In 2014, the California Nurse-Midwife Association (CNMA) reported that certified nurse midwives attended 11 percent of all conventional births in the state, assisting in the delivery of approximately 55,082 newborns that year.
California leads the nation when it comes to nurse-midwifery, issuing more Advanced Practice Nursing (APN) licenses to certified nurse-midwives (CNM) than anywhere else in the country. As of last count in 2014, some 1,200 CNMs were licensed to practice in the state, providing whole-person focused well-women care and family planning services in addition to the gentle antepartum, intrapartum and postpartum care they have come to be known for.
California’s certified nurse-midwives work independent of restrictive collaborative practice agreements that are common elsewhere in the nation, and qualify to receive Medi-Cal reimbursement at 100 percent of physician fee levels. This has contributed to California’s CNMs being among the best paid in the nation, enjoying an average salary of $127,940 as of 2014, according to the US Department of Labor.
More and more women are choosing to work with certified nurse midwives through the antepartum, intrapartum and postpartum periods, and for general health and gynecological care throughout the course of their lives. The reason behind the growing preference for nurse-midwifery care is perhaps best summarized in a San Diego Union-Tribune article quoting Paula McQueen, a mother of six and nurse-midwife in Fallbrook who said, “I felt intimidated to talk with my doctors, but I felt comfortable to talk with my midwives about anything.”
Steps to Becoming a Nurse-Midwife in California
Certified nurse-midwives are licensed as Advanced Practice Nurses (APN) through the California Board of Registered Nursing (BRN). California RNs with licenses in good standing may become licensed to practice as certified nurse midwives by following the steps in this guide:
Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery
California RNs interested in becoming certified nurse-midwives can fulfill education requirements by completing a master’s or higher degree in nurse-midwifery that meets one of these criteria:
- Completion of a nurse midwife program that is approved by the BRN
- Completion of a nurse midwife program that has equivalent standards to those of the BRN
- Completion of a nurse midwife program that is approved by the Accreditation Commission for Midwifery Education (ACME) (also known as the national certification route)
There are three schools in California that offer nurse-midwife graduate degree programs approved by both the BRN and the ACME, located in:
- San Diego
- San Francisco
Working RNs often prefer the convenience and flexibility of the ACME-accredited online programs that are available through nationally renowned schools.
All in state accredited master’s programs, as well as many online programs, offer students the option of dual specializations in the areas of nurse midwifery and women’s health. Earning an accredited master’s degree with a focus in these fields will give RNs the option to go on to become dually credentialed as both a certified nurse midwife (CNM) and women’s health nurse practitioner (WHNP). Accredited dual-focus graduate programs in nurse-midwifery/women’s health nurse practitioner (NM/WHNP) are designed to meet all requirements for national certification and state board recognition in both areas.
Common admissions requirements for nurse-midwife graduate programs include:
- Current RN license
- BSN or completion of nursing prerequisite courses
- Minimum 3.0 GPA
- Statement of goals, personal essay, or video essay
- Letters of recommendation
- Prior related work experience
While most candidates for nurse-midwife graduate programs hold a BSN, there are also accredited RN-to-MSN bridge programs in midwifery/women’s health for those that hold an associate’s degrees in nursing.
Nurse-Midwifery Graduate Program Structure
Full-time online and campus based-programs tend to be similar in length, with students completing the full course of study in around two years. Part-time programs typically take about three years to complete. All programs are comprised of the following elements:
- Classroom instruction – 40 to 60 semester credits
- Clinical instruction – around 1,000 hours
Important topics in midwifery and women’s health are covered throughout the course of a student’s didactic studies, including:
- Conducting advanced health assessments
- Legal issues and ethics in maternal healthcare
- Advanced physiology
- Disease prevention and health promotion
- Psychology for pregnancy
- Women’s reproductive health
- Labor, birth, and newborn care procedures
- Complicated pregnancies and deliveries
- Advanced integrated midwifery
- Nurse midwifery for the antepartum, intrapartum, and postpartum woman
- Mother and infant biostatistics
- Multicultural midwifery
- Research methods for advanced-practice nurses
- Advanced pharmacology for childbearing women
Sites where students can complete their clinical sequence are located throughout the state – both for in-state and online programs. Students involved in online studies will work closely with a faculty advisor to determine appropriate clinical placements at a convenient location. Online programs strive to develop relationships with clinical programs across the United States, and in California in particular since the state leads the nation in terms of nurse-midwife graduate program enrollment.
Locations in California were nurse-midwife graduate students complete clinical sequences include:
University of San Francisco Medical Center:
- Women’s Health Primary Care Center at Montgomery Street
- Women’s Health Primary Care at Mount Zion
- Centering Pregnancy Program
- Fetal Treatment Center
- Obstetrics and Gynecology Services at Serramonte
University of California Los Angeles:
- The BirthPlace Santa Monica
- The BirthPlace Westwood
- Acute Care Pediatrics Unit
- Fetal Diagnostics Unit
- Infant Security – Perinatal Unit
University California Davis Medical Center in Sacramento:
- Obstetrics and Gynecology Clinic
- Women’s Clinic
- Miscarriage Center
- Division of Maternal Fetal Medicine
Step 2. Take the National Certification Exam in Nurse-Midwifery
After completing a qualifying graduate program, candidates for APN licensure by national certification in nurse-midwifery would then go on to take the Certified Nurse-Midwife Exam through the American Midwifery Certification Board (AMCB). Graduates of dual focus nurse midwifery/women’s health nurse practitioner (NM/WHNP) programs may additionally choose to take the Women’s Health Care Nurse Practitioner Exam through the National Certification Corporation:
- American Midwifery Certification Board (AMCB) – Sponsor of the Certificate in Nurse Midwifery (CNM) for prospective certified nurse-midwives
- National Certification Corporation – Sponsor of the Women’s Health Care Nurse Practitioner (WHNP-BC) credential for prospective women’s health NPs
After registering with the respective sponsoring organizations, exam candidates can sign up for a testing date and location through Applied Measurement Professional (APM), which proctors both exams at H&R Block Centers located throughout California in the cities of:
- La Mesa near San Diego
- Long Beach
- Los Angeles
- Palm Springs
- San Francisco
- San Jose
- Santa Maria
- Van Nuys
Certified Nurse-Midwife (CNM) Exam – American Midwifery Certification Board (AMCB)
Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Candidates are encouraged to prepare for this exam by reviewing the Candidate Handbook. The test is taken on a computer and comprised of 175 multiple-choice questions. Candidates have four hours to complete their test, which covers the topics of:
- 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.
Women’s Health Care Nurse Practitioner (WHNP) Exam – National Certification Corporation
Candidates can register for this exam online through the NCC’s website, and prepare 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 unscored pretest questions). Subjects covered on the test are as follows:
- Gynecology – 35-40 percent
- Obstetrics – 25-30 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Pharmacology – 5-10 percent
Upon passing the exam, examinees will earn the NCC’s nationally recognized WHNP-BC credential.
Step 3. Apply for APN Licensure in Certified Nurse-Midwifery through the California BRN
Upon successfully completing the appropriate certification exam(s), applicants for APN licensure would complete the appropriate licensing application form to be submitted to the California Board of Registered Nursing:
Candidates can submit all application materials to the following address:
Board of Registered Nursing
Advanced Practice Unit – Nurse Midwife/Nurse Practitioner Certification [choose relevant unit]
PO Box 944210
Sacramento, CA 94244-2100
The California BRN allows both nurse-midwives and women’s health NPs to prescribe or furnish medications. To be eligible for this, APNs must complete a BRN-approved graduate course in advanced pharmacology. They can then submit the appropriate application(s) to the BRN in order to recieve a furnishing number:
- Application for a Nurse Midwife Furnishing Number
- Application for a Nurse Practitioner Furnishing Number
Step 4. Explore Career Opportunities Available to Nurse-Midwives and Maintain Credentials
Applicants can check the status of their APN application on the Board of Registered Nursing’s processing times webpage. Once they have received their designation from the BRN they can begin working as certified nurse-midwives in the state.
APN licensure does not need to be renewed and there are no continuing education requirements, save for those required to renew the basic RN license every two years. The respective national certifying bodies do require the CNM and WHNP-BC credentials to be renewed on a regular basis.
Renewing the Certificate in Nurse Midwifery (CNM) through the AMCB:
- CNM renewal is completed on a five-year cycle through the AMCB’s Certificate Maintenance Program, which requires one of the following:
- Completion of 3 certificate maintenance modules and 20 hours of continuing education
Renewing the Women’s Health Care Nurse Practitioner (WHNP-BC) Credential through the NCC
- WHNP-BC renewal is completed on a three-year maintenance cycle
- Continuing education hour requirement can range between 10-50 hours per cycle, and is based on the results of a Continuing Competency Assessment
California’s Top Employers of Certified Nurse-Midwives
While it is common for nurse-midwives and women’s health NPs to pursue career advancement in their current place of employment or at the site where they completed their clinical sequence, others may like the idea of starting an independent practice or joining a partner practice with other nurse-midwives and nurse practitioners.
The following are among the top employers of certified nurse-midwives in California:
- Los Angeles Center for Women’s Health
- Beach Area Women’s Health Center in San Diego
- Women’s Community Clinic in San Jose
- Women’s Community Clinic in San Francisco
- Women’s Health Center in Fresno
- The Birth Center in Sacramento
- Beach Cities Midwifery in Long Beach
- Sacred Birth Place in Oakland
- Mercy Family Birth Center in Bakersfield
- Natural Birth Center and Women’s Wellness in Anaheim
- California Pacific Medical Center’s Labor and Delivery Center in San Francisco
- California Hospital Medical Center’s Maternity and Neonatal Unit in Los Angeles
- Sharp Mary Birch Hospital for Women and Newborns in San Diego
The following list represents actual job vacancy announcements for CNMs posted on job boards throughout the state taken from a survey conducted in December, 2015 (shown for illustrative purposes only and not meant to imply an assurance of employment or the availability of jobs):
- Certified Nurse Midwife at Family Health Centers of San Diego
- Women’s Health NP at UCSF Medical Center in San Francisco
- Certified Nurse Midwife at Cedars-Sinai in Los Angeles
- Women’s Health NP at Planned Parenthood in Pasadena
- Certified Nurse Midwife at Saint Luke’s Hospital in San Francisco
- Women’s Health NP at the San Laredo Medical Center
- Certified Nurse Midwife at Walnut Creek Hospital
- Women’s Health NP at Concentra Outpatient Clinic in Redondo Beach
Salaries for Certified Nurse-Midwives in California
Work experience and employment setting remain the biggest factors that contribute to higher salaries among California’s certified nurse-midwives. In 2014, the United States Department of Labor reported that newly-certified nurse-midwives just entering the field in California earned an average annual salary of $88,800, while moderately experienced, mid-career CNMs earned an average annual salary of $127,940 that year. The most experienced nurse midwives working for large hospitals and integrated health systems in the state were recognized as those with salaries that fell within the 90th percentile, earning an average annual salary of $180,400.
New healthcare legislation, an increased reliance of cost-effective medical care, and an elevated awareness of the benefits of preventive care measures are at the heart of the growing demand for nurse-midwifery services in California.
The California Board of Registered Nursing (BRN) revealed that there were 1,237 certified nurse midwives licensed to practice in California as of 2012, accompanied by another 787 with the prescriptive authority necessary to prescribe controlled substances. A 2012 BRN survey found that certified nurse midwives that were also certified as nurse practitioners experienced a higher rate of employment and better pay.
Salary and Employment Trends within the Field of Nurse-Midwifery in California
In May 2014, the United States Department of Labor released salary and employment figures showing that California was among the country’s leaders in the field of nurse-midwifery:
- California held the second highest employment level for nurse midwives in the country. At that time, there were approximately 450 nurse midwives working statewide.
- California was also the second highest paying state in the country. In that year, nurse midwives working in the state earned an average annual salary of $127,940.
- The Los Angeles-Long Beach-Glendale metropolitan division was among the top ten metropolitan areas with the highest employment level for nurse midwives in the country. At that time, there were roughly 70 nurse midwives working in this district.
- San Jose-Sunnyvale-Santa Clara was the highest paying metropolitan area for nurse midwives in the country. Nurse midwives practicing here were paid an average annual salary of $139,290.
- San Diego-Carlsbad-San Marcos was the second highest paying metropolitan area for nurse midwives in the country. The average annual salary for nurse midwives employed here was $132,750.
- Los Angeles-Long Beach-Glendale was the third highest paying metropolitan area for nurse midwives in the country. Nurse midwives working here were given an average annual salary of $128,210.
- San Francisco-San Mateo-Redwood City was the fourth highest-paying metropolitan area for nurse midwives in the country. The average annual salary for nurse midwives working here was $125,900.
Nurse Midwife Salaries in California by Location
The data below shows a thorough analysis of nurse midwife employment and salaries in major metropolitan regions throughout California (US Bureau of Labor Statistics, May 2014):