Certified nurse midwives are found working in diverse settings where they provide primary healthcare services for women, gynecologic care, and prenatal, intrapartum, and postpartum care. According to the American College of Nurse-Midwives (ACNM), patients of nurse-midwives have reported lower healthcare costs due to fewer instances of invasive procedures and labor induction, as well as lower rates of cesarean birth. The ACNM has also documented that midwife care is associated with a lower infant mortality rate when compared to equally low risk deliveries taking place under the care of a physician.
New Hampshire’s certified nurse-midwives are recognized as advanced practice registered nurses (APRNs) who provide well-woman gynecological care, as well as antepartum, intrapartum and postpartum care in the state’s 14 state hospitals, four licensed free standing birthing centers, as well as the many OB/GYN physician practices and women’s clinics found throughout the state. New Hampshire is one of 22 states that allow CNMs and other advanced practice nurses to diagnose and treat patients to the full extent of their training without the need to maintain a collaborative agreement with a physician. This gives New Hampshire’s CNMs the freedom to pursue independent practice and a wider range of employment options.
The 40 certified nurse-midwives who were practicing in New Hampshire in 2014 earned an average annual salary of $111,700, which is 13% higher than the national average for CNMs according to the U.S. Bureau of Labor Statistics (BLS). In fact, in 2014 the BLS identified New Hampshire as the fifth highest paying state in the nation for nurse-midwives.
Steps to Becoming a Nurse-Midwife in New Hampshire
In order to begin practicing as a nurse midwife in New Hampshire, registered nurses must gain their CNM certification through the American Midwifery Certification Board and apply for advanced practice licensure through the New Hampshire Board of Nursing (NHBON).
RNs are encouraged to follow the steps in this guide to learn how to become a certified nurse-midwife in New Hampshire:
Step 1. Earn a Master’s Degree in Nurse Midwifery
In order to earn CNM certification through the American Midwifery Certification Board and go on to be licensed as an advanced practice registered nurse (APRN) in New Hampshire, all CNM candidates must earn a master’s or higher degree from a program accredited by the Accreditation Commission for Midwifery Education (ACME).
Bachelor’s prepared RNs may apply directly for Master’s of Science in nursing programs, while accredited RN-to-MSN programs in nurse-midwifery are available to RNs that hold an associate’s degree in nursing.
MSN programs vary in requirements, but all programs are made up of at least 40-60 hours of traditional coursework and 700-1000 clock hours of clinical practicums.
There are 39 nurse-midwifery programs accredited by ACME throughout the country, including 6 fully online options and 17 hybrid programs (hybrid programs involve online coursework as well as intensive on-campus courses for one-two weeks a semester). Both fully online and hybrid programs allow students to complete required clinical hours in hospitals and private practices that are located in New Hampshire and the surrounding states.
As traditional campus schooling options are not a reality for many working RNs, online programs are generally preferred for those seeking CNM certification.
In order to be accepted into these programs, most ACME accredited schools require:
- A BSN
- RN license and minimum one year practicing experience
- Minimum GPA
- Personal statement
- Letters of recommendation from previous instructors
Dual focus Nurse Midwife/Women’s Health Nurse Practitioner (NM/WHNP) master’s programs have become popular among aspiring nurse-midwives as they allow graduates the option of becoming dually credentialed as both certified nurse-midwives (CNM) and Women’s Health Nurse Practitioners (WHNP) if they so choose.
Nurse-midwife MSN programs often include the following courses:
- Theoretical Concepts for Advanced Practice Nursing
- Advanced Human Pathophysiology
- Health Informatics and Innovations in Technology
- Advanced Pharmacology and Therapeutics
- Nurse-Midwifery Care During Labor and Birth
- Advanced Health Assessment
Women’s Health Practitioner programs often include the following courses:
- Well Woman Health Care
- The Childbearing Family
- Primary Care for Women
- Women’s Health Issues
- Advanced Health Assessment
Both CNM and NM/WHNP programs involve a clinical sequence of between 700 and 1000 hours designed to give students exposure to working with patients at all stages of pregnancy. Online programs partner with local hospitals, physician’s clinics, and freestanding birth centers in New Hampshire so as to allow graduate students easy access to clinical locations.
Step 2. Register for and Pass the Nurse-Midwifery National Certification Examination
With a master’s degree or higher in nurse-midwifery from an accredited school, CNM candidates are eligible to sit for the Certification Examination in Nurse Midwifery. RNs who have completed a dual focus program with an emphasis in women’s health are also eligible to also sit for the Women’s Health Nurse Practitioner Exam if they so choose. Either one or both exams qualify candidates to apply for licensure through the New Hampshire Board of Nursing.
Candidates would apply for either one or both exams directly through Applied Measurement Professionals (AMP) and will receive a date and time to take the exam at one of four testing locations in New Hampshire (Concord, Manchester, Nashua, and Portsmouth).
Certification Examination in Nurse Midwifery
Those that pass the American Midwife Certification Board’s Certification Examination in Midwifery receive the Certified Nurse Midwife (CNM) credential. Exam candidates must sit for the exam within 24 months of completing a master’s program in nurse-midwifery.
The AMCB has published a candidate handbook is intended to prepare candidates for the exam, including an outline of questions covered. The test is four hours long, administered on a computer, and is divided into six components:
- Antepartum- 19%-26%
- Intrapartum- 17%-26%
- Postpartum- 15%-18%
- Newborn- 7%-16%
- Well Woman/Gynecology- 15%-18%
- Women’s Health/Primary Care- 8%-16%
Applicants can apply online or send a hard copy application directly to the following address:
American Midwifery Certification Board (AMCB)
849 International Drive, Suite 120
Linthicum, Maryland 21090
With the application, candidates must include:
- A $500.00 examination fee
- A copy of the candidates’ RN certification
- A signed letter from the program director confirming completion of midwife program
Candidates can schedule a test date and time through AMP online.
Women’s Health Care Nurse Practitioner Examination
RNs that complete dual-focus Nurse Midwife/Women’s Health Nurse Practitioner master’s programs may additionally take the Women’s Health Care Nurse Practitioner Exam.
Students must apply online through the National Certification Corporation and pay an examination fee of $325 at the time of registration. The NCC publishes a candidate guide that includes sample questions and scoring information. The test is three hours long, administered on a computer, and divided into five categories of questions:
- Gynecology- 35%-40%
- Obestrics- 25%-35%
- Primary Care- 10%-15%
- Diagnostic testing and physical assessment- 10%-15%
- Pharmacology- 5%-10%
Candidates can schedule a test date and time through AMP online.
Step 3. Apply for an APRN License through the New Hampshire Board of Nursing
After passing the required certification exams, candidates would then apply for advanced practice licensure as certified nurse midwives through the New Hampshire Board of Nursing.
The New Hampshire RN Board recognizes both CNM and WHNP certification as pathways to APRN licensure, as long as the candidate has completed over 225 hours of theoretical nursing content and 480 hours of clinical nursing practice, including precepted experience and pharmacological interventions.
Candidates must print the APRN application and mail it to the state board along with:
- Final, official transcript from an ACME approved CNM program
- $100 license fee in check or money order
- $49.75 fee for state background check
Mail the application and supporting documents and fees to:
State of New Hampshire
New Hampshire Board of Nursing
121 S. Fruit St.
Concord NH 03301
Step 4. Start Practicing as a Certified Nurse Midwife and Keep Credentials Current
Certified nurse midwives are qualified to begin practice in the state after receiving notification of APRN licensure in the mail from the New Hampshire Board of Nursing.
CNM and WHNP certifications must be maintained on a regular cycle. The New Hampshire APRN license is automatically renewed upon the regular renewal of approved certifications such as CNM and WHNP.
CNM Certification Maintenance – AMCB
CNM certificates are maintained through online modules provided by the AMCB.
Three modules must be completed every five years. Continuing education modules are made up of online exams as well as twenty contact hours per module. Contact hours offered in the form of continuing education units are accepted in the form of seminars, classes, and conferences offered by the following organizations:
- ACNM (American College of Nurse Midwives)
- ACCME (Accreditation Council for Continuing Medical Education)
- AMA (American Medical Association)
- AAFP (American Academy of Family Physicians)
- AANP (American Academy of Nurse Practitioners)
- NPWH (National Association of Nurse Practitioners in Women’s Health)
- ACPE (Accreditation Council for Pharmacy Education)
To fulfill continuing education requirements, CNMs will create a portal on the AMCB website and pay a yearly maintenance fee of $55.
In New Hampshire, if the CNM certification expires, the APRN license is no longer recognized by the state.
WHNP Certification Maintenance – NCC
The WHNP certification requires renewal every three years. The National Certification Corporation offers continuing education in the following topics:
- Maternal newborn
- Women’s health care
- High risk neonatal
- Electronic fetal monitoring and assessment.
For a fee of $100, WHNP certificate holders can create a continuing education plan through the NCC. The plan will allow nurses to track their progress in completing continuing education units, which can vary individually based on the plan.
In New Hampshire, if the WHNP certification expires, the APRN license is no longer recognized by the state.
Exploring Career Opportunities in New Hampshire
As APRNs, nurse-midwives are licensed to practice within hospitals, physician’s clinics, and independent birth and women’s wellness centers, as well as to run independent practices.
A few of New Hampshire’s top employers of CNMs include:
- Women’s Health at Memorial Hospital (North Conway, NH)
- Concord Hospital (Concord, NH)
- Birth Cottage of Milford (Milford, NH)
- Monadnock Birth Center (Swanzey, NH)
The following are examples of positions that were available in New Hampshire as of 2015 (shown as examples only; not meant to imply the availability of jobs or the assurance of employment):
- Certified Nurse Midwife at Catholic Medical Center (Manchester, NH)
- Certified Nurse Midwife at Cheshire Medical Center (Keene, NH)
- Certified Nurse Midwife at Dartmouth-Hitchcock Manchester (Manchester, NH)
Salaries for Certified Nurse-Midwives in New Hampshire
Nurse midwives in New Hampshire enjoyed the fifth highest average salary in the country in 2014 according to the US Bureau of Labor Statistics. Certified nurse-midwives in New Hampshire earned an average salary of $113,984 as of 2015 according to the state’s Economic & Labor Market Information Bureau. Those with the most experience earned an average of $128,024 a year, while those just entering the workforce in 2014 earned an average of $85,046.
The Number of Nurse Midwives is Dramatically Increasing in New Hampshire
The New Hampshire Economic & Labor Market Information Bureau expects the number of jobs for certified nurse midwives in the state to increase by 29.8% between 2012 and 2022. Currently, the number of nurse midwives in New Hampshire is increasing even faster than predicted.
The Bureau reported that 47 certified nurse-midwives practiced in New Hampshire in 2012, while 103 CNMs worked in the state in 2014 according to the American Association of Colleges of Nursing. On a population basis, New Hampshire has one of the highest densities of nurse midwives in the country.
Top Employment Settings and Employers of CNMs in New Hampshire
Most of New Hampshire’s nurse midwives worked in ambulatory health care services such as physician’s offices and other types of clinics in 2012 according to the state’s Economic & Labor Market Information Bureau. Only 8.5% of New Hampshire’s nurse midwives worked in hospitals that year.
New Hampshire has an unusually high number of birth centers for a state of its size. Most of these birth centers employ certified nurse-midwives. Five birth centers were located in New Hampshire as of 2015:
- The Birth Cottage – Milford
- Concord Birth and Wellness Center – Concord
- The Monadnock Birth Center – Swanzey
- Coastal Family Birth Retreat – Stratham
- The Birth Place at Southern New Hampshire Medical Center – Nashua
As of November 2015, four jobs were advertised for certified nurse-midwives in New Hampshire. The list shown below is for informational purposes only and does not provide a guarantee of employment:
- Manchester – Catholic Medical Center
- Manchester – Dartmouth-Hitchcock OB/GYN and Midwifery
- Keene – Dartmouth-Hitchcock Keene at Cheshire Medical Center
- Salem – part-time CNM for an independent practice