Last Updated: May 2025 | Reviewed by Abbie Jacobs
Certified Nurse-Midwives (CNMs) in Missouri provide a holistic, patient-centered approach to childbirth, reducing the need for invasive procedures like cesarean sections and episiotomies. 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, granting full prescriptive authority under the physician’s DEA number. With approximately 150 CNMs practicing in Missouri, they address a critical obstetric shortage, serving in hospitals, birth centers, and private practices. Services include newborn care, gynecological services, and prescribing medications like birth control, often fostering lifelong patient relationships.
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
Aspiring nurse-midwives must earn a master’s degree or higher in nurse-midwifery from a program accredited by the Accreditation Commission for Midwifery Education (ACME) to qualify for national certification and APRN licensure in Missouri.
Educational Pathways
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, 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) occurs in Missouri hospitals and birth centers, coordinated by program faculty. Potential clinical sites include:
- Urban Centers: Mercy Hospital St. Louis, Saint Luke’s Hospital of Kansas City, Missouri Baptist Medical Center
- Regional Hospitals: Boone Hospital Center (Columbia), Freeman Hospital West (Joplin), Southeast Hospital (Cape Girardeau)
- Rural Facilities: Golden Valley Memorial Hospital (Clinton), Missouri Baptist Sullivan Hospital
- Birth Centers: Mercy Birthing Center (St. Louis), Family Birth and Wellness (Springfield)
“Choosing to pursue nurse-midwifery at Mizzou was the best decision of my career. The collaborative practice model in Missouri has given me the autonomy to provide holistic care while having physician support when needed. I now deliver babies at Barnes-Jewish Hospital and have built lasting relationships with families throughout St. Louis.”
– Jessica Chavez, CNM, MSN, Class of 2022, University of Missouri
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, multiple-choice test offered at AMP testing centers in Jefferson City, Springfield, St. Louis, and Kansas City (Gladstone). It 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% |
Candidates can prepare using the AMCB’s Candidate Handbook. Applications are mailed to: AMCB, 849 International Drive, Suite 120, Linthicum, MD 21090.
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, offered at the same AMP centers, covers Pharmacology (5-10%), Primary Care (10-15%), Diagnostic Testing (10-15%), Obstetrics (25-30%), and Gynecology (35-40%). Study resources include the WHNP Candidate Guide.
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. Required materials include:
- $150 fee (check or money order to Missouri State Board of Nursing)
- Authorization to Release Confidential Information
- Copy of current AMCB certification and expiration letter
- Verification of unencumbered RN license
Mail to: Missouri State Board of Nursing, PO Box 656, Jefferson City, MO 65102-0656. Applicants must schedule a fingerprinting session for a criminal background check via L-1 Enrollment Services (866-522-7067).
Collaborative Practice Agreement and Prescriptive Authority
Missouri CNMs require a collaborative practice agreement with a physician for prescriptive authority, including controlled substances. Key agreement components include written protocols, treatment plan methods, scope delineation, geographic area, and service review processes. CNMs submit a Controlled Substance Prescriptive Authority Application and a Notice of Delegated Prescriptive Authority.
Missouri Midwifery Credentials
Missouri distinguishes between CNMs and direct-entry midwives, regulated differently:
| 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
With ~150 CNMs serving Missouri, where 8% of births are CNM-attended, opportunities abound in hospitals, birth centers, and private practices. Top employers include:
- Urban Centers: Mercy Hospital St. Louis, Saint Luke’s Hospital of Kansas City, Missouri Baptist Medical Center
- Regional Hospitals: Boone Hospital Center (Columbia), Freeman Hospital West (Joplin), Southeast Hospital (Cape Girardeau)
- Rural Facilities: Golden Valley Memorial Hospital (Clinton), Missouri Baptist Sullivan Hospital
- Birth Centers: Mercy Birthing Center (St. Louis), Family Birth and Wellness (Springfield)
Example job roles (illustrative, not offers):
- CNM-OB/GYN, University of Missouri Hospital (Columbia)
- Labor and Delivery RN, BJC Healthcare (St. Louis)
- CNM, Family Birth and Wellness (Springfield)
Credential Maintenance
AMCB Certification: Every five years, CNMs complete three AMCB Certificate Maintenance Modules and 20 CE hours or retake the exam ($500 fee). NCC WHNP-BC: Every three years, complete a continuing competency assessment and CE as required. Missouri APRN License: Submit national certification renewals to the Board; renew RN license by April 30 of odd-numbered years.
Step 5. Understand Salary Expectations for CNMs in Missouri
Certified nurse-midwives in Missouri benefit from high demand, with 109 of 114 counties designated as Healthcare Professional Shortage Areas. Nationally, CNMs earned a median salary of $132,050 in May 2024 (U.S. Bureau of Labor Statistics). Missouri’s lower cost of living enhances purchasing power.
National Certified Nurse-Midwife Salary Distribution (2024)
| Experience Level | Annual Salary Range | Missouri Market Factors |
|---|---|---|
| Entry Level (10th Percentile) | $98,520 | High demand in rural areas |
| Early Career (25th Percentile) | $108,840 | Opportunities in birth centers |
| Experienced (50th Percentile) | $132,050 | Competitive hospital salaries |
| Senior Level (75th Percentile) | $158,990 | Leadership roles in urban centers |
| Top Earners (90th Percentile) | $217,270 | Private practice opportunities |
(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2024. Figures represent national data, adjusted for Missouri’s market. 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 June 2025.)
Employment Growth: The U.S. Bureau of Labor Statistics projects 40% national growth for nurse-midwives from 2024 to 2033, with Missouri’s shortage suggesting strong local demand.
Step 6. Frequently Asked Questions About Becoming a Nurse-Midwife in Missouri
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, plus time for certification and licensure.
Can CNMs practice independently in Missouri?
No, CNMs require collaborative practice agreements with physicians but have significant autonomy and full prescriptive authority within these agreements.
What’s the difference between a CNM and a direct-entry midwife in Missouri?
CNMs are APRNs with graduate education, practicing in hospitals and birth centers with prescriptive authority. Direct-entry midwives (NARM-certified) have a limited scope, primarily attending home births.
Are there online CNM programs for Missouri residents?
Yes, ACME-accredited online/hybrid programs are available, but require 700-1,000 hours of in-person clinical rotations, often arranged in Missouri facilities.
What are the job prospects for new CNM graduates in Missouri?
Excellent, with 109 of 114 counties as Healthcare Professional Shortage Areas and 40% projected job growth through 2033, especially in underserved areas.
Is financial aid available for CNM programs?
Yes, options include federal loans, HRSA Nurse Corps Scholarships, state grants, and hospital loan forgiveness programs for multi-year commitments.