The scarcity of qualified and licensed nurse-midwives that is being seen across the country is no more apparent than in Iowa, according to a 2015 article in the Sioux City Journal. While many of today’s expectant mothers have come to value the personalized, holistic approach nurse-midwives provide, medical centers in some of Iowa’s largest cities have yet to follow suit, making midwifery services in the state hard to find oftentimes.
Belinda Lassen, a certified nurse-midwife of more than 30 years revealed in the article that because of Northeast Iowa’s lack of birth centers and certified nurse-midwives, expectant mothers must often travel as many as two hours to receive midwifery care.
RNs in Iowa with aspirations of becoming nurse-midwives may ease the shortage of nurse-midwives in the state and provide not only maternity care to their clients but well woman care throughout their lives, as well. This may include everything from gynecologic care and family planning to obstetrical care and newborn care.
Iowa’s nurse-midwives enjoy a broad scope of practice, with authorization to manage antepartum, intrapartum, post-partum and gynecologic care. Nurse-midwives in Iowa practice independently without a collaborative practice agreement.
In 2018, approximately 11-13.69% of births in Iowa 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.
Steps to Becoming a Nurse-Midwife in Iowa
RNs looking to become nurse-midwives must qualify for Advanced Registered Nurse Practitioner (ARNP) licensure by meeting the requirements set forth by the Iowa Board of Nursing. To learn how to become a nurse-midwife in Iowa, follow the steps in this guide:
Step 1. Earn a Qualifying Degree in Nurse-Midwifery
RNs in Iowa with their sights set on a career in nurse-midwifery must first complete a master’s degree or higher in nurse-midwifery through a program that has been accredited by the Accreditation Commission for Midwifery Education (ACME).
Master’s Degrees in Nurse-Midwifery and Nurse-Midwifery/Women’s Health
For RNs with bachelor’s degrees, the most streamlined path to ARNP licensure is the Master of Science in Nursing (MSN) with a focus on nurse-midwifery or the Master of Science (MS) in Nurse-Midwifery.
However, because not all RNs in Iowa possess bachelor’s degrees, ACME accredits a number of specialized master’s programs designed for nurses at various stages of their education, including:
- RN-to-MSN Degrees: These degree programs, designed for RNs with an associate’s degree in nursing, encompass both bachelor and master’s degree components in an accelerated format.
- Post-Graduate Certificate Programs: Post-graduate certificate programs are designed for Iowa ARNPs who want to add a certified nurse-midwife specialization to their license or for RNs with master’s degrees seeking initial ARNP licensure
ACME-accredited degree programs may encompass a number of features that appeal to today’s nursing professional:
- Institutions are increasingly adopting the dual specialization master’s degree program, with one of the most popular being the nurse-midwife/women’s health master’s degree. A dual-specialization allows aspiring nurse-midwives to broaden their scope of practice and advance their professional options.
- Part-time master’s degree programs have become commonplace as to accommodate working RNs. Full-time programs consist of about two years of study and clinical work, while part-time programs consist of about three years of study and clinical work.
- Many master’s degree programs feature online study, whether they are partially online or fully online. Online programs may be an ideal option for Iowa RNs, as there are no master’s degree programs in nurse midwifery in the state.
Nurse-Midwifery and Nurse-Midwifery/Women’s Health Program Structure
A master’s degree in nurse-midwifery or nurse-midwifery/women’s health includes academic and clinical components, both of which focus on the midwifery process of pregnancy, childbirth and newborn care.
Master’s degrees in nurse-midwifery prepare students for the full scope of midwifery practice. Therefore, program objectives focus on professional responsibilities, primary healthcare, pregnancy, childbirth, the post-partum period, family planning, care of the newborn, and the gynecologic needs of women. The core curriculum of these programs often includes:
- Maternal-fetal-newborn physiology
- Advanced pharmacology
- Breastfeeding, postpartum, and newborn care
- Diagnosis and management in primary care across the adult lifespan
- Advanced clinical assessment across the lifespan
Intensive clinical experiences provide students with the opportunity to gain exposure to diverse patients and to apply classroom knowledge in a number of clinical settings, including hospitals, women’s health clinics, OB/GYN practices, and birthing centers, among others. These graduate programs typically consist of 1,000 hours of clinical experience
Campus-based programs place students at sites within close proximity to the campus. Online programs, on the other hand, often partner with clinical sites throughout the country, thereby allowing students to complete their clinical experiences at sites close to home.
Just a few of the sites where Iowa students may complete the clinical component of their program include:
- University of Iowa Women’s Health, Iowa City
- University of Iowa Health Care, Coralville
- Covenant Medical Center, Waterloo
- Montgomery County Memorial Hospital, Red Oak
Admission Requirements
In addition to a current and unencumbered Iowa RN license, most graduate students hold a Bachelor of Science in Nursing (BSN). Schools often require candidates for master’s degrees in nurse-midwifery or nurse-midwifery/women’s health to possess:
- Minimum undergraduate GPA
- Minimum GRE score
- Admissions essay
- Letters of recommendation
Step 2. Take and Pass the National Certification Examinations
Upon completion of an ACME-accredited master’s degree program in nurse-midwifery, RNs in Iowa seeking ARNP licensure as a nurse-midwife must take and pass the Certified Nurse-Midwife (CNM) examination through the American Midwifery Certification Board.
In addition to the CNM examination, graduates of nurse-midwifery/women’s health master’s degrees may also choose to take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation.
Graduates must apply to take the appropriate examination(s) and receive approval before scheduling to take the exam at an Applied Measurement Professionals (AMP) testing center. AMP testing centers are located across the country. AMP testing center in Iowa are located in Davenport or Windsor Heights.
Step 3. Apply for ARNP Licensure as a Nurse-Midwife through the Iowa Board of Nursing
RNs in Iowa who have successfully completed a master’s degree in nurse-midwifery and have earned CNM certification may apply for licensure as an ARNP nurse-midwife by completing the Application for Advanced Registered Nurse Practitioner and selecting licensure as a Certified Nurse-Midwife and Certified Women’s Health Care Nurse Practitioner (if applicable).
Candidates must send the Application for Advanced Registered Nurse Practitioner to the Board, along with the following:
- $81 application fee (or $162 for both the CNM and WHNP designations)
- Transcripts of the institution where the graduate degree was obtained, sent directly to the Board
- Copy of CNM and WHNP (if applicable) national certifications
Iowa nurse-midwives are independent practitioners who practice without the need for a collaborative practice agreement with a physician.
Prescriptive Authority
ARNP licensure with the Iowa Board of Nursing permits nurse-midwives to prescribe substances or devices, including controlled substances.
ARNP certification with the Drug Enforcement Administration (DEA) and the Board of Pharmacy Examiners permits nurse-midwives to prescribe controlled substances. Nurse-midwives must obtain a DEA number, available through the Board of Pharmacy website.
Step 4. Maintain your Nurse-Midwife Certification and ARNP License
ARNP Renewal Requirements (Iowa Board of Nursing)
Nurse-midwives in Iowa must ensure they maintain their ARNP license and national certification as a nurse-midwife. RN and ARNP licenses expire together, every three years, 30 days prior to the 15th of the licensee’s birth month.
The cost of an RN renewal is $99, and the cost of an ARNP renewal is $81 (or $162 for both the CNM and WHNP designation). Licensees complete renewals online through IBON Online Services.
ARNPs holding current CNM certification (and WHMP certification, if applicable) are deemed to be in compliance with Iowa’s continuing education requirement.
CNM Renewal Requirements (American Midwifery Certification Board)
The American Midwifery Certification Board features a Certification Maintenance Program, which 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.
Resources for Nurse-Midwives in Iowa
Nurse-midwives in Iowa have a broad scope of practice, enjoying professional opportunities in settings like the following:
- Iowa Clinic, Women’s Center, Des Moines
- Waverly Health Center, Women’s Clinic, Waverly
- Edgerton Women’s Health Center, Davenport
- Unity Point Clinic Women’s Center, Fort Dodge
- Serenity Women’s Clinic, Knoxville
- Mercy Women & Infants Center, Des Moines
Nurse midwives in Iowa, whether they desire a job in one of the many facilities that support the practice of midwifery or whether they want to branch out on their own and start a private midwifery practice, benefit from membership and activity in Iowa’s professional associations:
Salaries for Certified Nurse-Midwives in Iowa
According to 2019 U.S. Bureau of Labor Statistics data, the annual mean salary for a nurse-midwife in Iowa is $104,420, which is $4K per year lower than the national average salary. Here are the other salaries for various percentiles:
- 10th percentile: $61,130
- 25th percentile: $85,960
- 75th percentile: $128,200
- 90th percentile: $161,590
A Growing Number of Opportunities Arise for Certified Nurse Midwives in Iowa
A study conducted by the Iowa Advanced Practice Nurse Tracking System of the University of Iowa found that the number of primary care advanced practice nurses (including certified nurse-midwives) increased by 215% between 1999 and 2014, while the number of physicians dropped by 10% during this time frame.
Iowa faces a shortage of physicians in its rural areas, with 62% of the state’s counties federally designated as physician shortage areas in 2011 according to the American Academy of Family Physicians. In particular, Iowa faces a shortage of doctors specialized in obstetrics according to a 2014 RadioIowa article. Certified nurse-midwives are seen as the solution, as they are able to provide high-quality obstetric care in the absence of physicians, a service that is especially critical in Iowa’s rural areas.
In a 2012 article, The Gazette reported that the number of home births is on the rise in Iowa. This article also described a shortage of certified nurse-midwives available to attend home births, partly due to the low salaries these CNMs tend to earn as compared to those working in hospitals.
A Review of Starting Salaries Offered to Certified Nurse-Midwives in Waterloo
As of 2015, Covenant Medical Center-Iowa advertised for a certified nurse-midwife to fill a vacancy in its Covenant Midwives & Women’s Health Center in Waterloo. This position offered a starting salary of $76,000 a year (provided only for illustrative purposes).
This certified nurse-midwife position involves providing care for pregnant women who do not display any signs of complications with pregnancy. The CNM may provide this care both prenatally and during labor and delivery. In addition, the certified nurse-midwife may provide care during the patient’s postpartum period.
(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.)