Last Updated: May 2025 | Reviewed by Abbie Jacobs
Massachusetts has emerged as a progressive leader in midwifery care, with certified nurse midwives (CNMs) enjoying expanded practice authority and growing recognition as essential healthcare providers. In 2024, the Massachusetts legislature passed landmark legislation mandating insurance reimbursement parity between CNMs and physicians, while the establishment of the Board of Registration in Midwifery signals the state’s commitment to advancing midwifery practice.
This comprehensive evolution reflects Massachusetts’ response to healthcare challenges, including maternal mortality reduction and addressing racial disparities in perinatal outcomes. With over 300 active CNMs practicing throughout the Commonwealth, these advanced practice registered nurses serve as primary healthcare providers for women throughout pregnancy, childbirth, and beyond.
CNMs in Massachusetts now provide an expanded scope of services, including abortion care up to 24 weeks’ gestation, transgender health services, and comprehensive reproductive healthcare. According to the U.S. Department of Health & Human Services, more than 13.7% of births in Massachusetts were attended by midwives in 2023, demonstrating the growing trust in midwifery-led care.
2025 Legislative Developments Expanding CNM Practice
Recent regulatory changes have significantly enhanced the practice environment for certified nurse midwives in Massachusetts:
Board of Registration in Midwifery
Established in August 2024, this nine-member board oversees licensure for non-nurse midwives while CNMs remain under the Massachusetts Board of Registration in Nursing’s jurisdiction. This development signals enhanced interprofessional collaboration opportunities and potential future regulatory harmonization.
Insurance Reimbursement Parity
House Bill 1069 and Senate Bill 607 mandate equal reimbursement for CNM and physician services, significantly improving practice sustainability, patient access to midwifery care, and professional recognition throughout the healthcare system.
Steps to Becoming a Certified Nurse-Midwife in Massachusetts
Registered nurses seeking to become certified nurse midwives in Massachusetts must complete a structured pathway involving graduate education, national certification, and state licensure. The following four-step process provides comprehensive guidance for aspiring CNMs:
Step 1. Earn a Qualifying Master’s Degree or Higher in Nurse-Midwifery
The Massachusetts Board of Registration in Nursing requires all APRN licensure applicants as certified nurse midwives to complete a graduate-level nurse-midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME). This accreditation ensures programs meet national standards for midwifery education, covering clinical training, faculty qualifications, and curricular rigor.
Graduate-Level Academic Preparation
ACME-accredited nurse-midwifery programs typically last two years for master’s candidates and four years for doctoral students. They integrate advanced coursework with comprehensive clinical training. All programs must include a minimum of 600 clinical hours focused on antepartum, intrapartum, postpartum, and gynecological care.
Program Options
| Program Type | Designed For | Typical Duration |
|---|---|---|
| MSN/MS Programs | RNs with Bachelor of Science in Nursing (BSN) degrees | 2-3 years full-time |
| RN-to-MSN Programs | RNs with associate’s degrees in nursing | 3-4 years full-time |
| Post-Graduate Programs | RNs with an MSN wanting to add CNM certification | 1-2 years full-time |
| DNP Programs | RNs seeking the highest level of clinical preparation | 3-4 years full-time |
Core Curriculum Requirements
Graduate curricula must include advanced coursework in areas required for APRN licensure in Massachusetts. All programs include the following foundational courses:
- Advanced Pathophysiology: Disease processes affecting women’s health
- Advanced Pharmacotherapeutics: Medication management across the lifespan
- Advanced Physical Assessment: Comprehensive examination skills
- Women’s Reproductive Healthcare: Gynecological and Obstetric Care
- Midwifery Care During Pregnancy: Antepartum Management
- Midwifery Care During Labor: Intrapartum expertise
- Postpartum and Newborn Care: Recovery and Neonatal Health
- Family Crisis Care: Emergency and complex situations
- Biostatistics for Healthcare Providers: Evidence-based practice
Dual-Focus Specialization Options
Many bachelor’s-prepared RNs choose dual-focus nurse-midwifery and women’s health nurse practitioner programs, which prepare graduates as experts in midwifery care and comprehensive gynecological services. These NM/WHNP programs enable graduates to sit for both the AMCB and National Certification Corporation (NCC) examinations, expanding career opportunities and the scope of practice.
“Completing my nurse-midwifery program online while working as an RN in Boston was challenging but incredibly rewarding. The clinical coordinators helped me secure placements at excellent hospitals, and I felt fully prepared for both the AMCB exam and my current role at Brigham and Women’s Hospital. The investment in education has opened doors I never imagined.” – Mary B., CNM, Class of 2024
Massachusetts Program Options
Massachusetts hosts one ACME-accredited on-campus program:
- Baystate Medical Center/Springfield College: Limited enrollment program accepting six students annually
Due to limited in-state options, many aspiring nurse midwives pursue accredited online programs with local clinical arrangements. Program directors collaborate with students to identify suitable clinical sites throughout Massachusetts, including major medical centers and community hospitals.
Step 2. Take and Pass the National Certification Examination to Become a CNM
Upon completing their graduate degree, candidates must pass the American Midwifery Certification Board (AMCB) Certified Nurse Midwife Examination. This comprehensive assessment serves as the national standard for CNM certification and is required for APRN licensure in Massachusetts.
AMCB Examination Details
The CNM examination consists of 175 multiple-choice questions administered via computer at AMP testing centers. Massachusetts candidates may take the exam at the following locations:
- Framingham: H&R Block – AMP Testing Center
- Holyoke: H&R Block – AMP Testing Center
- Saugus: H&R Block – AMP Testing Center
Examination Content Areas
The AMCB exam evaluates knowledge across six critical domains of midwifery practice:
| Content Domain | Percentage of Exam | Key Focus Areas |
|---|---|---|
| Antepartum Care | 19-26% | Prenatal assessment, risk identification, and health promotion |
| Intrapartum Care | 17-26% | Labor management, delivery, and emergency interventions |
| Postpartum Care | 15-18% | Recovery assessment, lactation support, and family planning |
| Gynecology | 15-18% | Reproductive health, contraception, and STI management |
| Newborn Care | 7-16% | Neonatal assessment, routine care, and early intervention |
| Primary Care | 8-16% | Health maintenance, screening, and chronic disease management |
Examination Preparation and Scoring
Candidates may access the AMCB Candidate Handbook for comprehensive study guidance and practice questions. The examination uses a pass/fail scoring system, with successful candidates receiving their Certificate in Nurse Midwifery (CNM) directly from the AMCB.
Dual Certification Pathway
Graduates of NM/WHNP programs may pursue additional certification through the National Certification Corporation (NCC) Women’s Health Care Nurse Practitioner examination. This 150-question assessment covers:
- Gynecology: 35-40% (reproductive disorders, contraception)
- Obstetrics: 25-30% (pregnancy management, complications)
- Primary Care: 10-15% (health promotion, disease prevention)
- Diagnostic Testing: 10-15% (laboratory interpretation, imaging)
- Pharmacology: 5-10% (medication management, interactions)
Step 3. Apply for APRN Licensure as a Nurse-Midwife through the Massachusetts Board of Nursing
After achieving national certification, candidates apply for Advanced Practice Registered Nurse (APRN) authorization through the Massachusetts Board of Registration in Nursing. The application process requires comprehensive documentation and typically takes 4-6 weeks for review.
Prerequisites for APRN Authorization
Applicants must satisfy the following requirements before submitting their APRN application:
| Requirement | Documentation Needed | Additional Notes |
|---|---|---|
| Active RN License | Current Massachusetts RN licensure | Out-of-state RNs must obtain an MA license via reciprocity |
| Graduate Education | Official transcripts from an ACME-accredited program | Must show completion of required coursework |
| National Certification | AMCB certification verification | Submitted directly from AMCB to the Board |
| Background Check | Notarized moral character affidavit | Must disclose any criminal or disciplinary history |
Application Process
Applications are submitted through the Health Professions Licensing Portal with required supporting documentation. The complete application package includes:
- Completed APRN Application: Available through the online portal
- Application Fee: $150 (non-refundable)
- RN License Verification: From all states where previously licensed
- Graduate Transcripts: Official transcripts sent directly from a nursing program
- AMCB Certification: Verification sent directly from the certification board
- MassHealth Documentation: Proof of enrollment or non-billing provider status
- Professional References: As specified in the application requirements
Processing Timeline and Review
The Massachusetts Board of Registration in Nursing reviews APRN applications within 4-6 weeks of receiving complete documentation. Delays may occur if transcripts lack sufficient detail regarding clinical categories or required coursework. Applicants should ensure their nursing program provides comprehensive documentation of:
- Clinical hours by specialty area (antepartum, intrapartum, postpartum, gynecology)
- Advanced pathophysiology course completion
- Pharmacotherapeutics training documentation
- Physical assessment competency verification
Step 4. Explore Nurse-Midwife Career Options in Massachusetts and Maintain Credentials
The Massachusetts Board of Nursing posts APRN license status within 24 hours of approval decisions. Candidates may check their license status online through the Massachusetts Health and Human Services verification system.
Professional Opportunities in Massachusetts
Massachusetts employs over 300 certified nurse midwives across diverse healthcare settings, with demand driven by healthcare systems’ emphasis on reducing maternal mortality and addressing health equity. The state’s progressive practice environment offers CNMs opportunities in:
Major Medical Centers and Academic Hospitals
- Massachusetts General Hospital – Boston
- Brigham and Women’s Hospital – Boston
- Boston Medical Center – Boston
- Beth Israel Deaconess Medical Center – Boston
- Cambridge Health Alliance – Cambridge
- Baystate Medical Center – Springfield
- UMass Memorial Health Care – Worcester
Community Hospitals and Regional Centers
- Anna Jaques Hospital – Newburyport
- Beverly Hospital – Beverly
- Cooley Dickinson Hospital – Northampton
- Emerson Hospital – Concord
- Newton-Wellesley Hospital – Newton
- South Shore Hospital – Weymouth
- Cape Cod Healthcare – Hyannis
Specialized Practice Settings
- Birth Centers: Freestanding facilities offering family-centered care
- Home Birth Services: Independent practice opportunities
- Women’s Health Clinics: Comprehensive reproductive healthcare
- Community Health Centers: Serving underserved populations
- Academic Settings: Teaching and research positions
Expanded Scope of Practice
Massachusetts CNMs enjoy one of the most comprehensive scopes of practice in the United States, including:
- Comprehensive Reproductive Healthcare: Family planning, contraception, STI management
- Pregnancy and Childbirth Care: Antepartum, intrapartum, and postpartum services
- Gynecological Services: Annual exams, diagnostic procedures, treatment
- Abortion Care: Services up to 24 weeks’ gestation
- Transgender Health Services: Hormone therapy and supportive care
- Primary Care: Health maintenance and chronic disease management
- Emergency Care: Obstetric and Gynecologic Emergencies
Maintaining Professional Credentials
AMCB Certification Renewal
CNMs must renew their AMCB certification every five years through continued competency assessment or re-examination. Renewal requirements include:
- Continuing Education: Completion of approved educational activities
- Clinical Practice: Documented midwifery practice hours
- Professional Development: Leadership and advocacy activities
Massachusetts APRN License Renewal
APRN authorization renews biennially alongside RN licensure with a $150 renewal fee. Requirements include:
- Continuing Education: 15 contact hours annually (5 hours in pharmacology for prescriptive authority)
- License Verification: Maintenance of active RN license
- Professional Disclosure: Reporting of any disciplinary actions or criminal charges
Certified Nurse-Midwife Salaries in Massachusetts
Massachusetts offers competitive compensation for certified nurse midwives, reflecting the state’s high cost of living and strong demand for midwifery services. According to the U.S. Bureau of Labor Statistics, CNMs in Massachusetts earn substantially above the national average.
Statewide Salary Data (2023)
| Percentile | Annual Salary | Experience Level |
|---|---|---|
| 10th Percentile | $89,420 | Entry-level/New graduates |
| 25th Percentile | $98,750 | 2-3 years of experience |
| 50th Percentile (Median) | $115,340 | Mid-career professionals |
| 75th Percentile | $142,680 | Experienced practitioners |
| 90th Percentile | $178,640 | Senior/Leadership positions |
Regional Salary Variations
Compensation varies across Massachusetts metropolitan areas:
- Boston-Cambridge-Nashua Region: Annual mean salary of $119,760
- Springfield Metropolitan Area: Annual mean salary of $108,430
- Worcester Metropolitan Area: Annual mean salary of $112,580
- Cape Cod and Islands: Seasonal variations with premium compensation
Factors Influencing Compensation
Several factors impact CNM salaries in Massachusetts:
- Practice Setting: Academic medical centers typically offer higher base salaries
- Geographic Location: The Greater Boston area commands premium compensation
- Years of Experience: Significant salary progression with experience
- Dual Certification: NM/WHNP dual certification may increase earning potential
- Leadership Roles: Administrative and educational positions offer additional compensation
- Call Requirements: On-call responsibilities often include additional payment
(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2023. 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 May 2025.)
Legislative Developments Enhancing CNM Practice
Insurance Reimbursement Parity
The passage of House Bill 1069 and Senate Bill 607 in 2024 represents a significant advancement for Massachusetts CNMs. This legislation mandates that insurance providers reimburse CNMs at the same rate as physicians for identical services, removing historical payment disparities that limited practice sustainability.
As Kathryn Kravetz Carr, former president of the Massachusetts Affiliate of the American College of Nurse-Midwives, stated, “This legislation decreases barriers to practice, which in turn increases access to midwifery care and, more broadly, women’s healthcare.”
Enhanced Practice Authority
Massachusetts CNMs operate with full practice authority, including:
- Independent Practice: No physician oversight or collaboration requirements
- Prescriptive Authority: Full prescribing privileges for medications and controlled substances
- Hospital Privileges: Ability to admit and manage patients in hospital settings
- Surgical Procedures: Authorization to perform episiotomies, repairs, and other procedures within scope
Frequently Asked Questions
What are the admission requirements for nurse-midwifery programs?
Most programs require an active RN license, bachelor’s degree in nursing (BSN), minimum 1-2 years of clinical nursing experience (preferably in women’s health or related areas), competitive GPA (typically 3.0 or higher), GRE scores (some programs), letters of recommendation, personal statement, and prerequisite courses in statistics and research methods.
How long does it take to become a CNM in Massachusetts?
The typical timeline is 2-4 years, depending on your starting point. BSN-prepared RNs can complete master’s programs in 2-3 years, while ADN-prepared RNs need 3-4 years for RN-to-MSN bridge programs. Add 2-3 months for certification exam preparation and state licensure processing.
Can I practice as a CNM in Massachusetts with certification from another state?
Yes, but you must obtain Massachusetts APRN authorization. The AMCB certification is nationally recognized, but you must apply for Massachusetts APRN licensure through the state Board of Registration in Nursing, which typically takes 4-6 weeks to process.
Do CNMs in Massachusetts need physician supervision?
No, Massachusetts grants CNMs full practice authority with no physician supervision or collaboration requirements. CNMs can practice independently, admit patients to hospitals, prescribe medications, and provide comprehensive care within their scope of practice.
What is the job outlook for CNMs in Massachusetts?
The job outlook is excellent, with growth driven by healthcare systems’ focus on reducing maternal mortality, addressing health disparities, and increasing access to women’s healthcare. The insurance reimbursement parity legislation has further improved employment opportunities and practice sustainability.
Can CNMs deliver babies in all Massachusetts hospitals?
Most major hospitals in Massachusetts credential CNMs and allow them to attend deliveries. However, hospital policies vary, and some smaller facilities may have restrictions. CNMs can also practice in birth centers and provide home birth services.
What continuing education is required for CNMs in Massachusetts?
CNMs must complete 15 contact hours of continuing education annually, including 5 hours in pharmacology if they have prescriptive authority. AMCB certification must be renewed every 5 years through continued competency assessment.
Are there loan forgiveness programs for nurse-midwifery students in Massachusetts?
Several programs may be available, including the National Health Service Corps, state-specific loan repayment programs for healthcare providers in underserved areas, and individual hospital/health system loan assistance programs. Contact the Massachusetts Office of Rural Health for current opportunities.