Pharmacotherapeutics
- Midwifery Management: Health Assessment and Gynecology
- Professional Issues in Midwifery
- Primary Care of Women
- Midwifery Management during Pregnancy
- Care of the Women during Labor, Birth, Postpartum, and Care of the Newborn
Step 2. Qualify for the Certified Nurse-Midwife (CNM) Credential through Examination
Graduates of nurse-midwifery programs must pass the certified nurse-midwife examination through the American Midwifery Certification Board (AMCB) to earn the CNM credential and qualify for advanced practice state licensure in all jurisdictions. All U.S. states and jurisdictions recognize the certified nurse-midwife exam and resulting CNM credential as the required route to licensure.
Certification in nurse-midwifery protects the public by ensuring that practicing nurse-midwives have met the stringent criteria for CNM recognition established by the AMCB.
Certification Examination Components
The AMCB national certification examination in nurse-midwifery tests the knowledge and clinical judgment needed to practice as a certified nurse-midwife. The examination consists of 175 multiple-choice questions not based on current practice standards established in nursing, medical, and midwifery literature.
The content areas of the certification examination include:
- Antepartum: 19-26 percent
- Intrapartum: 17-26 percent
- Postpartum: 15-18 percent
- Well-Woman/Gynecologic: 15-18 percent
- Women’s Health/Primary Care: 8-16 percent
Candidates can read a more detailed review of the examination content and test preparation recommendations by reviewing the AMCB Candidate Handbook.
Applying for and Scheduling the Certification Examination
Candidates have 24 months from the date they complete their nurse-midwifery program to pass the CNM examination. Examinees man attempt the examination a total of four times.
All candidates must apply to take the exam through the AMCB by completing the Application for Testing and Subsequent Certification as a CNM and submitting it to the AMCB, along with the $500 examination fee.
Once the AMCB has received the application and exam fee, candidates will receive notification by mail within two weeks. Candidates must then schedule to take the examination at an Applied Measurement Professionals (AMP) testing center. Candidates may schedule their examination online through the AMP website or by calling AMP at 800-345-6559. There are about 125 AMP testing centers located across the country.
Successful candidates will receive a certification number and CNM credential expiration date from the AMCB upon passing the exam.
Step 3. Apply for Advanced Practice State Licensure as a Certified Nurse-Midwife
CNMs must be state licensed through their state Board of Nursing to practice nurse-midwifery, usually as advanced practice registered nurses (APRN). The application process generally includes:
- Completing a APRN-CNM application
- Paying the state license fee
- Submitting proof of graduation from an ACME-accredited nurse-midwifery program
- Submitting proof of current CNM certification
While some states grant qualified nurse-midwives full prescriptive authority, allowing them to practice autonomously to the full extent of their training and education, others require practicing nurse-midwives to enter into a collaborative practice agreement with a physician (in general practice or when seeking prescriptive authority). Depending on the state, applicants may need to provide the Board with a signed collaborative practice agreement at the time they apply for licensure.
Depending on the state, an application for prescriptive authority may be part of, or separate from, the application process. All nurse-midwives seeking authority to prescribe controlled substances are required by law to register for a DEA number.
Step 4. Maintain CNM Certification and State Licensure through Continuing Education
All nurse-midwives in the U.S. must maintain their CNM designation to remain licensed by the state. The AMCB features a Certification Maintenance Program, which provides CNMs with two options for maintain their CNM designation at the conclusion of their five-year certification cycle:
- Option 1: Complete at least 3 AMCB Certificate Maintenance Modules during each five-year certification cycle and at least 20 contact hours of approved continuing education units; pay annual fees
- Option 2: Retake the AMCB Certification Examination and pay the $500 examination fee in lieu of annual fees
While some states view the successful renewal of the CNM certification as meeting continuing education requirements, other states require CNMs to complete a specific number of continuing education credits in addition to those required to maintain the CNM credential. Most states renew advanced practice licensure for CNMs on an annual or biennial basis upon completion of a renewal application and payment of a renewal fee.
Membership and participation in midwifery professional associations, at either the state or national level, may provide CNMs with ample opportunity to network with other nurse-midwifery professionals and satisfy their continuing education opportunities through classes, seminars, and conventions, among others:
- American College of Nurse-Midwives
- Citizens for Midwifery
- Midwives Alliance of North America
- Association of Midwifery Educators
- International Confederation of Midwives
- American Nurses Association
- American Holistic Nurses Association