Today, nurse-midwifery care is gaining in popularity among expectant mothers seeking a gentler, more whole-person centered approach to the birthing process, and a significantly reduced likelihood of having to undergo such invasive procedures as cesarean sections and episiotomies.
Missouri’s certified nurse-midwives are licensed as advanced practice registered nurses (APRN), and as such, must maintain a collaborate practice agreement with a physician. This collaborative practice agreement allows CNMs in the state full prescriptive authority of controlled substances under the physician’s DEA number without further authorization. Just some of the services Missouri CNMs provide to patients include:
- Providing newborn care
- Writing medication prescriptions such as birth control
- Providing gynecological services
Most of Missouri’s CNMs work in obstetric departments of large hospitals, while many also work in smaller independent birth centers, such as the Mercy Birthing Center in St. Louis, which opened in May of 2014. In just the first year since opening, the dedicated nurse-midwives of Mercy Birthing Center attended 174 births. Certified nurse-midwives often establish lifelong care-giver/client relationships with patients, providing well-woman gynecological care and family planning services long after the childbirth process.
Steps to Becoming a Nurse Midwife in Missouri
The Missouri Board of Nursing, a division of the Missouri Division of Professional Registration, licenses certified nurse-midwives as advanced practice registered nurses (APRN) once they have met the requirements for graduate-level education and national certification in nurse-midwifery. Missouri RNs with licenses in good standing must complete these steps to become certified nurse-midwives with APRN licensure in Missouri:
Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery
Aspiring nurse midwives must earn a master’s degree of higher in nurse-midwifery through a program that has been accredited by the Accreditation Commission for Midwifery Education (ACME) in order to become nationally certified in nurse-midwifery and licensed as an APRN through the Missouri Board of Nursing.
Standard Admissions Requirements
While bachelor’s prepared RNs are eligible for admission to conventional master’s programs in nurse-midwifery, RNs who hold an associate’s degree must apply to RN-to-MSN programs with a focus in nurse midwifery. These accelerated programs confer both a BSN and master’s in nurse-midwifery.
Among the typical admissions requirements for master’s programs in nurse-midwifery:
- Undergraduate GPA
- GRE scores
- Admissions essay
- Past work experience
- Letters of recommendation
Program Structure and Dual Focus Options
RNs interested in becoming nurse-midwives are more often choosing dual specialization tracks in nurse midwifery and women’s health structured as master’s degrees in Nurse-Midwifery/Women’s Health Nurse Practitioner (NM/WHNP). These programs allow graduates to become certified nurse-midwives (CNMs) exclusively, or pursue dual-certification as both a CNM and board certified women’s health nurse practitioner (WHNP-BC).
Nurse midwife programs offer a broad range of learning opportunities for RNs in both classroom and clinical settings. Didactic courses, which typically consist of 40-60 credits, cover topics such as:
- 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 coursework, designed to give RNs advanced practice experience under the guidance of a physician or APRN, takes place at Missouri hospitals and birth centers. Most programs require clinical work to consist of between 700-1,000 hours. Students of online programs will work closely with program coordinators to be placed in one of Missouri’s hospitals for the clinical component of their master’s program. Possible clinical sites in Missouri include:
- Boone Hospital Center in Columbia
- Freeman Hospital West in Joplin
- Golden Valley Memorial Hospital in Clinton
- Heartland Health Medical Center in St. Joseph
- Liberty Hospital in Liberty
- Mercy Hospital Springfield in Springfield
- Mercy Hospital St. Louis in St. Louis
- Mercy Hospital Washington in Washington
- Missouri Baptist Medical Center in St. Louis
- Missouri Baptist Sullivan Hospital in Sullivan
- Research Medical Center in Kansas City
- Saint Clare Hospital Family Birth in Fenton
- Saint Luke’s East Hospital in Lee’s Summit
- Saint Luke’s Hospital of Kansas City in Kansas City
- Southeast Hospital in Cape Girardeau
- Truman Medical Center Lakewood in Kansas City
Step 2. Pass the National Certification Examination for Certified Nurse-Midwives
After completing a qualifying master’s program, CNM candidates would then become nationally certified in nurse-midwifery.
CNM Certification through the American Midwifery Certification Board
The American Midwifery Certification Board (AMCB) allows RNs who have earned their master’s degree in nurse midwifery through ACME-accredited programs to apply to take the Certified Nurse Midwife Exam. The completed application should be mailed to the following address:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
In Missouri, the CNM exam is offered at AMP testing centers (found in H&R Block offices) in the following cities:
- Jefferson City
- Springfield
- Louis
- Kansas City (Gladstone)
Nurses have four hours to complete the exam, which consists of 175 multiple-choice questions covering the following topics:
- Antepartum – 19-26 percent
- Intrapartum – 17-26 percent
- Postpartum – 15-18 percent
- Gynecology – 15-18 percent
- Women’s health and primary care – 8-16 percent
- Newborn – 7-16 percent
The AMCB’s online Candidate Handbook is designed to help RNs prepare for the exam. Nurses who earn a passing score receive their national certification from the AMCB.
WHNP-BC Certification through the National Certification Corporation
RNs who have completed a dual-focus program in nurse midwifery and women’s health may also choose to take the Women’s Health Care Nurse Practitioner (WHNP) Exam, administered through the National Certification Corporation (NCC), to achieve WHNP-Board Certification.
The 150-question exam is offered at the same AMP testing centers as the CNM exam and covers the following areas:
- Pharmacology – 5-10 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Obstetrics – 25-30 percent
- Gynecology – 35-40 percent
RNs may study from the WHNP Candidate Guide found on the NCC website in preparation for the exam. The exam has a three-hour time limit.
Step 3. Apply for APRN Licensure as a Certified Nurse-Midwife through the Missouri Board of Nursing
Having achieved their national certification as certified nurse-midwives, advanced practice registered nurse (APRN) licensure candidates must apply for advanced practice recognition through the Missouri Board of Nursing. To begin the process, candidates would complete the APRN application and compile the following supporting documents and fees:
- A $150 fee in the form of a money order or check made payable to the Missouri State Board of Nursing
- A completed Authorization to Release Confidential Information
- A copy of the RN’s current certification and letter with certification expiration date
All materials must be sent to the following address:
Missouri State Board of Nursing
PO Box 656
Jefferson City, MO 65102-0656
Missouri’s APRN applicants must go through a criminal background check to receive certification to practice in the state. To do so, they must contact L-1 Enrollment Services (866-522-7067) to schedule a fingerprinting session.
Collaborative Practice Agreement and Prescriptive Authority
APRNs in Missouri are required to have a collaborative agreement in place with a licensed physician in order to gain authority to administer, dispense, or prescribe controlled substances. Details regarding the collaborative practice agreement may be found on the Missouri Board of Nursing website.
Upon establishing a collaborative practice agreement, certified nurse-midwives would then submit a Controlled Substance Prescriptive Authority Application and have the delegating physician complete the Notice of Delegated Prescriptive Authority for Controlled Substances.
Step 4. Explore Career Options in Nurse-Midwifery and Maintain CNM Credentials
The Missouri affiliate of the American College of Nurse Midwives reports that 8% of all births in Missouri are attended by CNMs, indicating the value of nurse midwifery in the state. Nurse midwives in Missouri are employed in hospitals, birth centers, and private midwifery practices. Among the top employers of midwives in the state are:
- Birth and Wellness Center in O’Fallon
- Boone Hospital Center in Columbia
- Family Birth and Wellness in Springfield
- Freeman Hospital West in Joplin
- Golden Valley Memorial Hospital in Clinton
- Heartland Health Medical Center in St. Joseph
- Liberty Hospital in Liberty
- Mercy Hospital Springfield in Springfield
- Mercy Hospital St. Louis in St. Louis
- Mercy Hospital Washington in Washington
- Missouri Baptist Medical Center in St. Louis
- Missouri Baptist Sullivan Hospital in Sullivan
- Research Medical Center in Kansas City
- Saint Clare Hospital Family Birth in Fenton
- Saint Luke’s East Hospital in Lee’s Summit
- Saint Luke’s Hospital of Kansas City in Kansas City
- Southeast Hospital in Cape Girardeau
- Truman Medical Center Lakewood in Kansas City
The following job postings taken from a survey of vacancy announcements demonstrate the variety of jobs available for CNMs in Missouri (Listed for illustrative purposes only and do not constitute a job offer.):
- Certified Nurse Midwife-OB/GYN at the University of Missouri Hospital in Columbia
- Registered Nurse – Labor and Delivery at Maxim Facility Nursing in Sullivan
- Staff Registered Nurse Labor And Delivery at BJC Healthcare in Saint Louis
- Registered Nurse Labor and Delivery OB Float Pool at Carondelet Health in Kansas City
- Travel Registered Nurse Labor and Delivery RN at StaffDNA in Springfield, MO
Keeping CNM Certification Current with the American Midwifery Certification Board
The AMCB requires CNMs to complete one of two continuing education requirements every five years to maintain national certification. CNMs may complete three AMCB Certificate Maintenance Modules and 20 AMCB-approved contact hours of CE, or they may retake the AMCB Certification Examination. CNMs who elect to complete the modules and contact hours are subject to an annual fee, as determined by the AMCB. CNMs retaking the exam are subject to a one-time $500 fee.
Keeping WHNP-BC Certification Current with the National Certification Corporation
The National Certification Corporation (NCC) requires nurses who hold WHNP-Board Certification to take a continuing competency assessment every three-year maintenance cycle. Nurses may additionally have to complete CE requirements as determined by the NCC.
APRNs in Missouri must mail their confirmation of national certification renewals to the Missouri Board of Nursing to maintain their APRN certification. While there are no renewal forms or fees to maintain APRN certification, all APRNs must renew their Missouri RN license by every April 30th of odd numbered years.
Salaries for Certified Nurse-Midwives in Missouri
Certified nurse-midwives in Missouri earned an average salary of $86,530 as of 2014 according to the US Bureau of Labor Statistics (BLS). Experienced nurse midwives whose salaries fell within the top 90th percentile earned an average of $115,410 in 2014, while their colleagues just starting out and earning within the tenth percentile averaged $55,830 that year.
The number of jobs for certified nurse-midwives is expected to grow dramatically nationwide, and Missouri is no exception. In fact, the Missouri Economic Research and Information Center has found job prospects and salary potential for CNMs to be so promising that it gave the profession an A rating. This rating is reserved for professions that have a high job growth rate, high salaries, and a large number of job openings.
How CNMs are Compensating for the Shortage of Physicians in Missouri
As of February 2014, there were 86 certified nurse-midwives practicing in Missouri according to the American College of Nurse-Midwives. This represents one of the lowest ratios of CNMs to residents nationwide; however, changes are afoot as a greater number of women in Missouri seek the less invasive and more personalized care nurse-midwives provide.
Like most advanced practice RNs, certified nurse-midwives have been shown to provide care that is comparable in virtually every way to the services physicians provide, and often with an even greater level of patient satisfaction. The shift towards a preference for nurse-midwifery among pregnant women can be seen in a recent analysis of Medicaid recipients in the state. As of 2012, more CNMs than physicians attended the births of patients in Missouri who were on Medicaid according to the American College of Nurse-Midwives. While physicians attended 44.24% of these births, certified nurse-midwives attended 50.87%.
An increase in the number of certified nurse-midwives would help to ameliorate the shortage of obstetric services in much of Missouri, since large portions of the state are medically underserved. According to a publication entitled The Status of Advanced Practice Registered Nurses in Missouri, 109 of Missouri’s 114 counties were designated as having Healthcare Professional Shortage Areas (HPSA). This designation is reserved for areas with less than one primary care physician per 3,000 people and/or a lack of primary care services within a 30 minute radius of travel time.
Salaries for Nurse Midwives in the Saint Louis Area
The US Bureau of Labor Statistics provides a full analysis of salaries for nurse midwives in the St. Louis metropolitan area as of 2014. According to this analysis, the average salary for certified nurse-midwives was higher in the St. Louis area than in Missouri as a whole:
