Last Updated: May 2025 | Reviewed by Abbie Jacobs
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 collaborative 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. At the same time, 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 childbirth.
“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
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 or 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.
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
While bachelor ‘s-prepared RNs are eligible for admission to conventional master’s programs in nurse-midwifery, RNs with an associate’s degree must apply to RN-to-MSN programs focusing on nurse-midwifery. These accelerated programs confer both a BSN and a master’s in nurse-midwifery.
Among the typical admissions requirements for master’s programs in nurse-midwifery:
- 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
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 become nationally certified in nurse-midwifery. Missouri law requires CNMs to be “registered nurses who are currently certified as nurse midwives by the American College of Nurse-Midwives or other nationally recognized certifying body approved by the board of nursing.”
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
- St. Louis
- Kansas City (Gladstone)
Nurses have four hours to complete the exam, which consists of 175 multiple-choice questions covering the following topics:
| 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% |
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 a letter with a certification expiration date
- Verification of current RN license in good standing
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 with a licensed physician 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.
Key requirements for collaborative agreements include:
- Written protocols for consultation and referral
- Methods for treatment plan development
- Scope of practice delineation
- Geographic practice area
- Methods for review of services provided
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 with 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 no renewal forms or fees exist to maintain APRN certification, all APRNs must renew their Missouri RN license by April 30th of odd-numbered years.
Salaries for Certified Nurse-Midwives in Missouri
Certified nurse-midwives in Missouri earned an average salary of $114,140 as of 2023, according to the U.S. Bureau of Labor Statistics (BLS). Experienced nurse midwives whose salaries fell within the top 90th percentile earned an average of $153,730 in 2023, while their colleagues just starting out and earning within the 10th percentile averaged $87,580 that year.
The number of certified nurse-midwives’ jobs is expected to grow dramatically nationwide, and Missouri is no exception. In fact, the U.S. Department of Labor projects a nearly 18% growth in jobs from 2023 to 2033 for nurse-midwives.
How CNMs are Compensating for the Shortage of Physicians in Missouri
As of 2024, there were approximately 150 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, often with an even greater level of patient satisfaction. A recent analysis of Medicaid recipients in the state shows a shift towards a preference for nurse-midwifery among pregnant women.
In 2023, approximately 8.5% of births in Missouri were attended by midwives, according to the U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, and the National Center for Health Statistics.
An increase in the number of certified nurse-midwives would help ameliorate the obstetric services shortage 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 travel radius.
Salaries for Nurse Midwives in Saint Louis & Kansas City
The U.S. Bureau of Labor Statistics provides a full analysis of salaries for nurse midwives in the St. Louis and Kansas City metropolitan areas as of 2023. See the breakdown below:
| Metropolitan Area | 10th Percentile | Mean Salary | 90th Percentile |
|---|---|---|---|
| Kansas City, Mo. | $76,720 | $111,420 | $152,420 |
| St. Louis, Mo. | $80,430 | $102,440 | $140,200 |
(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.)
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 typically take 2-3 years, ADN to MSN bridge programs take 3-4 years, and post-graduate certificates for nurses with existing master’s degrees take 18-24 months. This is in addition to the time needed to pass certification exams and complete the APRN licensing process.
Can CNMs practice independently in Missouri?
No, Missouri requires all APRNs, including CNMs, to maintain collaborative practice agreements with licensed physicians. However, within these agreements, CNMs have significant autonomy in providing care and full prescriptive authority under the physician’s DEA number.
What’s the difference between a CNM and a direct-entry midwife in Missouri?
CNMs are advanced practice registered nurses with graduate-level education who can practice in hospitals and birth centers with prescriptive authority. Direct-entry midwives follow a different certification pathway through NARM and typically attend home births, with a more limited scope of practice.
Are there online CNM programs available for Missouri residents?
Yes, several ACME-accredited programs offer online or hybrid formats for the didactic portion of CNM education. However, all programs require in-person clinical rotations of 700-1,000 hours, which can often be arranged at facilities near your location in Missouri.
What are the job prospects for new CNM graduates in Missouri?
Excellent. With 109 of Missouri’s 114 counties designated as Healthcare Professional Shortage Areas and projected 18% job growth through 2033, new CNM graduates typically receive multiple job offers, especially those willing to work in underserved areas.
Is financial aid available for CNM programs?
Yes, multiple options exist, including federal student loans, HRSA Nurse Corps Scholarship Program (offering full tuition plus stipend in exchange for service commitment), state workforce development grants, and employer tuition assistance programs. Many hospitals offer loan forgiveness programs for CNMs who commit to multi-year employment.