Kentucky’s nurse-midwives provide personalized care to women during their childbearing years and throughout their lives, from prenatal care, labor and delivery, and well-woman care, to family planning, menopausal care, and even care of the newborn during the first 28 days of life. These advanced practice registered nurses (APRNs) provide women and their families with a more individualized, less routine approach to care.
As of 2015, the American College of Nurse-Midwives reported that 121 APRNs in Kentucky held certified nurse-midwife (CNM) status. In 2013, certified nurse-midwives attended about 3,300 births in Kentucky, representing more than 9 percent of all vaginal births in the state that year.
Steps to Become a Nurse-Midwife in Kentucky
RNs in Kentucky with aspirations of expanding their scope of practice by earning CNM certification and an Advanced Practice Registered Nurse (APRN) license must meet a number of specific requirements as stipulated by the Kentucky Board of Nursing:
|Earn a Qualifying Degree in Nurse-Midwifery|
|Take and Pass the National CNM and WHNP Certification Examinations|
|Apply for APRN Licensure through the Kentucky Board of Nursing|
|Now That You’re a Nurse-Midwife in Kentucky|
Step 1. Earn a Qualifying Degree in Nurse-Midwifery
Aspiring nurse-midwives must complete a master’s or higher degree in nurse-midwifery through a program accredited by the Accreditation Commission for Midwifery Education (ACME), the sole accrediting agency for nurse-midwifery degree programs in the U.S.
Master’s Degrees in Nurse-Midwifery and Nurse-Midwifery/Women’s Health
RNs in Kentucky who possess a Bachelor of Science in Nursing (BSN) must complete a master’s degree in nurse-midwifery, which may be structured as a Master of Science in Nursing (MSN) with a focus on nurse-midwifery or a Master of Science (MS) in Nurse Midwifery.
Other program options available in many of today’s ACME-accredited schools that offer master’s degrees in nurse-midwifery include:
- Dual specialization: Many institutions have begun offering master’s degree programs with dual nursing specializations. Once such specialization gaining in popularity is the nurse-midwife/women’s health master’s degree, which allows students to broaden their scope of practice in women’s health and earn dual APRN recognition as a nurse-midwife and women’s health nurse practitioner.
- Part-time format: Because so many RNs pursuing a master’s degree in nurse-midwifery are practicing professionals, part-time programs are commonplace. A full-time master’s degree in nurse-midwifery usually takes about two years to complete, while a part-time program usually takes about three years to complete.
- Online formats: Due to the lack of nurse-midwifery master’s degree programs in Kentucky and throughout the U.S., online coursework has become widely available.
Master’s degrees in nurse-midwifery or nurse-midwifery/women’s health include a didactic component and a clinical component. The clinical practicum occurs in the community, where students have the opportunity to work closely with certified nurse-midwives in real-world settings.
On-campus master’s degree programs frequently require students to complete their clinical practicums at sites within close proximity to the campus. Online programs often partner with institutions throughout the U.S., thus allowing students to choose sites that are within close proximity to home. Clinical practicum requirements may exceed 1,000 hours, with students required to complete rounds in a variety of settings, such as hospitals, OB/GYN practices, women’s health clinics, and birthing centers.
The following is a sampling of some of the clinical sites in Kentucky where students may complete portions of their clinical practicum:
- The Women’s Hospital at St. Joseph East, Lexington
- Central Baptist Hospital, Lexington Women’s Health, Lexington
- Norton Women’s Care, Louisville
- Clark Regional Medical Center, Center for Women & Babies, Winchester
The curriculum of a master’s degree in nurse midwifery is designed to prepare students to not only become competent and qualified nurse-midwives, but to also serve as leaders and policy advocates in maternal and infant healthcare.
The foundation of these programs includes study in:
- Principles of health promotion
- Epidemiology and biostatistics
- Evidence-based practice
- Advanced pathophysiology
- Advanced health assessment
Core coursework includes study in:
- Primary care of women
- Role of the nurse-midwife
- Midwifery care during pregnancy
- Midwifery care during postpartum
- Advanced midwifery care of the childbearing woman
- Women’s health
RNs in Kentucky who do not possess a BSN can still earn a master’s degree in nurse-midwifery by pursuing an ACME-accredited program that accommodates their level of education. For example:
- RN-to-MSN Degree Programs: RNs with an associate’s degree in nursing may pursue RN-to-MSN programs, accelerated programs encompassing all of the necessary components to complete both a bachelor and master’s degree in nursing.
- Post-Graduate Certificate Programs: Current Kentucky APRNs may pursue post-graduate certificate programs in nurse-midwifery as a way to add a nurse-midwifery specialization to their APRN license. Master’s-prepared RNs without an APRN license may also pursue post-graduate certificate programs.
However, most candidates for master’s degree programs possess a Bachelor of Science in Nursing (BSN) from an accredited college or university. These programs tend to be quite competitive; therefore, other admission requirements may include:
- Current and unencumbered RN license
- Minimum GRE score
- Minimum undergraduate GPA
- Minimum GPA in specific undergraduate nursing courses
- Letters of recommendation
- Admissions essay
Step 2. Take and Pass the National CNM and WHNP Certification Examinations
After completing an ACME-accredited master’s degree or other graduate degree in nurse midwifery, candidates for APRN licensure in Kentucky must take and pass the Certified Nurse-Midwife (CNM) examination offered through the American Midwifery Certification Board.
Graduates of master’s degrees in nurse-midwifery and women’s health also have the option of taking the Women’s Health Care Nurse Practitioner (WHNP) examination offered through the National Certification Corporation if they desire dual APRN specialization.
Before taking these examinations, candidates must apply through the appropriate credentialing agency and receive approval to schedule their examination. Candidates then take their exam(s) through Applied Measurement Professionals (AMP), which has testing centers throughout the U.S.
Kentucky’s AMP testing centers are located in Louisville and Lexington.
Step 3. Apply for APRN Licensure through the Kentucky Board of Nursing
Once candidates for APRN licensure have taken and passed the CNM examination (and WHNP examination, if applicable), they may apply for initial APRN license with the Kentucky Board of Nursing.
Applicants for initial APRN licensure who currently hold a Kentucky RN license must submit the following:
- APRN license application (checking the CNM specialization, and WHNP specialization, if applicable)
- APRN license fee of $165
- Fingerprint card and fee
- Kentucky criminal history report
- Official transcripts sent directly from the institution showing proof of nurse-midwifery education
- Proof of current CNM certification (and WHNP certification, if applicable)
Prescriptive Authority/Collaborative Agreement
APRNs in Kentucky serve as practitioners for prescriptive authority purposes for non-scheduled legend drugs and controlled substances. Nurse-midwives in Kentucky must acquire a written collaborative agreement with a physician licensed in Kentucky before engaging in prescribing or dispending non-scheduled legend drugs or controlled substances:
- Collaborative Agreement for Prescriptive Authority for Non-Scheduled Drugs (CAPA-NS)
- Collaborative Agreement for Prescriptive Authority for Controlled Substances (CAPA-CS)
- A current DEA registration is also required for prescribing controlled substances in Kentucky.
Step 4. Now That You’re a Nurse-Midwife in Kentucky
All nurse-midwives in Kentucky must ensure they maintain their Kentucky RN and APRN licenses, as well as their CNM designation.
APRN Renewal Requirements Renewal Requirements through the Kentucky Board of Nursing
All APRNs in Kentucky must renew their RN and APRN licenses annually, between September 15 and October 31. The cost to renew both an RN and APRN license is $65, plus an additional $55 for each APRN designation renewed.
The Kentucky Board of Nursing recognizes a national certification or recertification as meeting continuing education requirements. In other words, nurse-midwives are in compliance with their continuing education requirements if they maintain their CNM.
However, all APRNs with prescriptive authority must earn at least five contact hours of pharmacology education during each licensure period. Those with a CAPA-CS must earn 1.5 approved continuing education hours on the use of KASPER, pain management, or addiction disorders.
CNM Renewal Requirements through the American Midwifery Certification Board
The American Midwifery Certification Board has a Certification Maintenance Program, which allows CNMs to satisfy their continuing education requirements by completing one of the following options:
- 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 through the 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 Kentucky
Nurse-midwives in Kentucky work in a wide array of settings, such as:
- Lexington Women’s Health, Lexington
- Physicians for Women Center, Auxier
- Seven Hills Women’s Health Centers, Florence
- Norton Women’s Pavilion, Louisville
- OB/GYN & Women’s Health, Louisville
- Family Health Centers, Louisville
- Women First, Louisville
- Associates for Women’s Care, Lexington
Nurse-midwives in Kentucky with dreams of opening their own women’s health clinic, birthing center, or private midwifery practice may find a wealth of resources through some of the state’s professional associations:
- Kentucky Coalition of Nurse Practitioners and Nurse-Midwives
- Kentucky Home Birth Coalition
- Kentucky Nurses Association
Salaries for Certified Nurse-Midwives in Kentucky
The average salary for a nurse midwife in Kentucky was $88,499 as of 2014 according to the state’s Education and Workforce Development Cabinet. Experienced nurse midwives in Kentucky earned an average of $112,070 in 2014, while the average among those new to the field was $73,040 that year.
More than one-third of Kentucky’s 190 nurse midwives were employed in the Lexington-Fayette area in 2014. Even with just 70 certified nurse-midwives working in Lexington-Fayette, this metropolitan area had the unique distinction of having the highest concentration of CNMs of any such area in the country in 2014 according to the US Bureau of Labor Statistics (BLS).
Greater Autonomy Helps CNMs Offset the Physician Shortage in Rural Kentucky
Certified nurse-midwives have been shown to provide high quality gynecological and perinatal care and frequently substitute for OB/GYN physicians. The Kentucky Institute of Medicine sees this as the most promising solution for the rural areas of Kentucky that have been struggling with a shortage of physicians for years.
Until recently, certified nurse-midwives who wanted to set up practices in rural areas faced legislative barriers, since they were not allowed to prescribe drugs without first establishing a collaborative agreement with a physician. Operating under a collaborative agreement can be financially ruinous according to the National Law Review, which reported that nurse practitioners have paid as much as $100,000 in order to establish and maintain these agreements.
With heavy lobbying from the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, Senate Bill 7 became law in 2014. This legislation enabled advanced practice nurses such as certified nurse-midwives to prescribe most types of drugs after gaining four years of practice experience. This legal change is expected to revolutionize care in Kentucky’s rural areas by enabling certified nurse-midwives to set up independent practices.
How Nurse-Midwife Salaries Vary Depending on Location in Kentucky
The average salary among certified nurse-midwives in different areas of Kentucky varied by more than $8,000 according to a 2014 report published by the state’s Education and Workforce Development Cabinet:
- Lincoln Trail: $88,124
- Northern Kentucky: $86,124
- Bluegrass: $79,619
Detailed salary data from the US Bureau of Labor Statistics revealed a difference of nearly $13,000 in the average salary of certified nurse-midwives in Louisville-Jefferson County and Lexington-Fayette (2014):