Last Updated: January 2026 | Reviewed by Abbie Jacobs
Certified Nurse-Midwives (CNMs) in Missouri provide holistic, patient-centered care in a state facing critical healthcare shortages. As Advanced Practice Registered Nurses (APRNs), CNMs are licensed by the Missouri Board of Nursing and must maintain a collaborative practice agreement with a physician. With only 80-82 CNMs serving Missouri’s 6.2 million residents—37% below the national average—the state offers substantial career opportunities, particularly in the 109 counties designated as Health Professional Shortage Areas. CNMs provide comprehensive services, including prenatal care, labor and delivery, gynecological care, and primary healthcare for women across the lifespan.
Steps to Becoming a Nurse-Midwife in Missouri
Missouri RNs with unencumbered licenses must complete the following steps to become certified nurse-midwives with APRN licensure:
Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery
Important Update: Missouri currently has no ACME-accredited nurse-midwifery programs located within the state. Aspiring CNMs must pursue accredited online or distance education programs or attend programs in neighboring states to qualify for national certification and Missouri APRN licensure.
Educational Pathways for Missouri Residents
No In-State Programs Available
According to the Accreditation Commission for Midwifery Education (ACME) official database (accessed January 2026), Missouri residents must choose from these options:
Distance Education Programs (Recommended):
- Frontier Nursing University (Kentucky) – The nation’s largest producer of CNMs, graduating approximately 40% of all new nurse-midwives annually. Offers fully online MSN and Post-Graduate Certificate programs with only 2-3 required campus visits. Clinical practicum can be completed in Missouri using its network of 13,000+ clinical sites.
- Georgetown University (DC) – Online MS, DNP, and Post-Graduate Certificate with 3 on-campus intensives
- Shenandoah University (Virginia) – Online MSN and Post-Graduate Certificate with 2 immersions
- University of Cincinnati (Ohio) – Online MSN program
Neighboring State Programs:
- University of Kansas (Kansas City, KS) – DNP and Post-Graduate Certificate; clinical sites extend into the Missouri metro area
- University of Arkansas for Medical Sciences (Little Rock) – Newly accredited program (2025)
- University of Tennessee Health Science Center (Memphis) – Recently accredited (2025)
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 |
Standard Admissions Requirements
BSN-prepared RNs are eligible for conventional MSN programs in nurse-midwifery, while ADN-prepared RNs can pursue RN-to-MSN bridge programs. Typical admission requirements include:
- Undergraduate GPA (typically 3.0 or higher)
- GRE scores (varies by program)
- Admissions essay
- Past work experience (minimum 1-2 years as RN)
- Letters of recommendation
- Current unencumbered RN license
- Background check and drug screening
Program Structure and Dual Focus Options
Many RNs opt for dual specialization tracks in Nurse-Midwifery/Women’s Health Nurse Practitioner (NM/WHNP), enabling dual certification as a CNM and Women’s Health Nurse Practitioner (WHNP-BC). Programs include 40-60 didactic credits covering topics like:
- Family Crisis Care
- Ambulatory Care of Women
- Pharmacology
- Biostatistics for Health Care Providers
- Women’s Reproductive Healthcare
- Physiology & Pathophysiology
- Newborn Care
- Midwifery Care During Labor
- Midwifery Care During Pregnancy
Clinical training (700-1,000 hours) can be coordinated at Missouri hospitals and birth centers through program faculty. Potential clinical sites include:
- St. Louis Metro: BJC HealthCare (Barnes-Jewish Hospital, Missouri Baptist Medical Center), Mercy Hospital St. Louis, SSM Health
- Kansas City Metro: Saint Luke’s Health System, HCA Midwest Health, Meritas Health
- Regional Hospitals: MU Health Care (Columbia), CoxHealth (Springfield), Freeman Hospital West (Joplin), Southeast Hospital (Cape Girardeau)
- Birth Centers: Mercy Birthing Center (St. Louis), Family Birth and Wellness (Springfield)
“Choosing Frontier’s distance education program allowed me to continue working in Kansas City while earning my CNM. The flexibility to complete clinical hours locally was invaluable, and I now deliver babies at Research Medical Center with the support of a collaborative physician practice.”
– Jessica Chavez, CNM, MSN, Frontier Nursing University Graduate
Step 2. Pass the National Certification Examination for Certified Nurse-Midwives
After completing an ACME-accredited master’s program, candidates must achieve national certification through the American Midwifery Certification Board (AMCB), as required by Missouri law.
CNM Certification through the American Midwifery Certification Board
The AMCB Certified Nurse-Midwife Exam is a 175-question, four-hour, computer-based test offered at AMP testing centers throughout Missouri, including Jefferson City, Springfield, St. Louis, and Kansas City. The exam covers:
| Content Area | Percentage of Exam |
|---|---|
| Antepartum | 19-26% |
| Intrapartum | 17-26% |
| Postpartum | 15-18% |
| Gynecology | 15-18% |
| Women’s Health and Primary Care | 8-16% |
| Newborn | 7-16% |
Exam Details (Updated February 2025):
- Application fee: $500
- Retake fee: $350
- Results are provided immediately at the testing center
- Passing scaled score: 75
- Certification valid for 5 years
Candidates can prepare using the AMCB’s Candidate Handbook and Certificate Maintenance Modules, which provide comprehensive study resources.
WHNP-BC Certification through the National Certification Corporation
Dual-focus NM/WHNP graduates can pursue Women’s Health Care Nurse Practitioner (WHNP-BC) certification via the National Certification Corporation (NCC). The 150-question, three-hour exam covers Pharmacology (5-10%), Primary Care (10-15%), Diagnostic Testing (10-15%), Obstetrics (25-30%), and Gynecology (35-40%).
Step 3. Apply for APRN Licensure as a Certified Nurse-Midwife through the Missouri Board of Nursing
After national certification, candidates apply for APRN licensure through the Missouri Board of Nursing.
2024 Licensure Updates
Recent Regulatory Changes: Missouri APRN regulations were updated in May 2024 (20 CSR 2200-4.100, effective May 31, 2024) and August 2023 (RSMo §334.104, effective August 28, 2023). These updates clarify documentation requirements and collaborative practice standards.
Initial APRN Licensure Requirements:
- Application fee: $150 (check or money order to the Missouri State Board of Nursing)
- Graduate education verification: Must include a minimum of 500 faculty-supervised clinical hours (for programs completed after January 2009)
- Three separate graduate courses documented in transcripts: advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology
- AMCB certification: Copy of current certification and expiration letter
- RN license verification: Unencumbered active Missouri RN license or multistate compact license
- Criminal background check: State and federal fingerprint checks via the Missouri State Highway Patrol
- Processing time: 4-6 weeks after complete submission
Mail application to: Missouri State Board of Nursing, PO Box 656, Jefferson City, MO 65102-0656.
Collaborative Practice Agreement and Prescriptive Authority
Missouri requires collaborative practice agreements for all CNMs under RSMo §334.104 and 20 CSR 2200-4.200. While HB 1773 (full practice authority legislation) passed the House Committee in April 2024, it did not achieve final passage. Missouri remains a restricted practice state.
Mandatory Collaborative Practice Requirements:
- One-month supervision period: The Collaborating physician must be physically present during the initial practice period
- Chart review minimums: 10% of all healthcare services reviewed every 14 days; 20% minimum for controlled substance prescriptions
- Physician limits: No more than 6 full-time equivalent APRNs per collaborating physician
- Geographic proximity: Required unless telehealth waiver applies (RSMo §191.1145)
- Written protocols: Must document treatment plan methods, scope delineation, geographic area, and service review processes
Prescriptive Authority Requirements:
- Schedule III, IV, V: Full prescribing authority as delegated by collaborating physician
- Schedule II hydrocodone: Limited to 120-hour supply, no refills
- Buprenorphine: Up to 30-day supply for medication-assisted treatment
- Prerequisites: 300 hours of preceptorial experience and 1,000 hours post-graduation practice
- Documentation: Controlled Substance Prescriptive Authority Application and Notice of Delegated Prescriptive Authority must be submitted to the Board
Missouri Midwifery Credentials
Missouri distinguishes between CNMs and direct-entry midwives, regulated by different agencies:
| Credential | Educational Requirements | Regulatory Oversight | Practice Authorization |
|---|---|---|---|
| Certified Nurse-Midwife (CNM) | Graduate nursing degree (ACME-accredited) | Missouri Board of Nursing | Full APRN scope with collaborative agreement |
| Direct-Entry Midwife | NARM certification (non-nursing) | Missouri Department of Health and Senior Services | Limited scope, primarily home births |
Step 4. Explore Career Options in Nurse-Midwifery and Maintain CNM Credentials
Critical Workforce Shortage: With only 80-82 CNMs serving Missouri’s 6.2 million residents, the state faces a significant workforce shortage. Missouri’s CNM employment is 37% below the national average (location quotient of 0.63), creating substantial career opportunities.
Federal Loan Repayment for Underserved Areas
109 of Missouri’s 114 counties are designated Health Professional Shortage Areas (HPSAs), making CNMs eligible for federal loan repayment programs:
- NHSC Loan Repayment: Up to $50,000 for 2-year commitment
- NHSC Enhanced Award: Up to $75,000 for the highest-need rural areas
- Maternity Care Target Area Supplement: Additional $40,000 for qualifying sites
- Combined potential: Up to $115,000 in loan repayment for CNMs in qualifying Missouri locations
Major Employers and Healthcare Systems
St. Louis Metropolitan Area:
- BJC HealthCare – Barnes-Jewish Hospital (Missouri’s largest hospital), Missouri Baptist Medical Center; currently hiring CNM hospitalists with student loan repayment available
- Mercy Health – Mercy Birthing Center features dedicated low-intervention midwifery care; active CNM recruitment
- SSM Health – St. Joseph Hospital, Lake Saint Louis, St. Mary’s Hospital, Jefferson City; FlexPath Funded tuition coverage
Kansas City Metropolitan Area:
- HCA Midwest Health – Operates the region’s largest midwifery program across Research Medical Center, Lee’s Summit Medical Center, Overland Park Regional
- Saint Luke’s Health System – Nationally recognized maternity care (U.S. News & World Report, 4 consecutive years)
- Meritas Health – Northland Women’s Health Care is actively seeking CNMs
Regional Markets:
- Springfield: Mercy Clinic Midwifery, CoxHealth (3,500+ annual deliveries)
- Columbia: MU Health Care Birthing Center with Low-Intervention Birth Program
- Cape Girardeau: Mercy Hospital Southeast (recognized Best Maternity Care Hospital by Newsweek)
- Joplin: Freeman Hospital West
Credential Maintenance
AMCB Certification Renewal (Every 5 Years):
- Option 1: Complete three Certificate Maintenance Modules plus 20 continuing education hours; annual fee $70 (or $315 prepaid for 5 years)
- Option 2: Retake certification exam ($500 fee)
- Current modules: Intrapartum/Postpartum/Newborn (2024-2026), Gynecologic/Sexual/Reproductive (2025-2027), Antepartum/Primary Care (cycle varies)
Missouri APRN License Renewal:
- APRN Document of Recognition tied to RN license (renewed biennially, April 30 of odd-numbered years)
- Fee: approximately $85
- No state-mandated continuing education required – only maintenance of national certification
- Submit updated AMCB certification documentation to the Board upon renewal
- Collaborative practice agreement must remain current
NCC WHNP-BC Renewal (Every 3 Years): Complete continuing competency assessment and required continuing education hours.
Step 5. Understand Salary Expectations for CNMs in Missouri
Updated May 2023 Bureau of Labor Statistics Data:
Certified nurse-midwives in Missouri benefit from high demand despite lower-than-national-average salaries. Missouri’s location quotient of 0.63 indicates employment concentration 37% below the national average, representing significant unmet demand.
Missouri vs. National CNM Employment and Wages (May 2023)
| Metric | Missouri | National |
|---|---|---|
| Total Employment | 80-82 CNMs | 8,600 CNMs |
| Location Quotient | 0.63 (37% below average) | 1.00 |
| Mean Annual Wage | $122,900 | $131,570 |
| Median Hourly Wage | $60.02 | $62.33 |
National Certified Nurse-Midwife Salary Distribution (2023-2024)
| Experience Level | Annual Salary Range | Missouri Market Factors |
|---|---|---|
| Entry Level (10th Percentile) | $98,520 | High demand in rural HPSAs with federal loan repayment |
| Early Career (25th Percentile) | $108,840 | Opportunities in birth centers and community health |
| Experienced (50th Percentile) | $132,050 | Competitive hospital salaries in metro areas |
| Senior Level (75th Percentile) | $158,990 | Leadership roles in major health systems |
| Top Earners (90th Percentile) | $217,270 | Private practice and specialized roles |
Cost of Living Advantage: Missouri’s cost of living index is 89.3 (10.7% below the national average), enhancing purchasing power. A $122,900 salary in Missouri has similar buying power to approximately $137,600 in an average-cost state.
Employment Growth Projections:
- National (BLS 2024-2034): 11% growth for CNMs specifically; 35% growth for combined APRN categories
- Missouri (MERIC 2022-2032): 8.54% growth (82 to 89 CNMs), approximately 5 annual job openings
- Shortage context: Missouri needs approximately 476 additional primary care providers to remove HPSA designations, creating sustained demand
(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2023. Missouri-specific data accessed January 2026. Job growth data provided by Projections Central and MERIC. Information accessed January 2026.)
Step 6. Frequently Asked Questions About Becoming a Nurse-Midwife in Missouri
Are there any nurse-midwifery programs in Missouri?
No. Missouri currently has no ACME-accredited nurse-midwifery programs. Missouri residents must pursue distance education programs (such as Frontier Nursing University) or attend programs in neighboring states like Kansas, Arkansas, or Tennessee. Clinical practicum hours can typically be completed at Missouri healthcare facilities.
How long does it take to become a CNM in Missouri?
The timeline varies by educational pathway: BSN to MSN programs take 2-3 years, ADN to MSN bridge programs take 3-4 years, and post-graduate certificates take 18-24 months. Add approximately 3-6 months for certification examination and Missouri APRN licensure processing.
Can CNMs practice independently in Missouri?
No. Missouri is a collaborative practice state requiring CNMs to maintain agreements with collaborating physicians. However, CNMs have significant autonomy within these agreements and possess full prescriptive authority under physician supervision. Recent legislative attempts to establish full practice authority (HB 1773 in 2024) did not achieve passage.
What’s the difference between a CNM and a direct-entry midwife in Missouri?
CNMs are Advanced Practice Registered Nurses with graduate education, regulated by the Missouri Board of Nursing, and authorized to practice in hospitals, birth centers, and clinics with full prescriptive authority. Direct-entry midwives hold NARM certification (non-nursing), are regulated by the Missouri Department of Health and Senior Services, and have a limited scope focused primarily on home births.
Are online CNM programs accepted for Missouri licensure?
Yes. ACME-accredited online and distance education programs are fully accepted for Missouri APRN licensure. Programs require 700-1,000 hours of in-person clinical rotations, which can typically be arranged at Missouri healthcare facilities through the program’s clinical placement network.
What are the job prospects for new CNM graduates in Missouri?
Excellent. Missouri has only 80-82 CNMs serving 6.2 million residents—37% below the national average. With 109 of 114 counties designated as Health Professional Shortage Areas, opportunities are substantial. Major health systems actively recruit CNMs, and federal loan repayment programs offer up to $115,000 for practice in underserved areas.
Is financial aid available for CNM programs?
Yes. Options include federal student loans, HRSA Nurse Corps Scholarships and Loan Repayment, NHSC Students to Service Loan Repayment (up to $120,000), state grants, and institutional loan forgiveness programs offered by Missouri hospitals and health systems for multi-year practice commitments.
Does Missouri require continuing education for APRN license renewal?
No. Missouri does not mandate state-specific continuing education for APRN license renewal. CNMs must only maintain their AMCB national certification (which requires CE) and submit updated certification documentation to the Missouri Board of Nursing with their biennial license renewal.