In August of 2014, the Massachusetts Board of Registration in Nursing announced that certified nurse midwives (CNMs) in the state would no longer require physician oversight in the form of a collaborative agreement when caring for patients. The Board also announced that CNMs would no longer require written guidelines for prescribing medications. As the healthcare industry rises to meet the challenges posed by a greater number of people with access to healthcare and a growing elderly population, these changes reflect an increased reliance on certified nurse midwives to serve as primary healthcare providers for women throughout all stages of pregnancy and beyond.
CNMs are recognized as Advanced Practice Registered Nurses (APRNs) who specialize in antepartum, intrapartum and postpartum care. Women are more often turning to certified nurse midwives to help facilitate the birthing process and tend to their healthcare needs during antepartum, intrapartum and postpartum stages. According to the Massachusetts Affiliate of the American College of Nurse Midwives, in 2013 CNMs attended roughly 10% of all deliveries in Massachusetts’s birth centers, and 20% of all conventional births statewide.
With the implementation of the 2014 practice authority laws, and a growing demand for a less invasive whole-person approach to wellness and childbirth, Massachusetts’s CNMs enjoy a greater diversity of opportunities for career advancement and independent practice than ever before.
Steps to Becoming a Nurse Midwife in Massachusetts
Registered nurses interested in becoming certified nurse midwives in Massachusetts must meet the requirements for national certification through the American Midwifery Certification Board and Advanced Practice Registered Nurse (APRN) licensure through the Massachusetts Board of Registration in Nursing.
The steps in this guide provide a detailed explanation of what’s involved in becoming a certified nurse midwife in Massachusetts:
Step 1. Earn a Qualifying Master’s Degree in Nurse Midwifery
The Massachusetts Board of Registration of Nursing requires all applicants for APRN licensure as certified nurse midwives to complete a nurse midwife master’s degree or higher that has received accreditation from the Accreditation Commission for Midwifery Education (ACME).
Registered nurses aspiring to become certified nurse midwives apply to graduate programs based on their existing level of education. Bachelor’s prepared RNs have the opportunity to apply to conventional nurse midwifery master’s programs or dual focus programs in such areas as nurse midwifery/women’s health nurse practitioner. Associate’s prepared RNs typically apply to RN-to-MSN bridge programs with a focus in midwifery, which confer both a BSN and MSN in one accelerated program.
Many bachelor’s prepared RNs choose nurse midwife programs that offer dual specialization options in women’s health. Nurse-Midwife/Women’s Health Nurse Practitioner (NM/WHNP) master’s programs prepare graduates to be experts in antepartum, intrapartum and postpartum care as well as gynecology and obstetrics.
Massachusetts is home to only one nationally accredited nurse midwifery program. Because the Springfield-based program is limited to six students, many aspiring nurse midwives elect to pursue a degree in nurse midwifery online.
Nurse midwife programs consist of didactic coursework and clinical sequences. Classroom-based coursework typically consists of between 40-60 credits and covers topics including, but not limited to:
- Women’s Reproductive Healthcare
- Pharmacology
- Midwifery Care During Pregnancy
- Midwifery Care During Labor
- Ambulatory Care of Women
- Biostatistics for Health Care Providers
- Physiology & Pathophysiology
- Family Crisis Care
- Newborn Care
CNM applicants in Massachusetts are required to complete graduate courses in the following areas, which are included as a standard part of all accredited programs designed for APRNs:
- Advanced pharmacotherapeutics
- Advanced assessment
- Advanced pathophysiology
Clinical coursework, which usually consists of between 700 and 1,000 hours of work, takes place at a local birthing clinic or hospital. Nurse midwives pursuing their degree online collaborate with their program director to find a suitable local clinical setting. For a list of Massachusetts employers of nurse midwives, visit Step 4 of this article.
Step 2. Pass the National Nurse-Midwife Certification Examination
The Certified Nurse Midwife Exam, offered by the American Midwifery Certification Board (AMCB), serves as the evaluation standard for aspiring nurse midwives. Candidates must complete their master’s degree in nurse midwifery to be eligible to take the exam. Aspiring CNMs may apply to take the exam by mailing their completed application form to the following address:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
In Massachusetts, the Certified Nurse Midwife Exam is offered at AMP testing centers, which are located at H&R Block offices in the following cities:
- Framingham
- Holyoke
- Saugus
The CNM exam consists of 175 multiple-choice questions and covers the following areas of nurse midwifery:
- Newborn – 7-16 percent
- Women’s health and primary care – 8-16 percent
- Postpartum – 15-18 percent
- Gynecology – 15-18 percent
- Intrapartum – 17-26 percent
- Antepartum – 19-26 percent
Aspiring nurse midwives may use the online Candidate Handbook to study for the exam.
The AMCB uses a pass/fail system to determine candidate eligibility for certification. RNs who pass the exam receive a Certificate in Nurse Midwifery (CNM) from the AMCB directly.
While the AMCB certification allows nurses to apply for licensure as a CNM, graduates of dual focus Nurse-Midwifery/Women’s Health Nurse Practitioner (NM/WHNP) programs may additionally take the Women’s Health Care Nurse Practitioner (WHNP) Exam administered by the National Certification Corporation (NCC) to achieve their WHNP-Board Certification.
The NCC offers a WHNP Candidate Guide to help RNs prepare for the exam in advance. The 150-question multiple-choice test is divided into the following segments:
- 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
The exam may be taken at the same Massachusetts AMP test centers that offer the Certified Nurse Midwife Exam.
Step 3. Apply to Become a Certified Nurse-Midwife APRN in Massachusetts
After successfully completing national certification exam(s), applicants apply to become Advanced Practice Registered Nurses (APRN) with certified nurse-midwife recognition through the Massachusetts Board of Registration in Nursing. The APRN application is offered on the Professional Credential Services (PCS) website. Applicants must instruct the director of their nurse midwife program to send an official transcript to PCS. Along with their completed application forms, applicants are responsible for sending the following materials to PCS
- A copy of their current Massachusetts RN license
- A verification of their AMCB certification
- A payment form, found within the application link, and a $150 application fee
All materials must be sent to the following address:
Professional Credential Services
ATTN: MA Nurse Coordinator
P.O. Box
Step 4. Explore Nurse-Midwife Career Opportunities and Keep Credentials Current
The Massachusetts Board of Nursing posts the status of APRN licenses within 24 hours of their decision. RNs may check the status of their license on the Massachusetts Health and Human Services website. Those who receive approval from the Board may begin exploring career opportunities through Massachusetts’ many hospitals, birth centers, and women’s clinics.
Massachusetts’ top employers of nurse midwives are found throughout the state, from the greater Boston area to Western Massachusetts. Just some of the state’s top employers of CNMs include:
- Anna Jaques Hospital in Newburyport
- Beth Israel Deaconess Hospital in Plymouth
- Beverly Hospital in Beverly
- Boston Medical Center in Boston
- Brigham and Women’s Hospital in Boston
- Cooley Dickinson Hospital in Northampton
- Emerson Hospital in Concord
- Falmouth Hospital in Falmouth
- HealthAlliance Hospital in Leominster
- Holy Family Hospital in Methuen
- Holyoke Medical Center in Holyoke
- Lawrence General Hospital in Lawrence
- Melrose – Wakefield Hospital in Melrose
- Midwives-Mount Auburn Hospital in Arlington
- Mount Auburn Hospital in Cambridge
- Newton-Wellesley Hospital in Newton
- Norwood Hospital in Norwood
- Saint Vincent Hospital in Worcester
- Southcoast Health System: Charlton Memorial Hospital in Fall River
- South Shore Hospital in Weymouth
- Winchester Hospital in Winchester
Job vacancy announcements posted in November 2015 offer insight into the types of opportunities that may be available to Massachusetts’s CNMs (shown for illustrative purposes only and does not imply a job offer or assurance of employment):
- Certified Nurse Midwife – OB/GYN Staff at Saint Vincent Hospital Physician Services in Worcester
- Certified Nurse Midwife at Bay State Health in Greenfield
- Certified Nurse Midwife at RiverBend Medical Group in Springfield
- Certified Nurse Midwife at Harvard Vanguard Medical Associates in Wellesley
- Certified Nurse Midwife at Cape Cod Healthcare in Hyannis
Salaries for Certified Nurse-Midwives in Massachusetts
In May 2014, the United States Department of Labor reported that the average annual salary of nurse-midwives in Massachusetts was $103,600. This worked out to approximately $49.81 per hour.
Salaries tended to vary across the state depending upon experience. While nurse-midwives just entering the field earned salaries in the 10th percentile ($42,300 per year), those practicing at mid-career saw a drastic increase in average earnings with an average of $103,890, annually. Highly experienced nurse-midwives in Massachusetts enjoyed annual salaries between $121,460 and $152,630. Earnings for CNMs in Massachusetts far surpassed the national average for these professionals, which was $97,700 as of 2014.
New Bill Allows More Freedom to Practice Nurse-Midwifery in Massachusetts
In 2012, a bill was passed to allow certified nurse-midwives in Massachusetts to practice without specific physician oversights. This new law provides expanded practice opportunities for nurse-midwives working in conventional settings like hospitals, but also gives them the freedom to open their own birthing facilities, women’s clinics and home-birth practices if they so desire.
Speaking of this new development in Massachusetts, Kathryn Kravetz Carr, president of the Massachusetts Affiliate of the American College of Nurse-midwives, stated, “It decreases barriers to practice, which in turn increases access to midwifery care and, more broadly, women’s healthcare.”
More access for patients means a higher demand for more certified nurse-midwives statewide.
Nurse-Midwife Salaries In Various Metropolitan and Non-Metropolitan Areas of Massachusetts
Nurse-midwives employed throughout the state of Massachusetts recorded varied annual and hourly earnings for different regions of the state.
For instance, according to an analysis performed by the U.S. Department of Labor in 2014, those who worked in Springfield earned an average salary of $90,800, annually, ($43.63/hour). Nurse-midwives in the Boston-Cambridge-Quincy, MA-NH statistical earned much higher average salaries of $108,280, annually, ($52.06/hour). And, the Boston-Cambridge-Quincy, MA NECTA Division reported similarly competitive salaries for certified nurse-midwives with an average of $108,960, ($52.38/hour) as of 2014.
A detailed analysis of nurse-midwife salary information in Massachusetts by region is shown below (U.S. Department of Labor, 2014):
