According to the D.C.-based American College of Nurse-Midwives (ACNM), 996 (10.7 percent) of the 9,288 childbirths that took place in the greater Washington, D.C. metropolitan area in 2013 were attended by certified nurse midwives. This means that each of the 33 certified nurse-midwives licensed to practice in the District that year attended an average of 300 deliveries.
Of the 11,030 registered nurses practicing in the greater D.C. area in 2013, just 0.3 percent specialized as certified nurse-midwives (US Department of Labor, 2014). The relatively low number of CNMs practicing in the District combined with a rising demand for less-invasive, more whole-person centered care among expectant mothers has brought renewed attention to the fact that certified nurse-midwives are in short supply in the District.
The growing need for more certified nurse-midwives to provide the women of Washington, D.C., with personalized antepartum, intrapartum and postpartum care was summarized in a 2011 feature in Washington City Paper, which described how expectant mothers often scramble to secure a spot in a birthing center or hospital with a nurse-midwife on staff. The article described a situation that has only worsened in the years since the piece was published; in which expectant mothers are waitlisted from the day they find out they are pregnant with the hope of having a nurse-midwife available to attend the birth of their child.
As trying as this situation may be for expectant mothers, this helps speak to the opportunities available to RNs in the District that choose to go into advance practice as certified nurse-midwives. As an independent-practice jurisdiction, certified-nurse midwives in D.C. enjoy prescriptive authority and the ability to practice independent of physician oversight. This helps support opportunities for establishing independent and partner-practice birthing centers and women’s health clinics.
Steps to Becoming a Nurse-Midwife in the District of Columbia
Registered nurses with an unrestricted RN license in good standing can become certified nurse-midwives in Washington, D.C., by meeting the requirements for advanced practice registered nurse (APRN) licensure through the D.C. Department of Health’s Board of Nursing:
|Earn a Qualifying Master’s or Higher Degree in Nurse-Midwifery|
|Pass the National Nurse-Midwife Certification Exam|
|Apply for an APRN Nurse-Midwife License from the DC Board of Nursing|
|Consider Career Options in Nurse-Midwifery and Maintain Credentials|
Step 1. Earn a Qualifying Master’s or Higher Degree in Nurse-Midwifery
DC-based RNs interested in becoming certified nurse-midwives start by enrolling in a graduate program in nurse-midwifery approved by the Accreditation Commission for Midwifery Education (ACME).
Prospective nurse-midwifery graduate students can find nearby campus-based ACME-accredited programs in Washington and Winchester, Virginia. ACME-accredited schools throughout the nation also offer part-time online programs designed to accommodate the busy schedules of RNs who continue to work while earning a graduate degree.
Increasingly, schools are offering master’s programs in nurse-midwifery that are combined with a focus in the related field of women’s health. These programs result in a dual focus master’s degree in Nurse Midwifery/Women’s Health Nurse Practitioner (NM/WHNP). In addition to meeting the requirements for the CNM credential, completing this type of dual-focus program will fulfill the education requirements for RNs interested in also earning board certification as a women’s health nurse practitioner.
Graduate Program Admissions
While every graduate program has its own admissions standards many share common elements, which often include:
- GRE General Test
- Video essay, statement of purpose or personal essay
- Letters of recommendation
- Current RN license
- BSN or completion of nursing prerequisite courses
- Minimum GPA
- Curriculum Vitae
Most candidates for nurse-midwife graduate programs hold a BSN. ACME also accredits accelerated RN-to-MSN bridge programs that grant both a BSN and master’s in midwifery for candidates who hold an associate’s degree in nursing.
Structure of Graduate Programs in Nurse Midwifery/Women’s Health
Graduate programs for nurse-midwives consist of a didactic education segment and a clinical education segment. The didactic education segment is between 40 and 60 semester credits, while the clinical segment consists of approximately 1,000 hours. These segments are usually completed concurrently.
This segment covers important advanced topics and theory that nurse midwives/women’s health NPs use on a daily basis throughout their careers, including topics like:
- Antepartum, intrapartum and postpartum nurse midwifery
- Mother and infant biostatistics
- Research methods for advanced-practice nurses
- Advanced pharmacology for childbearing women
- Advanced health assessment
- Legal issues and ethics in maternal healthcare
- Advanced physiology and pathophysiology
- Disease prevention and health promotion
- Psychology for pregnancy
- Women’s reproductive health
- Complicated pregnancies and deliveries
- Advanced integrated midwifery
RNs use the clinical segment of their program to apply their advanced didactic knowledge. Online colleges and universities assign students a faculty advisor who will assist them in identifying local sites where the clinical education can take place. Online schools make a concerted effort to establish local clinical partnerships with hospitals and clinics throughout the nation to minimize the need for students to commute or relocate.
Examples of potential clinical sites in the D.C. area include:
- Sibley Memorial Hospital
- Medstar Washington Hospital Center
- George Washington University Hospital
- Providence Hospital
- Inova in Alexandria and Fairfax, Virginia
By earning a master’s degree in nurse-midwifery or women’s health/nurse-midwifery, graduates can apply to take the qualifying national exams required to become certified nurse midwives or dually certified as nurse midwives/women’s health nurse practitioners.
Step 2. Pass the National Nurse-Midwife Certification Exam
The DC Board of Nursing recognizes the American Midwifery Certification Board (AMCB), sponsor of the Certificate in Nurse Midwifery (CNM), as being able to grant the national certification required for nurse-midwives to become licensed as advanced practice nurses in the state.
Graduates of dual-focus nurse-midwife/women’s health nurse practitioner master’s programs may also elect for secondary certification as a Women’s Health Care Nurse Practitioner, Board Certified (WHNP-BC) through the National Certification Corporation (NCC).
Candidates can register for either one or both exams directly with the AMCB and NCC. After registering with the sponsoring organizations, exam candidates may then sign up for a testing date and time with the Applied Measurement Professional (APM) company. APM administers both tests, which can be taken at its testing locations in H&R Block Centers found in nearby locations like:
- Randallstown, Maryland
- Baltimore, Maryland
- Alexandria, Virginia
- Fredericksburg, Virginia
- Norfolk, Virginia
- Richmond, Virginia
Certified Nurse Midwife (CNM) Exam
Certified nurse-midwife exam candidates can start preparing for this exam by reviewing the Candidate Handbook. It is comprised of 175 multiple-choice questions to be completed in four hours. The topics covered are:
- 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
Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Successful examinees will receive a Certificate in Nurse Midwifery (CNM) from the AMCB.
Women’s Health Care Nurse Practitioner (WHNP) Exam
Candidates can prepare for this exam by studying the WHNP Candidate Guide. Three hours are allowed for this exam, which is comprised of 150 scored multiple-choice test questions and up to 25 unscored pretest questions. Subjects covered on the test are:
- 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
Candidates can register for this exam online through the NCC’s website.
Upon passing the exam nurses will earn the NCC’s WHNP-BC credential.
Step 3. Apply for an APRN Nurse-Midwife License from the DC Board of Nursing
APRNs in Washington, D.C., including certified nurse-midwives are not required to enter into a collaborative practice agreement with physicians or other healthcare professionals, and can work independently.
Once RNs have gained national certification from the AMCB and/or NCC they may complete an APRN Application for Licensure with the DC Board of Nursing. Candidates can indicate if they are applying for a nurse-midwife license and/or a women’s health nurse practitioner license on the same application. The completed application and all supporting documents can be mailed to:
DC Board of Nursing
PO Box 37802
Washington, D.C. 20013
Candidates can check to see if their application is missing anything by logging into their DC Department of Health account. Processing the application takes between 30-45 days.
APRNs in DC are permitted to prescribe controlled substances after taking these two steps:
Step 4. Consider Career Options in Nurse-Midwifery and Maintain Credentials
Applicants can see if their APRN license has been approved and is active by checking its status on the DC Department of Health license verification page. Once this is activated the license will be mailed to the new APRN within 10 business days. At this point APRNs can begin pursuing employment throughout the D.C. area.
Employers and Practice Models
Nurse midwives who have just earned their APRN license will be excited to pursue promotional opportunities at their current place of employment, or perhaps where they completed their clinical education. Other APRNs may be interested collaborating or starting their own nurse midwifery birthing center or women’s health clinic.
Potential practice models and significant employers in the D.C. area include the following:
- Labor and Delivery at Sibley Memorial Hospital
- The Family Birth Place at Medstar Washington Hospital
- George Washington Women’s Center at the GW University Hospital
- Jacobs Institute of Women’s Health
- Providence Hospital’s Center for Perinatal Advocacy or Neonatal Intensive Care Unit
- Community of Hope’s Family Health and Birth Center
- Developing Families Center
- Capital Women’s Care
Prospective nurse midwives and women’s health NPs can get a sense of D.C.’s job market through the following vacancy announcements. (Taken from a survey of D.C. healthcare jobs conducted in 2015 and are provided here as illustrative examples only):
- Reproductive Health Family Planning Nurse Midwife with (Johns Hopkins University Affiliate)
- Women’s Health Nurse Practitioner, Pre-Surgical Testing with MedStar Georgetown University Hospital
- Clinical Manager at MedStar Georgetown’s Perinatal Department
- Clinical Nurse Coordinator with MedStar Georgetown’s Lombardi Clinic for Gynecologic Oncology
- Clinical Manager of MedStar Georgetown’s Inpatient Mother-Baby Unit
- Clinical Manager of MedStar Georgetown’s Parenting and Lactation Services
Renew APRN License with the DC Board of Nursing
While exploring their new careers, APRNs must also remember to keep their credentials current. This starts with renewing the APRN license. These expire the same time as traditional RN licenses: June 30th of even-numbered years. The DC Board of Nursing will notify APRNs that they must renew their licenses 60 days before this date approaches. To be eligible for renewal, APRNs must meet these requirements:
- Have a valid DC RN license
- Maintain national certification with the AMCB and/or NCC
- Complete 15 hours of continuing education in the APRN’s field of specialization – this must also include continuing education in pharmacology
Maintain CNM Certification with the American Midwifery Certification Board (AMCB)
Maintaining national certification with the AMCB involves a five-year cycle. To begin this APRNs enroll in the AMCB’s Certificate Maintenance Program and complete one of the following:
- Re-examination with the National Certification Examination in Nurse Midwifery
- Completion of three certificate maintenance modules and 20 hours of continuing education
Maintain WHNP-BC Certification with the National Certification Corporation (NCC)
NCC certification is on a three-year maintenance cycle, which APRNs can complete by first taking the NCC’s Continuing Competency Assessment. Depending on the results of this assessment, APRNs must complete between 10-50 hours of approved continuing education during each maintenance cycle.
Salaries for Certified Nurse-Midwives in the District of Columbia
The median salary among the 140 certified nurse-midwives working in the D.C. metropolitan area (which includes Washington, Arlington and Alexandria across the District of Columbia, Maryland and Virginia) as of 2019 was $103,700 according to the U.S. Bureau of Labor Statistics. Starting salaries for recently licensed CNMs representing the 10th percentile salary bracket for this profession in DC earned an average of $64,870, which is less than the national average of $69,000 for this bracket. In contrast, the most experienced certified nurse-midwives in the top 90% earned an average of $130,120 per year.
Job Growth Projections and Employment Options for CNMs in Washington, DC
The number of jobs for certified nurse-midwives is rising dramatically throughout the country. The US Bureau of Labor Statistics estimates the national rate of increase for nurse-midwives to be 45% over the 10-year period ending 2029, which is much faster than average.
For a city of its size, Washington, D.C., has a large number of hospitals that employ certified nurse-midwives, as well as and independent nurse-midwifery practices.
Some of the active practices in the District that employ certified nurse-midwives include:
- MedStar Washington Hospital Center
- Midwifery Services at George Washington University Hospital
- M.A.M.A.S. Midwives
- BirthCare & Women’s Health
DC Nurse-Midwife Practice Attracts Washington’s Elite
WashingtonCityPaper highlighted the Midwifery Services at George Washington University Hospital in an extensive article published in 2011. Famed certified nurse-midwife Whitney Pinger serves as the Director of Midwifery Services for the hospital.
The hospital’s midwife services are in such demand among Washington’s elite with such a long waiting list that some women book a spot as soon as they learn they are pregnant. Most of the clients are highly educated and affluent professionals.
Pinger’s clients must be in excellent health and are required to hire a doula. The statistics on the births under the care of these certified nurse-midwives helps speak to the excellent care they provide. About 95% of these women deliver vaginally, and 80% do so without any intervention. While the national rate for cesarean sections is 33%, the rate at Midwifery Services is about 5%.
(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.)