According to the Connecticut Childbirth and Women’s Center, the number of certified nurse midwife-attended births in the state increased by nearly 1000 percent between 1975 and 1994. During that time, even though the state’s overall birth rate was declining, the number of women giving birth in a home environment also managed to increase by 28 percent.
Today, the Connecticut Department of Labor looks to the future, publishing projections showing that the number of certified nurse midwives licensed to practice in the state will likely increase by 22 percent over the ten-year period leading up to 2022. The US Department of Labor reports that on average, Connecticut’s certified nurse midwives earned $99,730 as of 2014, compared to an average of just $76,370 for regular RNs in the state.
The American College of Nurse-Midwives found that CNMs attended 12 percent of all traditional births in Connecticut in 2013, accounting for approximately 4,330 deliveries that year. Even as more women turn to certified nurse midwives for everything from primary well-woman care to antepartum, intrapartum and postpartum care, statistics released by the Connecticut Department of Public Health show that nurse-midwives made up only 0.34 percent of all nurses in the state as of 2013. The coming years will bring a significant increase as more of Connecticut’s RNs make the decision to enter advanced practice and specialize in nurse-midwifery.
Steps to Becoming a Nurse-Midwife in Connecticut
Connecticut’s Department of Public Health is responsible for issuing nurse midwife licenses to qualified registered nurses in the state. The Department of Public Health recognizes nurse midwives as a class of professional separate from women’s health nurse practitioners and other Advanced Practice Registered Nurses (APRNs).
Connecticut RNs interested in becoming licensed as certified nurse midwives must complete these steps:
Step 1. Earn a Qualifying Master’s or Higher Degree in Nurse Midwifery
The Connecticut Department of Licensing requires all nurse midwives to hold national certification through the American Midwifery Certification Board (AMCB) before being licensed in the state. To be eligible for AMCB certification, RNs must earn a master’s or higher degree in nurse midwifery from a program that has been accredited by the Accreditation Commission for Midwifery Education (ACME).
Connecticut is home to one such graduate program in nurse midwifery with a campus location in Orange. In-state RNs may also prefer to choose from one of the several ACME-accredited online programs designed to accommodate the busy schedules of working nurses.
It is becoming increasingly common for nurse-midwifery graduate schools to include an additional focus in women’s health through dual-focus Nurse Midwife/Women’s Health Nurse Practitioner (NM/WHNP) master’s programs. With the additional focus in women’s health, graduates are eligible to become both a certified nurse-midwife and a women’s health nurse practitioner, a separate class of Advanced Practice Registered Nurse (APRN).
Nurse-Midwifery Graduate Program Admissions Requirements
Common admissions requirements for nurse-midwife graduate programs include:
- BSN or completion of nursing prerequisite courses
- Minimum GPA
- Curriculum Vitae
- GRE General Test
- Personal essay, video essay, or statement of purpose
- Letters of recommendation
- Current RN license
Although most candidates for nurse-midwife graduate programs hold a BSN, ACME also accredits RN-to-MSN bridge programs in midwifery/women’s health for those that hold associate’s degrees in nursing.
Graduate Program Structure
Nurse-midwifery graduate programs can be divided into two segments, which may be completed simultaneously:
- Classroom education – between 40-60 semester credits
- Clinical education – approximately 1,000 hours
Throughout the didactic portion of their education, nurse-midwifery graduate students will study important topics related to nurse midwifery and women’s health, including:
- Advanced health assessments
- Advanced pathophysiology
- Theoretical foundations of care for childbirth
- Women’s reproductive health
- Legal issues and ethics in maternal healthcare
- Complicated pregnancies and deliveries
- Care of women’s complex health issued
- Advanced integrated midwifery
- Pharmacology for midwives – must be at least 30 hours
- Mother and infant biostatistics
- Multicultural midwifery
- Research methods for midwives and advanced-practice RNs
The clinical education portion of an RN’s education helps translate theoretical knowledge into practical skills. Students enrolled in online graduate programs are assigned a faculty advisor who helps them identify appropriate sites where the clinical component of their education can be completed. Online colleges and universities have partnerships with hospitals and clinics throughout the nation to ensure students have convenient access to a local clinical education site.
Examples of potential clinical sites located in Connecticut include:
- Middlesex Hospital in Middletown
- Greenwich Hospital
- Danbury Hospital
- Hartford Hospital
- Saint Mary’s Hospital in Waterbury
- Yale-New Haven Children’s Hospital
- Saint Vincent’s Medical Center in Bridgeport
- Backus Hospital in Norwich
With a master’s degree in nurse-midwifery or women’s health/nurse-midwifery, graduates can apply to take the national exams required to become certified nurse midwives or dually certified as nurse midwives (CNM)/women’s health nurse practitioners (WHNP).
Step 2. Pass the National Certification Exam through the American Midwifery Certification Board
The Connecticut Department of Licensing requires nurse-midwives to earn certification through the American Midwifery Certification Board. Those interested in becoming dually certified as women’s health NPs would additionally earn the appropriate certification through the National Certification Corporation:
- American Midwifery Certification Board (AMCB) – sponsor of the nationally-recognized Certificate in Nurse Midwifery (CNM)
- National Certification Corporation (NCC) – sponsor of the nationally-recognized Women’s Health Care Nurse Practitioner (WHNP-BC) credential
Candidates for either one or both certifications will first need to register for their exam through the sponsoring agency. Upon approval, they can then sign up for a testing date with Applied Measurement Professional (APM). This company administers both exams at the H&R Block testing center in Southington, located on 768 Queen Street, zip code 06489.
Certified Nurse Midwife Exam
Candidates can register 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 is computer-based and comprised of 175 multiple-choice questions. The time limit is four hours, and the test 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
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 computer-based, and is comprised of 150 scored multiple-choice test questions. Tests may contain up to 25 additional unscored pretest questions.
Topics 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 nationally recognized WHNP-BC credential through NCC.
Step 3. Apply with the Connecticut Department of Public Health to Become Licensed as a Nurse Midwife
After gaining national certification in the appropriate areas, prospective nurse midwives and/or women’s health nurse practitioners are ready to apply for licensure with the Connecticut Department of Public Health.
Prospective nurse midwives can submit their completed Nurse-Midwife License Application to:
Connecticut Department of Public Health
Nurse Midwife Licensure
410 Capitol Ave., MS 12 MQA
PO Box 340308
Hartford, CT 06134
Those that choose to hold women’s health NP licensure in addition to their certified nurse-midwife license would submit a competed Nurse Pracitioner License Application to:
Connecticut Department of Public Health
APRN Application Processing
410 Capitol Ave., MS 12 MQA
PO Box 340308
Hartford, CT 06134
Upon receiving a complete application for licensure, the Connecticut Department of Public Health will issue a licensing decision within three to four weeks. Applicants can check the status of their license on the department’s online license verification webpage.
Collaborative Practice and Prescriptive Authority
Nurse midwives and women’s health nurse practitioners must enter into a collaborative practice agreement with a licensed Connecticut physician during their first three years of practice. This physician must work in the same field, and will be responsible for assessing patient outcomes and dealing with referrals. While working under the collaborative agreement, nurse midwives and women’s health NPs are authorized to prescribe medication. The details of the collaboration and prescriptive authority must be recorded in writing.
After three years that include at least 2,000 hours of practice within this collaborative practice agreement, nurse midwives and women’s health NPs can work and prescribe medications independently.
To gain full authorization to prescribe controlled substances, all eligible medical professionals in Connecticut must first register with the Connecticut Department of Consumer Protection, and then register with the Drug Enforcement Agency (DEA).
Step 4. Explore Career Options and Maintain Credentials
Once nurse midwives and women’s heath NPs become authorized to practice they will be ready to pursue advanced employment opportunities throughout the state. While pursuing their career goals, these medical professionals must also keep up with their credentials.
Renewing a License with the Connecticut Department of Public Health
Nurse midwives and women’s health NPs will receive a renewal notice 60 days before their license is set to expire, and must complete an online renewal process to maintain these each year. All APRNs including women’s health NPs must complete 50 hours of continuing education that is specific to their field every two years.
While maintaining national certification is not a requirement for continued practice in Connecticut, RNs may want to renew these to keep their options open. Doing so may also satisfy Connecticut Department of Public Health continuing education requirements for women’s heath NPs.
Renewing the Certificate in Nurse Midwifery (CNM) with the American Midwifery Certification Board (AMCB)
Nurse midwives can renew their AMCB certification by enrolling in its Certificate Maintenance Program. This will involve completing one of the following every five years:
- Retaking the National Certification Examination in Nurse-Midwifery
- Completing three certificate maintenance modules and 20 hours of continuing education
Renewing the Women’s Health Care Nurse Practitioner (WHNP-BC) with the National Certification Corporation
Women’s health NPs can renew this credential by enrolling in the NCC’s three-year maintenance cycle program. This starts with a Continuing Competency Assessment. Based on the examinee’s score, they would be required to complete between 10-50 hours of continuing education during the given renewal cycle.
Employers and Practice Models for Specialized Nurses
Many nurse midwives and women’s heath NPs will be interested in pursuing their career goals by advancing at their current place of employment or applying for positions at the site of their clinical education. Still others will be interested in collaborating with partners to open local birth centers and women’s health clinics.
Examples of important employers in this field, as well as potential independent practice models in the state, include:
- Connecticut Childbirth and Women’s Center in Danbury
- The Center for Women’s Health in Stamford
- Central Connecticut OBGYN (CCOG) in Bristol and Southington
- Strong Women’s Health in New Haven and Guilford
- Pregnancy and Birthing Center at Middlesex Hospital in Middletown
- Labor and Delivery Unit at Greenwich Hospital
- Family Birth Center at Danbury Hospital
- Childbirth Center at Hartford Hospital
- Women and Infants’ Center at Saint Mary’s Hospital in Waterbury
- Family, Birthing, Midwifery, and Maternity Center at Saint Vincent’s Medical Center in Bridgeport
- Birthing Center at Backus Hospital in Norwich
Some of Connecticut’s top CNM employers advertised for the following positions in December of 2015 (show as examples only and do not represent job offers or the assurance of employment):
- Certified Nurse Midwife with First Choice Health Centers in East Hartford
- Women’s Health Nurse Coordinator with Greenwich Hospital in New Haven
- Nurse Midwife with the Cornell Scott Hill Health Center in New Haven
- Nurse Midwife or Women’s Health NP for an Educator position with the Hartford Hospital
- Certified Nurse Midwife with Harborpark OBGyn in Middletown
- Certified Nurse Midwife or Women’s Health NP with Planned Parenthood in West Hartford
- Certified Nurse Midwife with Saint Francis Care in Stafford Springs
Salaries for Certified Nurse-Midwives in Connecticut
The Connecticut Department of Labor reported that certified nurse midwives in Connecticut earned an average salary of $101,123 as of 2015. This value is 3.5% higher than the national average for CNMs. Newly licensed certified nurse midwives just entering the workforce in Connecticut earned an average of $89,627 that year.
Connecticut’s certified nurse-midwives enjoy independent practice authority, allowing them to provide well-women care in addition to the perinatal care they are best known for. This is particularly important in areas of the state that suffer from an inadequate number of OB/GYN physicians. Although Connecticut as a whole is home to a relatively high number of OB/GYN specialists on a population basis, this is not true for all parts of the state according to the 2014 fact sheet on Connecticut published by the American Congress of Obstetricians and Gynecologists. In particular, Tolland and Windham Counties were shown to have an exceptionally low number of OB/GYN physicians with fewer than 2.0 of these specialists for every 10,000 women, a ratio that is lower than the national average.
Nurse Midwifery in Practice in Connecticut
The Connecticut Department of Labor included certified nurse midwives on its list of occupations in high-demand. This ranking is reserved for professions with a projected job growth rate that is determined to be much faster than average. The Department expects the number of jobs for certified nurse midwives in Connecticut to increase by 22.3% between 2012 and 2022.
A survey of job vacancy announcements provides some insight into the type of opportunities available in Connecticut’s hospitals, women’s clinics and birthing centers. Three jobs were advertised for certified nurse-midwives in Connecticut in December 2015 (these examples are shown for illustrative purposes only and are not meant to imply a guarantee of employment):
- Cornell Scott Hill Health Corporation—New Haven
- Johnson Memorial Medical Center—Stafford Springs
- Private OBGYN practice—Middletown
Nurse Midwife Salaries in Connecticut’s Major Cities
The Connecticut Department of Labor provides salary data for certified nurse midwives in Hartford and New Haven showing the starting salary in New Haven to be nearly $10,900 more than Connecticut’s average for this category:
The US Bureau of Labor provides a more detailed analysis of the salaries of nurse midwives in the Hartford area as of 2014: