Last Updated: May 2025 | Reviewed by Abbie Jacobs
Washington State is a national leader in midwifery care, offering two distinct professional pathways to becoming a midwife: Certified Nurse-Midwife (CNM) and Licensed Midwife (LM). With one of the nation’s highest rates of midwife-attended births, supportive regulatory frameworks, and competitive compensation, Washington provides exceptional opportunities for aspiring midwives. This comprehensive guide outlines how to become a midwife in Washington through either pathway, from initial education through professional licensure and career development.
According to recent data, Washington employed 110 certified nurse-midwives as of 2019, with the profession projected to grow 16.7% from 2018 to 2028. Additionally, the state licenses numerous Licensed Midwives who provide comprehensive care through the direct-entry pathway. Both types of midwives enjoy strong market demand and the ability to practice across diverse healthcare settings throughout Washington.
“Washington’s dual-pathway system allowed me to choose the educational route that best matched my background and career goals. The state’s progressive approach to midwifery practice has enabled me to provide comprehensive, woman-centered care while maintaining full professional autonomy. The collaborative relationship between CNMs and LMs here creates a strong professional community.” – Maria L., CNM, Spokane
Understanding Midwifery Pathways in Washington
Washington recognizes two distinct professional pathways to midwifery practice, each with specific educational requirements, licensing procedures, and practice scopes. Understanding these pathways is essential for choosing the route that best aligns with your educational background and career objectives.
Midwifery Pathway Comparison
| Aspect | Certified Nurse-Midwife (CNM) | Licensed Midwife (LM) |
|---|---|---|
| Educational Foundation | Nursing education plus graduate midwifery training | Direct-entry midwifery education |
| License Type | Advanced Registered Nurse Practitioner (ARNP) | Licensed Midwife (LM) |
| Educational Duration | 4-6 years (BSN + MSN) | 3-4 years (direct midwifery program) |
| Practice Settings | Hospitals, birth centers, clinics, and private practice | Birth centers, homes, private practice, and some hospitals |
| Scope of Practice | Full women’s health across the lifespan | Pregnancy, birth, postpartum, newborn care |
| Prescriptive Authority | Full prescriptive authority with additional training | Limited to approved medications within scope |
Certified Nurse-Midwife (CNM) Pathway
The CNM pathway represents the nursing model of midwifery care, combining advanced nursing education with specialized midwifery training. CNMs in Washington are licensed as Advanced Registered Nurse Practitioners (ARNPs) with midwifery specialization.
Steps to Becoming a CNM in Washington
CNM Educational Requirements
The foundation for becoming a CNM begins with nursing education, followed by specialized graduate-level training in nurse-midwifery.
Foundation Prerequisites:
- Active Washington State RN license or multistate compact license
- Bachelor of Science in Nursing (BSN) from a CCNE or ACEN-accredited institution
- Clinical nursing experience (requirements vary by program)
- Competitive undergraduate GPA, typically minimum 3.0-3.5
Graduate Education Options:
CNM Program Types
| Program Type | Designed For | Typical Duration |
|---|---|---|
| Master of Science in Nursing – CNM Track | RNs with Bachelor of Science in Nursing (BSN) degrees | 18-24 months full-time |
| RN-to-MSN Bridge Programs | RNs with associate’s degrees in nursing | 3-4 years full-time |
| Post-Graduate Certificate Programs | RNs with an MSN wanting to add CNM certification | 12-18 months full-time |
| Doctor of Nursing Practice (DNP) | RNs seeking the highest level of clinical preparation | 3-4 years full-time |
Core Curriculum Components:
Graduate programs in nurse-midwifery provide comprehensive preparation for advanced practice, including:
Advanced Clinical Sciences:
- Advanced pathophysiology across the lifespan
- Advanced pharmacology for women’s health
- Advanced health assessment techniques
- Clinical diagnostic reasoning and decision-making
Midwifery Specialty Content:
- Antepartum care management and risk assessment
- Intrapartum care and delivery management
- Postpartum care and lactation support
- Newborn assessment and initial care
- Family planning and contraceptive management
- Gynecological health maintenance across the lifespan
Professional Practice Foundations:
- Legal and ethical issues in advanced practice
- Healthcare policy and advocacy
- Evidence-based practice integration
- Leadership in women’s health
Clinical Training Requirements:
All accredited nurse-midwife programs include extensive supervised clinical experiences across multiple healthcare settings:
- Hospital labor and delivery units
- Ambulatory women’s health clinics
- Birth centers and alternative birthing facilities
- Community health organizations
- Private OB/GYN practices
- High-risk obstetric services
Washington Clinical Training Sites:
- Providence Everett Medical Center, Pavilion for Women & Children
- University of Washington Medical Center, Seattle
- Sacred Heart Women’s Health, Spokane
- Trios Women’s and Children’s Hospital, Kennewick
- Women’s Clinic at Overlake, Bellevue
- MultiCare Health System locations
Washington-Based CNM Programs:
- University of Washington School of Nursing – Seattle (Campus-based DNP program)
- Seattle University College of Nursing – Seattle (Campus-based programs)
Many Washington residents also complete accredited online programs coordinating clinical placements throughout the state. Popular options include dual-focus nurse-midwife and women’s health nurse practitioner programs.
Program Admission Requirements:
Competitive candidates typically present:
- Current, unencumbered RN licensure
- Bachelor’s degree in nursing with strong academic performance
- Professional nursing experience (1-2 years preferred)
- Professional references from nursing supervisors and healthcare colleagues
- Personal statement demonstrating commitment to midwifery philosophy
- Graduate Record Examination (GRE) scores (program-dependent)
- Interview with faculty and admissions committee
CNM National Certification
Upon graduation from an ACME-accredited program, candidates pursue national certification through the American Midwifery Certification Board (AMCB).
Certification Process:
- Submit application to AMCB with required documentation
- Receive eligibility approval before scheduling the examination
- Complete, comprehensive computer-based examination
- Achieve a passing score to earn the CNM credential
Examination Content Areas:
- Antepartum management (25%)
- Intrapartum management (30%)
- Postpartum management (15%)
- Newborn care (10%)
- Primary gynecologic care (20%)
Testing Locations Throughout Washington:
| Region | Cities |
|---|---|
| Puget Sound | Bellevue, Everett, Kirkland, Seattle, Tacoma |
| Eastern Washington | Spokane, East Wenatchee, Yakima |
| Southwest Washington | Vancouver |
| Northwest Washington | Bellingham |
| Southeast Washington | Kennewick |
ARNP Licensure for CNMs
CNMs in Washington must obtain Advanced Registered Nurse Practitioner (ARNP) licensure through the Washington State Nursing Care Quality Assurance Commission.
Required Documentation:
- Completed ARNP application with CNM designation
- Official transcripts sent directly from an educational institution
- AMCB certification verification
- FBI fingerprint background check
- Prescriptive Authority Attestation (if seeking prescriptive privileges)
- Pharmacology education documentation
- Application and licensing fees
Prescriptive Authority Requirements:
- Completion of graduate-level pharmacology coursework
- Attestation of competency in prescriptive practices
- Ongoing continuing education requirements in pharmacology
- Scope limited to CNM practice areas
CNM Credential Maintenance
ARNP License Renewal (Every 2 Years):
- Complete a minimum of 250 hours of independent clinical practice
- Obtain 30 contact hours of continuing education
- Complete 15 contact hours of pharmacology CE (if prescriptive authority)
- Submit the renewal application and fees before your birthday
AMCB Certification Maintenance (Every 5 Years):
- Option 1: Complete 3 AMCB modules plus 20 hours of continuing education
- Option 2: Retake the AMCB certification examination
Licensed Midwife (LM) Pathway
The Licensed Midwife pathway offers direct-entry education to midwifery practice without requiring nursing education. LMs provide comprehensive care throughout pregnancy, birth, and the postpartum period.
LM Educational Requirements
Program Structure:
- Three-year accredited midwifery education program
- Curriculum meeting the International Confederation of Midwives standards
- Standards exceeding the North American Registry of Midwives requirements
- Combination of didactic education and supervised clinical experiences
Clinical Training Requirements:
- Minimum of 50 women cared for during the prenatal period
- A minimum of 50 women attended during labor and delivery
- Minimum of 50 women cared for during the early postpartum period
- Additional observation of 50 women during the intrapartum period
LM Licensing Process
Licensure Requirements:
- Graduation from an approved midwifery education program
- Successful completion of national and state examinations
- Application to the Washington State Department of Health
- Initial application fee of $541 (as of 2024)
- Background check and documentation review
NARM Certification Pathway:
- Washington accepts North American Registry of Midwives certification
- Streamlined licensure process for NARM-certified midwives
- Recognition of rigorous NARM standards
LM Scope of Practice
Authorized Services:
- Complete prenatal care, including laboratory work and ultrasound referrals
- Education, pregnancy, and birth counseling
- Continuous support during labor and delivery
- Newborn care for the first two weeks of life
- Postpartum care of the mother for up to eight weeks
- Administration of approved medications
- Routine newborn procedures
Practice Settings:
- Independent midwifery practices
- Group practices with other midwives or physicians
- Birth centers
- Home birth services
- Some hospital settings
LM License Maintenance
Annual Renewal Requirements:
- License renewal by birthday with a $541 fee
- 30 hours of continuing education every three years (25 hours clinical midwifery)
- Consultation, Emergency Transfer, and Transport form submission
- Data submission to an approved research organization
- Peer review participation (5 cases every two years)
Midwife Salaries in Washington
Washington offers competitive compensation for both certified nurse-midwives and licensed midwives, with variations based on education level, experience, practice setting, and geographic location.
CNM Salary Data (2023):
- Entry-Level: $89,420
- Average: $112,180
- Median: $113,890
- Experienced: $135,880
Seattle-Tacoma-Bellevue Metropolitan Area:
- Entry-Level: $107,800
- Average: $119,130
- Median: $121,040
- Experienced: $133,840
| Experience Level | Statewide CNM | Seattle Metro CNM | LM Range* |
|---|---|---|---|
| Entry-Level (0-2 years) | $89,420 | $107,800 | $65,000-$85,000 |
| Mid-Career (3-7 years) | $112,180 | $119,130 | $75,000-$105,000 |
| Experienced (8+ years) | $135,880 | $133,840 | $85,000-$125,000 |
*LM salary ranges vary significantly by practice setting and business model
(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2022. 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.)
Career Opportunities for Midwives in Washington
Washington’s progressive regulatory environment creates diverse opportunities for both CNMs and Licensed Midwives across multiple practice settings and specialized areas.
Primary Care Settings:
- Hospital Systems: Providence Health, MultiCare Health System, CHI Franciscan Health
- Birth Centers: Cascade Birth Center (Everett), Center for Birth (Seattle), Puget Sound Birth Center
- Academic Medical Centers: University of Washington Medical Center, Seattle Children’s Hospital
- Community Health: Federally Qualified Health Centers, Planned Parenthood affiliates
- Private Practice: Independent midwifery practices, collaborative care models
Specialized Practice Areas:
- High-risk obstetric consultation and co-management
- Reproductive endocrinology and fertility services
- Adolescent and young adult gynecology
- Menopause and hormonal health management
- Global health and humanitarian midwifery
- Lactation consulting and breastfeeding support
- Childbirth education and community outreach
Notable Employers and Organizations:
- Providence Health and Services
- Group Health Permanente (Kaiser Foundation Hospitals)
- MultiCare Health System
- Evergreen Health
- PeaceHealth
- The Birthing Inn (Tacoma)
- Mount Vernon Birth Center
- WomanCare (Olympia)
Professional Resources and Support
Washington maintains strong professional support networks for both CNMs and Licensed Midwives through established organizations, regulatory bodies, and continuing education providers.
Professional Organizations:
- Midwives’ Association of Washington State – Supports both CNMs and LMs
- Washington State Nurses Association – CNM professional support
- ARNPs United of Washington State – ARNP advocacy and resources
- Puget Sound Nurse Practitioners Association – Regional ARNP support
Regulatory and Certification Bodies:
- Washington State Nursing Care Quality Assurance Commission – CNM licensing
- Washington State Department of Health – LM licensing
- American Midwifery Certification Board – CNM certification
- North American Registry of Midwives – LM certification
- Accreditation Commission for Midwifery Education – Program accreditation
Frequently Asked Questions
Which midwifery pathway is right for me?
The choice depends on your educational background and career goals. If you’re already an RN or interested in full-scope women’s health beyond pregnancy and birth, the CNM pathway may be ideal. The LM pathway could be the right choice if you’re specifically interested in pregnancy, birth, and postpartum care with direct-entry education.
How long does it take to become a midwife in Washington?
CNM pathway: 4-6 years total (BSN + MSN), or 3-4 years after obtaining RN licensure. LM pathway: 3-4 years through direct-entry midwifery education programs.
Do midwives in Washington require physician supervision?
No. In Washington, both CNMs and Licensed Midwives can practice independently without mandatory physician supervision, though they maintain consultation relationships for complex cases.
Can I attend home births as a midwife in Washington?
Yes. Both CNMs and Licensed Midwives can attend home births in Washington, subject to their individual practice scope and risk assessment protocols.
What insurance coverage is available for midwifery services?
Most major insurance plans in Washington cover midwifery services provided by both CNMs and Licensed Midwives, including Medicaid coverage for eligible patients.
Are online midwifery programs accepted in Washington?
Yes, for CNM education, provided programs maintain ACME accreditation and coordinate appropriate clinical experiences. LM education typically requires in-person clinical components.
Can midwives prescribe medications in Washington?
CNMs with prescriptive authority can prescribe medications within their scope of practice. Licensed Midwives can administer approved medications specific to their scope but have more limited prescriptive authority.
What continuing education is required?
CNMs: 30 hours every 2 years (15 hours pharmacology if prescriptive authority). LMs: 30 hours every 3 years (25 hours clinical midwifery-related).