More and more, expectant mothers are realizing the advantages of working with nurse midwives before during and after childbirth. Even as residency trained healthcare practitioners with broad authority and practice privileges, nurse-midwives are able to offer women a more holistic, non-interventionalist approach to pregnancy, delivery and general care. OBGYN MDs are also realizing the value that nurse midwives can bring to a small or medium-sized clinic, allowing for a practice to take on a greater number of patients.
In 2018, approximately 7-10.99% of births in Alabama 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.
As more and more women turn to Certified Nurse Midwives for both primary care and care through pregnancy, Alabama may present one of the strongest potential job markets in the nation since so few currently practice in the state. According to the U.S. Department of Labor, there was only one Certified Nurse Midwife employed in Birmingham, and only 20 total practicing in hospitals and clinics statewide, though this doesn’t account for those that work independently in women’s clinics and midwifery practices.
Nurse midwives are also seen as vital to helping fill the particularly glaring gap in the availability of women’s healthcare services in rural Alabama. A 2015 article published by the Alabama Media Group found that many women in Alabama were being forced to travel more than 50 miles to given birth because of a lack of local birthing services. In a troubling revelation, the article revealed that in 1980, 85 percent of Alabama’s counties had hospitals with obstetrics departments. Fast-forward to 2014, and the number of counties with hospitals that offered adequate childbirth services had shrunk to just 43 percent.
Steps to Becoming a Nurse-Midwife in Alabama
Registered nurses interested in becoming Certified Nurse Midwives must meet the extensive education, experience and examination requirements for Advanced Practice Nurse (APN) licensure through the Alabama Board of Nursing:
|Earn a Qualifying Degree in Nurse Midwifery|
|Pass the National Certification Examinations|
|Apply to Become a Certified Nurse Midwife/Women’s Health Nurse Practitioner|
|Begin a Career as a Certified Nurse Midwife/Certified Registered Nurse Practitioner|
Step 1. Earn a Qualifying Degree in Nurse Midwifery
To achieve the Certified Nurse Midwife (CNM), advanced practice nursing designation, candidates will need to pass the CNM Exam through the American Midwifery Certification Board. Being eligible to sit for the exam requires a master’s degree at minimum in the field of midwifery. Furthermore, this degree must be obtained from a school that is approved by the Accreditation Commission for Midwifery Education (ACME).
Alabama’s registered nurses can choose from flexible online master’s degree programs in nurse-midwifery specifically designed to accommodate the busy schedules of working RNs. While there are no campus locations in Alabama offering graduate studies in nurse-midwifery, programs are available through schools with physical locations in the neighboring states of Florida, Georgia, and Tennessee.
Master’s degrees in nurse-midwifery are designed in a number of different ways to cater to the unique needs of RNs at various stages of their education:
- A bachelor’s degree in nursing – RNs in this situation complete any number of MSN programs that includes a focus on nurse-midwifery or a dual focus in midwifery and women’s health
- An associate’s degree in nursing – RNs in this situation complete an RN-to-MSN program with a focus on nurse-midwifery, which will result in earning both a BSN and MSN
Completing a Qualifying Midwifery Program
Each MSN program has its own admission requirements, which often include the following:
- A BSN, or a related education that includes completion of nursing prerequisites
- Current RN license
- Minimum GPA
- Personal statement or video essay
- Letters of recommendation
- GRE General Test
The midwifery program itself can be divided into two parts:
- Classroom study – can range 40-60 semester credits
- Clinical training – usually at least 1000 hours
Dual focus midwifery programs may include the study of related fields in women’s health such as obstetrics, and/or gynecology. These programs can result in multiple competitive academic credentials such as Nurse-Midwife/Women’s Health Nurse Practitioner (NM/WHNP). This allows these advanced practice nurses to gain a broader depth of knowledge that encompasses the larger picture of a woman’s overall health. Graduates of dual focus programs such as this are also able to sit for the Women’s Health Care Nurse Practitioner (WHNP) Exam.
Women’s health and midwifery programs will cover important theoretical topics in the classroom that can include:
- Biostatistics and other research methods for advanced-practice nurses
- Advanced pharmacology topics for childbearing women
- Health care legal issues and ethics
- Advanced physiology and pathophysiology
- Advanced topics in women’s reproductive health
- Labor, birth, and newborn care
- Integrated midwifery care of women
Clinical courses serve to transition the prospective midwife from theory to practice. The clinical portion of training can take place at relevant local healthcare facilities, or at locations that require commuting or relocation. Upon initial admission to the graduate program, a clinical advisor will work with students to identify appropriate local clinical locations. In Alabama these might include:
- Huntsville Hospital for Women and Children
- UAB Women and Infants Center in Birmingham
- Madison Hospital
- USA Children’s and Women’s Hospital in Mobile
- Children’s of Alabama in Birmingham
Topics covered during clinical classes include:
- Ambulatory primary care of women
- Advanced ambulatory care of women
- Full-spectrum midwifery care
- Advanced midwifery care
- Clinical health data for pregnancy and childbirth
- Applied obstetrics and gynecological methods
Once students have completed their master’s program they can apply to take their national certification examinations.
Step 2. Pass the National Certification Examinations
Holding a master’s degree in the field of nurse-midwifery would qualify an RN to sit for the Certified Nurse-Midwife Exam. With a dual focus Nurse-Midwife/Women’s Health Nurse Practitioner (NM/WHNP) degree, RNs can also take the Women’s Health Care Nurse Practitioner Exam to achieve the WHNP-BC credential. In both cases, passing the exams leads to an Advanced Practice Nurse license through the Alabama Board of Nursing.
While each exam is sponsored by a different organization, testing locations are the same and both are administered at Applied Measurement Professional (APM) test centers (located in H&R Block Centers) in the cities of:
The exam application process for both exams is detailed below. Upon receiving notification from the respective national certification boards, candidates can sign up for testing dates through Applied Measurement Professional (APM) test centers.
Certified Nurse Midwife Exam
The Certified Nurse Midwife Exam is sponsored by the American Midwifery Certification Board (AMCB). Candidates are eligible to take this exam if they hold a valid RN license and have graduated from a relevant graduate program approved by the American Commission for Midwifery Education (ACME).
Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Prospective nurse midwives can start preparing for this exam by reviewing the Candidate Handbook. The test itself is taken on a computer and is comprised of 175 multiple-choice questions. The time limit is four hours, and the test covers the following topics:
- 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
Successful examinees will receive a Certificate in Nurse Midwifery (CNM) from the AMCB. Upon passing this exam, candidates would meet all the eligibility requirements to become a licensed Certified Nurse Midwife with the Alabama Board of Nursing.
Women’s Health Care Nurse Practitioner (WHNP) Exam
Women’s Health Care Nurse Practitioner (WHNP) Exam is sponsored by the National Certification Corporation (NCC). To be eligible to sit for the exam, candidates must have a current RN license and be graduates of a relevant program that meets the NCC’s standards. Candidates can register for this exam online through the NCC’s website.
Candidates can prepare for this exam by studying the WHNP Candidate Guide. Testing lasts three hours, is administered on a computer, and is comprised of 150 scored multiple-choice test questions (tests may contain up to 25 un-scored pretest questions). Subjects covered on the test are as follows:
- 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
Upon passing the exam, nurses will earn the NCC’s WHNP-BC nationally-recognized credential and qualify for an advanced practice license through the Alabama Board of Nursing.
Step 3. Apply to Become a Certified Nurse Midwife/Women’s Health Nurse Practitioner
Applications for advanced practice licensure through the Alabama Board of Nursing can be submitted online by selecting the appropriate portal:
- Certified Nurse Midwife (CNM) – select First Time CNM Application
- Certified Registered Nurse Practitioner (CRNP) in Women’s Health –select First Time CRNP Application
Both of these designations fall under the Advanced Practice Nursing (APN) license through the Alabama Board of Nursing.
Collaborative Practice Agreement
Prior to applying for licensure through the Alabama Board of Nursing, candidates will need to find a licensed medical or osteopathic doctor who is willing to enter into a Collaborative Practice Agreement. This collaborating physician is responsible for providing professional medical oversight as needed and required by law. Both CNMs and CRNPs must enter into such an agreement. This can be done on the same application page by selecting, “Add a New Collaboration.”
Step 4. Begin a Career as a Certified Nurse Midwife/Certified Registered Nurse Practitioner
After submitting their application to practice in an APN area, successful applicants will receive a Notice of Approval for Practice from the Alabama Board of Nursing. Upon receiving this, newly licensed APNs may strike out in their new career as a CNM and/or CRNP in their predetermined collaborative practice.
Renewals and Continuing Education
While busy growing in a new career, nurses should not forget that they must still meet continuing education and renewal requirements:
Advanced Practice Nursing renewal with the Alabama Board of Nursing
- CNM and CRNP designations must be renewed every two years by December 31 of even-numbered years, at the same time as the basic RN license
- 24 credits of board-approved continuing education
- Proof of current national certification
Certificate in Nurse Midwifery (CNM) renewal with the American Midwifery Certification Board (AMCB)
- Completion on a five-year cycle of the AMCB’s Certificate Maintenance Program – one of the following:
- Completion of 3 certificate maintenance modules and 20 hours of continuing education
Women’s Health Care Nurse Practitioner (WHNP-BC) with the National Certification Corporation
- Three-year maintenance cycle
- Continuing education hour requirement can range between 10-50 hours per cycle, depending on the results of the Continuing Competency Assessment
Important Employers for Nurse Midwifes and Women’s Health NPs
Many new nurse midwives and women’s health NPs will be interested in pursuing employment where they completed the clinical segment of their graduate studies or may seek internal advancement where they already have work experience. Others may want to strike out independently or in a partnership to form their own clinical practices.
Potential employers and practice models can include any of the following establishments, located throughout Alabama:
- Tennessee Valley OBGYN Clinic in Huntsville
- Clinic for Women in Madison
- Ladies First Obstetrics and Gynecology in Ozark, Enterprise, and Dothan
- East Alabama Women’s Clinic in Opelika
- Shelby OBGYN in Alabaster
- Women’s Clinic Shoals in Sheffeld
- OBGYN Associates of Alabama in Decatur, Madison, and Huntsville
- Huntsville Hospital for Women and Children
- University of Southern Alabama Children’s and Women’s Hospital in Mobile
- Children’s of Alabama in Birmingham
- University of Alabama Women and Infants Center in Birmingham
- Madison Hospital Clinic for Women
- Princeton Baptist Medical Center Women’s Center
- Shelby Baptist Medical Center’s Level III Neo-Natal Intensive Care Unit
Illustrative Examples of Relevant Jobs in Alabama
Graduates who have passed their respective national examinations can apply for jobs such as the ones shown here. (Provided as examples only):
- Registered Nurse OB/GYN with Trinity Medical Center in Birmingham
- RN OB/GYN with Crestwood Medical Center in Huntsville
- RN Obstetrics Unit with Crestwood Medical Center in Huntsville
- Clinical Nurse Practitioner with Family Medicine in Springhill
- Registered Nurse with Planned Parenthood in Mobile and Birmingham
Salaries for Certified Nurse-Midwives in Alabama
To keep pace with the growing demand for comprehensive perinatal and gynecological care, as well as the growing interest in less invasive approaches to childbirth, the U.S. Department of Labor Statistics (BLS) expects the number of nurse midwives to increase by an astounding 45% nationwide during the 10-year period leading up to 2029.
In 2019, the BLS found that certified nurse-midwives practicing throughout the U.S. earned an average annual salary of $105,030, while entry-level CNMs were paid an average annual salary of $69,000. The most experienced nurse midwives whose salaries fell within the 90th percentile earned an average annual salary of $158,990.
A Closer Look at Nurse-Midwifery in Practice in Alabama
In February 2014, the American College of Nurse-Midwives released data providing a candid look at the profession of nurse-midwifery in Alabama. Key points included in the report:
- There were 46 licensed certified nurse midwives (CNM) practicing in Alabama
- 56% of these licensed certified nurse midwives were members of the American College of Nurse-Midwives
- In 2012, 1.59% of the 58,448 births reported in Alabama were attended by certified nurse midwives
Certified nurse-midwives who have established themselves as highly skilled and experienced healthcare professionals, can generally expect higher compensation for their expertise. The majority of Alabama’s nurse midwives work in area hospitals and birth centers. However, some also work collaboratively with OBGYN physicians in smaller independent practices and women’s clinics.
(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.)