Thanks to a large Amish population and an increasing concern over unnecessary medical interventions during labor and delivery, Indiana now ranks among the top ten states in the nation for home births.
Working as independent practitioners, Indiana’s nurse-midwives do everything from performing prenatal checks and ordering labs and ultrasounds to delivering babies in a clinical environment or at home. Nurse-midwives provide women with a holistic approach to pregnancy—and to healthcare in general.
Indiana’s nurse-midwives provide women with a full range of primary healthcare services, from adolescence through menopause. Services provided by these certified and licensed healthcare providers include primary care, gynecologic care, family planning services, preconception care, care of the newborn during the first 28 days of life, and much more.
According to the American College of Nurse-Midwives, there were 155 certified nurse-midwives licensed in Indiana in 2015. In 2013 alone, Indiana’s certified nurse-midwives attended nearly 5,300 births, accounting for about 9 percent of all vaginal births in the state that year.
Steps to Become a Nurse-Midwife in Indiana
The Indiana State Board of Nursing is unique in that it does not license RNs who earn Certified Nurse Midwife (CNM) certification through the American College of Nurse-Midwives as advanced practice nurses (APNs) unless they are also pursuing prescriptive authority. In other words, Indiana’s nurse-midwives are licensed independently of other APNs in the state; however, they must possess a limited license to practice as a nurse-midwife whether or not they pursue prescriptive authority:
|Earn a Qualifying Degree in Nurse-Midwifery|
|Take and Pass the National Certification Examinations|
|Apply for a Nurse-Midwife License through the Indiana State Board of Nursing|
|Maintain National Certification and Nurse-Midwife Licensure in Indiana|
Step 1. Earn a Qualifying Degree in Nurse-Midwifery
The first step to becoming a licensed nurse-midwife in Indiana involves the successful completion of a master’s degree with a focus on nurse-midwifery through a nationally accredited graduate program. The sole accrediting agency for schools of midwifery in the U.S. is the Accreditation Commission for Midwifery Education (ACME).
Master’s Degree Options in Nurse-Midwifery for Indiana RNs
For RNs that already have a BSN, a Master of Science in Nursing (MSN) with a focus on nurse-midwifery or a Master of Science (MS) in Nursing are the appropriate degrees.
However, not all RNs in Indiana possess a bachelor’s degree. ACME accredits a number of programs that satisfy the requirements of students with different educational backgrounds.
- RN-to-MSN programs: Designed for RNs that possess an associate’s degree in nursing; these accelerated programs combine the components of both a bachelor’s and master’s degree in nursing
- Post–graduate certificate programs: Designed for RNs that possess a master’s degree and are seeking initial licensure as a nurse-midwife
Today’s master’s degrees in nurse-midwifery may include a number of program features designed to appeal to today’s practicing RN:
- Full-Time/Part-Time Programs: Many institutions offer master’s degrees in nurse-midwifery as either full-time or part-time programs. While full-time programs tend to consist of about two years of didactic and clinical work, part-time programs usually consist of about three years of study and clinical experiences.
- Partial or Fully Online Programs: Many institutions offer partially or fully online programs, which appeal to students who do not reside near a nurse-midwifery program and/or to working RNs that require the flexibility online study offers. Online study may be particularly well suited for residents of rural Indiana since the state is home to just one nurse-midwifery degree program, located in Indianapolis.
- Dual-Specialization Option: A number of institutions now offer dual specializations in nurse-midwifery and women’s health. Although Indiana does not license women’s health nurse practitioners, students of these dual-specialization master’s degree programs still have the option of achieving the Women’s Health Nurse Practitioner certification through the National Certification Corporation and becoming dually certified as both a nurse-midwife and a nurse practitioner specializing in women’s health.
Nurse-Midwifery Master’s Degrees: Program Structure and Design
MSN and MS degrees in nurse-midwifery consist of a didactic component and a clinical component.
The didactic component of a master’s degree in nurse-midwifery consists of a combination of graduate core courses, advanced practice courses, and specialty courses in nurse-midwifery, such as:
- Advanced Health and Physical Assessment
- Advanced Physiology and Pathophysiology
- Reproductive Healthcare Management
- Advanced Pharmacology for Primary Care
- Management of the Newborn
- Primary Care for Nurse-Midwives
- Advanced Women’s Healthcare Management
The clinical component of a master’s degree in nurse-midwifery, which often consists of up to 1,000 hours of clinical experience, allows students to gain real-world exposure in a wide array of settings, such as community health centers, women’s clinics, hospitals, and private OB/GYN practices.
While campus-based nurse-midwifery programs schedule students at clinical sites located in close proximity to the campus, online programs allow students to satisfy the clinical components of the program at sites located in close proximity to their home. This is because many institutions offering online programs partner with clinical facilities throughout the U.S., thus accommodating students, regardless of their location.
In Indiana clinical sites for nurse-midwife students may include:
- Vincent’s Women’s Hospital, Indianapolis
- Vincent Women’s Center, Fishers
- Francis Spirit of Women, Indianapolis
- Parkview Women and Children’s Hospital, Fort Wayne
Nurse-Midwifery Master’s Degree Programs: Admission Requirements
Most students entering a master’s degree program in nurse-midwifery possess a Bachelor of Science in Nursing (BSN) and all hold a current and unencumbered RN license. Depending on the institution, candidates for these graduate programs must also meet these admission criteria:
- Minimum undergraduate GPA
- Minimum GRE scores
- Admission essay
- Letters of recommendation
- Comprehensive resume
Step 2. Take and Pass the National Certification Examinations
The Indiana State Board of Nursing requires graduates of master’s degree programs in nurse-midwifery to take and pass the certification exam offered through the American Midwifery Certification Board in order to be recognized as a certified nurse-midwife (CNM) and qualify for state licensure as such.
Graduates of master’s degree programs with a dual focus in nurse-midwifery/women’s health may also choose to take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation so as to earn the WHNP credential.
In order to take the CNM and the WHNP examinations, candidates must first submit an application and receive approval before scheduling the examinations through the third-party exam provider, Applied Measurement Professionals (AMP).
In Indiana, AMP testing centers are located in:
- Fort Wayne
Step 3. Apply for a Nurse-Midwife License through the Indiana State Board of Nursing
Upon achieving the CNM designation, candidates for a nurse-midwife license in Indiana must complete and sign the Application for a Limited License to Practice Nurse-Midwifery and send it, along with the following, to the Indiana State Board of Nursing:
- Application fee of $50
- Transcripts sent directly from the institution to the Board showing proof of graduation from a master’s degree program in nurse-midwifery
- Copy of CNM designation through the American College of Nurse Midwives
Certified nurse-midwives may apply for prescriptive authority by completing the Application for Prescriptive Authority as an Advanced Practice Nurse (application is located by clicking on the Advanced Practice Nurse Application link). The cost of applying for prescriptive authority is $50, and the cost of Indiana State Controlled Substances Registration (CSR) is $60.
After receiving CSR approval, the nurse-midwife must apply for a federal Drug Enforcement Administration registration (more information can be found here).
Collaborative Practice Agreement
The Indiana State Board of Nursing requires a collaborative practice agreement to be in place for nurse-midwives in the state who possess prescriptive authority. Both the nurse-midwife and the collaborating physician must sign the collaborative agreement.
The collaborative practice agreement must include information regarding locations where prescriptive authority is authorized, the manner of collaboration between the physician and the nurse-midwife, and a description of limitations the physician has placed on the nurse-midwife’s authority.
A collaborative practice agreement template can be found here.
Step 4. Maintain National Certification and Nurse-Midwife Licensure in Indiana
Nurse-midwives in Indiana must satisfy continuing education and other requirements in order to maintain their CNM designation (and WHMP designation, if applicable), as well as their Indiana nurse-midwife license.
Nurse-Midwife License Renewal Requirements (Indiana State Board of Nursing)
Indiana nurse-midwives must renew their limited licenses by October 31 of all odd-numbered years. The cost of renewal is $50. Nurse-midwives in Indiana who DO NOT possess prescriptive authority are NOT required to complete continuing education as a condition of their license.
Nurse-midwives in Indiana must renew their prescriptive authority licenses by October 31 of all odd-numbered years. The cost of renewal is $10.
Nurse-midwives in Indiana who possess prescriptive authority must obtain at least 30 hours of continuing education every renewal cycle; eight of those hours must be in pharmacology. Additional information on continuing education requirements can be found here.
Nurse-midwives in Indiana must renew their state licenses and prescriptive authority licenses through Indiana’s Online Licensing portal.
CNM Renewal Requirements (American Midwifery Certification Board)
The American Midwifery Certification Board’s Certification Maintenance Program allows CNMs to satisfy their continuing education requirements by completing one of the following:
- Option 1: Complete at least 3 AMCB Certificate Maintenance Modules during each five-year certification cycle and at least 20 contact hours of approved continuing education units; pay annual fees
- Option 2: Retake the AMCB Certification Examination and pay the $500 examination fee in lieu of annual fees
WHNP Renewal Requirements (National Certification Corporation)
The National Certification Corporation requires WHNPs to take a continuing competency assessment at the beginning of each three-year maintenance cycle and complete a specific number of continuing education credits hours based on the results of the assessment.
Employment Opportunities for Nurse-Midwives in Indiana
Currently, Indiana is home to just three birth centers, which may mean that a large percentage of the population is not located within close proximity to a midwifery birth center. For RNs seeking to expand their careers into nurse-midwifery and start their own midwifery practice/birthing center, this is good news.
For other RNs with an eye on the nurse-midwifery profession, the growth in midwife care throughout Indiana may also mean a greater number of nurse-midwife positions in hospitals, OB/GYN practices, and healthcare clinics, such as:
- Clinic for Women, Inc., Indianapolis
- Women’s Care Center, Elkhart
- Women’s Care Center, Fort Wayne
- Women & Children’s Clinic, Terre Haute
Recent job posts (November 2015) reveal a number of opportunities for nurse-midwives in Indiana. Although the following list is for illustrative purposes only, it does provide insight into the types of jobs available to nurse-midwives in the Hoosier state:
- Certified Nurse Midwife, IU Health Arnett OB/GYN, Lafayette
- Nurse Midwife, Bloomington Hospital, Indianapolis
- Nurse Midwife, Indiana University Health, Indianapolis
- Certified Nurse Midwife, Indiana University Health, Lafayette
- Nurse-Midwife, St. Vincent Anderson Regional Hospital, Anderson
- Supervisor-Nurse Midwifery Services, Bloomington Hospital, Indianapolis
Salaries for Certified Nurse-Midwives in Indiana
The median salary among certified nurse-midwives in Indiana was $81,994 as of 2014 according to the state’s Department of Workforce Development. Experience and practice setting continue to be the biggest factors in determining salaries for Indiana’s nurse midwives. Those with the most experience and who served as primary care providers in women’s clinics specializing in obstetrics and gynecology were among those whose salaries fell within the top 10% in Indiana, earning an average of $116,542 as of 2014.
A 2013 white paper published by the Indiana Action Coalition entitled Advanced Practice Nurse Reimbursement and Scope of Practice in Indiana discussed the roles of certified nurse-midwives in the state. At that time, approximately 84 certified nurse-midwives were licensed to practice in Indiana in a variety of settings ranging from hospitals and private practices to home birth practices and birth centers.
How More CNMs Can Offset the Shortage of Physicians in Indiana
As of 2014, Indiana ranked 39th lowest in the nation in terms of the ratio of physicians to population according to the IndyStar. This shortage is particularly problematic in rural areas of Indiana, and more than half of the counties in the state have been designated as medically underserved. Nurse midwives are in a position to offset the critical physician shortage in Indiana by providing antepartum, intrapartum, postpartum and general gynecological care to women and serving as primary care providers.
Numerous studies have shown that births attended by certified nurse-midwives are as safe as those attended by physicians, and data suggests that CNMs use fewer invasive procedures such as caesareans and episiotomies. This results in improved safety for the mother and neonate, and also reduces the costs incurred during childbirth.
In 2009, certified nurse-midwives attended 6.54% of all the births in Indiana. The American College of Nurse-Midwives reported the results of a 2012 analysis of childbirths among women on Medicaid, finding that certified nurse-midwives attended 51.33% of these births, while physicians attended 45.06%.
Nurse Midwife Salaries in the East Chicago and Louisville Sections of Indiana
The Indiana Department of Workforce Development provides an analysis of salaries that certified nurse-midwives earned in the Indiana sections of the East Chicago and Louisville metropolitan statistical areas as of 2014. Experience was much less of a factor in the salaries of these nurse midwives than it was for those in Indiana overall.
The average earnings for certified nurse-midwives with salaries that fell within the bottom 10% (usually those new to the field) was substantially higher in the East Chicago and Louisville areas than in Indiana as a whole. Nurse midwives in these areas earned 1.5 to 2.1 times more than the average salary for nurse midwives earning within this percentile statewide:
Indiana Section of Louisville Metro Area
- 90th Percentile: $118,664
- 50th Percentile: $96,075
- 10th Percentile: $78,291
- 90th Percentile: $120,952
- 50th Percentile: $90,771
- 10th Percentile: $55,619