Last Updated: 2025-2026 | Reviewed by Abbie Jacobs
According to the North Carolina Affiliate of the American College of Nurse-Midwives (NCACNM), certified nurse-midwives (CNMs) have been licensed and practicing in North Carolina for over 35 years. These advanced practice registered nurses (APRNs), educated and skilled in advanced practice nursing and midwifery, provide safe, individualized, minimally invasive care to women and their families.
This care encompasses not only care for the childbearing woman but also comprehensive care for women from adolescence to menopause and beyond. CNMs are master’s-prepared, nationally certified, and state-registered (licensed) advanced practice registered nurses (APRNs) who practice in hospital obstetric centers and less conventional settings like birth centers, women’s clinics, and clients’ homes.
The NCACNM believes that the high-quality care CNMs deliver is essential to improving the health of North Carolina’s women and babies. Recent studies have demonstrated that midwifery care is associated with fewer interventions, lower cesarean section rates, and higher patient satisfaction scores compared to traditional obstetric care.
According to the U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, and the National Center for Health Statistics, as of 2024, approximately 15.2% of births in North Carolina were attended by midwives. This represents a notable increase from previous years and demonstrates the growing importance of nurse-midwives in North Carolina’s maternal healthcare landscape.
2024-2025 Regulatory Update: In October 2024, North Carolina implemented permanent rules establishing independent practice authority for experienced CNMs. This landmark change, following decades of mandatory physician supervision, allows CNMs with at least 24 months and 4,000 hours of practice experience to practice independently without a collaborating provider. Despite this progress, North Carolina continues to face significant workforce challenges, with 41 of 100 counties lacking any CNM presence and the state earning a D+ grade from the March of Dimes 2025 maternal health report card.
Interested in becoming a Certified Nurse-Midwife in North Carolina? Here’s everything RNs need to know to start a rewarding CNM career in the state.
Steps to Becoming a Certified Nurse-Midwife in North Carolina
North Carolina RNs with licenses in good standing may become certified nurse-midwives (CNM) by meeting all requirements for registration set forth by the North Carolina Board of Nursing Midwifery Joint Committee:
Step 1. Earn a Qualifying Master’s Degree in Nurse Midwifery
To qualify for APRN licensure as a CNM in North Carolina, would-be nurse-midwives must earn a master’s or higher degree in nurse-midwifery. North Carolina’s Midwifery Joint Committee only recognizes graduate programs accredited by the American Commission for Midwifery Education (ACME).
2025-2026 Update: North Carolina is home to one ACME-accredited nurse-midwifery program at East Carolina University in Greenville. ECU’s program holds continued accreditation through July 31, 2026, with its next scheduled ACME review that month. No new ACME-accredited programs have opened in North Carolina since 2024, and no programs have lost accreditation. ECU remains the only ACME-accredited nurse-midwifery program in both North and South Carolina.
Many of today’s accredited nurse-midwifery programs are offered partially or fully online, with clinical requirements satisfied through local facilities in North Carolina. This allows North Carolina residents to pursue degrees from nationally recognized programs while completing their clinical rotations at sites close to home.
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 |
Dual Focus Master’s Degrees in Nurse-Midwifery/Women’s Health
Several schools offer dual specialization nurse-midwifery degrees, such as the nurse-midwifery/women’s health nurse practitioner program. This program offers students a more comprehensive course of study, providing an opportunity to earn dual certification as a certified nurse-midwife (CNM credential) and a board-certified women’s health nurse practitioner (WHNP-BC credential).
The nurse-midwifery/women’s health nurse practitioner dual focus degree remains a popular dual specialty, given the similar patient population focus of these two APRN specialties and the many overlapping skills. According to recent North Carolina workforce data, CNMs with dual certification as WHNPs have expanded practice opportunities and often command higher salaries due to their broader scope of practice.
Graduates of dual-focus nurse-midwife/women’s health nurse practitioner programs are skilled in treating women with acute and chronic conditions and providing care to women across the lifespan (including their childbearing years).
Admission Requirements
Admission into an ACME-accredited nurse-midwifery program generally requires:
- An unencumbered RN license
- A Bachelor of Science (BSN) from an accredited college or university
- A minimum undergraduate GPA (typically 3.0 or higher)
- A minimum GRE score (some programs are now waiving this requirement)
- Letters of recommendation
- Clinical experience (many programs prefer 1-2 years in labor & delivery or women’s health)
- Personal statement or essay
- Interview
Program Structure and Design
Most MSN degree programs are two years in length, with part-time programs typically lasting approximately three years. Students pursuing a career as a Certified Nurse-Midwife in North Carolina can expect their program to include a competency-based curriculum that focuses on both didactic and clinical components.
Didactic Coursework
The coursework requirements consist of a core in:
- Research
- Leadership
- Advanced health assessment
- Advanced pharmacology
- Advanced pathophysiology
Just a few of the courses specific to the study of nurse-midwifery include:
- Primary care of women
- Antepartum care
- Intrapartum care
- Postpartum care and care of the newborn
- Well-woman gynecology
- Advanced nurse-midwifery role development
Clinical Rotations
The clinical requirements of an MSN in nurse-midwifery, which typically range between 600 and 1,000 hours, allow students to complement their didactic studies with real-world experiences in various settings under the guidance and supervision of CNMs and other healthcare providers.
While students ordinarily complete their clinical requirements at sites close to the program’s campus, online programs often allow students to complete their clinical requirements at sites close to home.
In North Carolina, nurse-midwife students may complete clinical requirements at facilities such as:
| Region | Clinical Sites |
|---|---|
| Triangle Area | • NC Women’s Hospital, Chapel Hill – UNC OB/GYN at Timberlyne, Chapel Hill – Duke Regional Hospital, Durham – UNC REX Healthcare, Raleigh – North Carolina Birth Center, Chapel Hill – Haven Women’s Health & Birth Center, Cary – Aya Birth & Community Wellness, Durham |
| Triad Area | • Women’s Hospital, Greensboro – Center for Women’s Healthcare at Kernersville – Novant Health, Winston-Salem – Cone Health, Greensboro |
| Eastern NC | • Vidant Medical Center, Greenville – Physicians East PA, Greenville – New Hanover Regional Hospital, Wilmington – Coastal OB/GYN Specialists & Midwifery, Wilmington |
| Western NC | • Mission Hospital, Asheville – New Dawn Midwifery, Asheville – Carolinas HealthCare System, Charlotte – Summit Crossing Midwifery, Gastonia |
2024 Update: Three new birth centers opened in the Triangle area during 2024, expanding clinical placement opportunities for nursing students. North Carolina Birth Center in Chapel Hill achieved CABC accreditation in March 2025, Haven Women’s Health & Birth Center opened in Cary, and Aya Birth & Community Wellness became North Carolina’s first Black-owned birth and wellness center in Durham.
Step 2. Take and Pass the National Nurse-Midwife Certification Examination
Graduates of MSN programs in nurse-midwifery in North Carolina must take and pass the American Midwifery Certification Board’s CNM certification examination.
CNM Exam Components
| Domain | Percentage of Exam |
|---|---|
| Antepartum | 19-26% |
| Intrapartum | 17-26% |
| Postpartum | 15-18% |
| Newborn | 7-16% |
| Well-Woman/Gynecologic | 15-18% |
| Women’s Health/Primary Care | 8-16% |
The CNM certification exam consists of 175 multiple-choice questions. The examination fee is $500 (as of 2025), and most candidates receive unofficial results immediately upon completion.
Testing Locations in North Carolina
Students must take the exam at one of the Prometric testing centers after applying for—and receiving—approval to test through the American Midwifery Certification Board.
| Region | Testing Center Locations |
|---|---|
| Western NC | Asheville, Charlotte, Gastonia |
| Central NC | Greensboro, Winston-Salem, Durham, Raleigh |
| Eastern NC | Fayetteville, Greenville, Wilmington |
Note: Graduates of a dual specialization degree in nurse-midwifery/women’s health can take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation, if desired. Candidates must apply for the exam, receive approval, and schedule the exam at one of the testing centers located in North Carolina or throughout the United States.
Step 3. Apply for APRN Registration as a Nurse-Midwife with the North Carolina Board of Nursing
Upon achieving the CNM designation, candidates for APRN registration as a nurse-midwife in North Carolina must complete the Registration and Initial Approval to Practice applications through the NC Board of Nursing. Note: Paper applications are no longer accepted. The cost of initial registration is $100.
October 2024 Regulatory Update: North Carolina implemented permanent rules (21 NCAC Chapter 33) effective October 1, 2024, codifying the landmark changes established by Session Law 2023-14 (Care for Women, Children, and Families Act). This ended 40 years of mandatory physician supervision under the 1983 Midwifery Practice Act.
Application Requirements
The registration process requires applicants to provide:
- Proof of graduation from an accredited nurse-midwifery program (official transcripts)
- Verification of current CNM certification (sent directly from AMCB)
- Documentation of practice experience OR identification of collaborating provider (see below)
- Documentation of the sites where they intend to practice midwifery
- Application fee ($100)
Independent Practice vs. Collaborative Practice Requirements
North Carolina now offers two practice pathways depending on experience level:
Independent Practice Eligible: CNMs with at least 24 months AND 4,000 hours of practice experience may practice without a collaborating provider. This threshold remains unchanged since its establishment in 2023.
Collaborative Practice Required: CNMs below the experience threshold must maintain a written collaborative practice agreement with either:
- A physician with 4+ years (8,000+ hours) of obstetric experience, OR
- An experienced CNM with 4+ years (8,000+ hours) of practice
The collaborative practice agreement must specify:
- The scope of the CNM’s practice
- Arrangements for consultation and referral
- Methods for reviewing and approving care provided
- Prescriptive authority parameters (if applicable)
90-Day Transition Provision: If a collaborative agreement terminates, CNMs have 90 days to secure a new agreement while continuing to practice. CNMs must notify the Board and pay a $100 fee when their collaborative arrangement changes or they add an arrangement.
Prescriptive Authority
A Certified Nurse-Midwife in North Carolina may obtain prescriptive authority as part of their APRN registration, including the ability to prescribe controlled substances (Schedules II-V). Under the current rules (21 NCAC 33 .0117):
- CNMs may prescribe medications, including controlled substances
- CNMs may order diagnostic tests and medical devices
- CNMs may implement treatments within their scope of practice
- CNMs under collaborative agreements must have drug authority specified in their agreement
CNMs with prescriptive authority must obtain a DEA registration to prescribe controlled substances. Continuing education requirements mandate AMCB Certificate Maintenance Program compliance plus a minimum of 1 CE hour annually on controlled substance topics before prescribing.
Pending Legislation: H514/S537 (APRN Definitions/SAVE Act), introduced March 25, 2025, would further expand APRN authority by eliminating the Joint Subcommittee and granting the NC Board of Nursing direct authority for APRN prescribing privileges. This represents the sixth consecutive session this full-practice-authority bill has been filed.
Step 4. Explore Career Opportunities as a Certified Nurse-Midwife in North Carolina
As a Certified Nurse-Midwife in North Carolina, you’ll have access to diverse professional settings ranging from hospitals to birthing centers and private practice.
2025 Workforce Update: According to the NC Health Professions Data System (UNC Sheps Center, October 2023 data), North Carolina employs 391 CNMs in active practice—a remarkable 49% increase from 262 in 2013. However, significant geographic disparities persist: 41 of 100 counties have no CNMs, and only 13% of CNMs practice in rural areas (down from 17% in 2013). Twenty counties qualify as maternity care deserts with no hospitals providing OB services, no birth centers, and no OB/GYNs or CNMs.
Practice Settings
| Practice Setting | Percentage of NC CNMs | Description |
|---|---|---|
| Hospital-Based | 65% | Employment within hospital systems, attending births, and providing full-scope midwifery care |
| Private Practice | 20% | Collaborative practice with physicians in OB/GYN offices |
| Birth Centers | 10% | Practice in freestanding birth centers focusing on low-intervention births |
| Other Settings | 5% | Academic positions, home birth practices, public health departments, etc. |
Major Healthcare Systems Actively Recruiting CNMs
Potential employers of CNMs in North Carolina include:
- Atrium Health (Charlotte-based, part of Advocate Health)
- Charlotte Women’s Care hospitalist positions
- Concord Northeast OB/GYN
- Atrium Health Wake Forest Baptist, Winston-Salem
- Duke Health
- Duke University Hospital, Durham
- Duke Regional Hospital, Durham
- Duke Birthing Center
- Central Carolina Hospital (Duke Lifepoint), Sanford
- UNC Health System (expanded from 5 to 12+ nurse-midwives at UNC Hospitals, Chapel Hill)
- UNC Health Care, Chapel Hill
- Women’s Birth and Wellness Center, Chapel Hill
- UNC REX Healthcare, Raleigh (7 CNMs)
- Rex Holly Springs
- UNC Health Southeastern, Lumberton (6 midwives)
- UNC Health Goldsboro
- Novant Health (currently employs 15+ nurse-midwives with plans to double the midwife team within five years)
- Novant Health, Winston-Salem
- Bradford OB/GYN Matthews
- Harbor Pointe OB/GYN, Mooresville/Huntersville
- WakeMed Health (employs 7 nurse-midwives)
- WakeMed Health & Hospitals, Raleigh
- WakeMed Physician Practices, Cary
- Triad Area
- Cone Health, Greensboro
- Atrium Health, Charlotte
- Charlotte OB/GYN, Charlotte
- Eastern NC
- New Hanover Regional Hospital, Betty H. Cameron Women’s and Children’s Hospital, Wilmington
- Coastal OB/GYN Specialists & Midwifery, Wilmington
- ECU Health (formerly Vidant Health), Greenville
- Western NC
- Summit Crossing Midwifery, Gastonia
- New Dawn Midwifery, Asheville
- Mission Health, Asheville
Birth Centers in North Carolina
2024 Update: Three new birth centers opened in the Triangle area during 2024:
- North Carolina Birth Center (Chapel Hill) – Opened 2024, achieved CABC accreditation in March 2025. Features 4 suites with birth tubs, TENS units, and nitrous oxide.
- Haven Women’s Health & Birth Center (Cary) – Founded 2024, features birth suites with tubs and walk-in showers.
- Aya Birth & Community Wellness (Durham) – North Carolina’s first Black-owned birth and wellness center. Currently operating an Open Access Maternity Clinic with birth center deliveries planned for future phases.
- Natural Beginnings Birthing and Women’s Wellness Center (Statesville) – The state’s oldest operating birth center.
CNMs in North Carolina may also find many opportunities to advance their careers and network with others in the nurse-midwifery field by becoming members of professional associations:
- Midwives of North Carolina: North Carolina Affiliate of the American College of Nurse-Midwives
- North Carolina Friends of Midwives
- North Carolina Nurses Association
Important Note on Practice Experience Requirements: Remember that North Carolina requires at least 24 months and 4,000 hours of practice experience as a CNM for independent practice. New CNMs with less experience will need to practice under a collaborative practice agreement with a designated collaborating provider until they meet this threshold. This requirement ensures patient safety while allowing new CNMs to gain valuable experience.
Step 5. Salary Information for Certified Nurse-Midwives in North Carolina
Certified nurse-midwives in North Carolina earn competitive salaries that reflect their advanced education and specialized expertise. According to the most recent data from the U.S. Bureau of Labor Statistics (May 2024), CNMs in North Carolina demonstrate strong earning potential across all experience levels and geographic regions.
2024-2025 Salary Update: Multiple sources indicate North Carolina CNM salaries remain below national averages. BLS data (May 2023) reports a mean salary of $118,660, while more recent industry data from December 2025 shows averages around $106,899. North Carolina CNMs earn approximately 9-18% below the national mean of $129,650, ranking among the lowest-paying states for this profession.
Statewide Salary Overview
| Percentile | Annual Salary | Hourly Wage |
|---|---|---|
| 10th Percentile | $94,310 | $45.34 |
| 25th Percentile | $110,590 | $53.17 |
| Median (50th Percentile) | $121,490 | $58.41 |
| 75th Percentile | $135,420 | $65.11 |
| 90th Percentile | $143,100 | $68.80 |
| Mean Annual Wage | $120,060 | $57.72 |
North Carolina employs approximately 391 certified nurse-midwives (based on 2023 workforce data), representing approximately 0.071 jobs per 1,000 total employment positions statewide. This employment concentration places North Carolina at 1.3 times the national average for CNM employment density.
Metropolitan Area Salary Variations
| Metropolitan Area | Salary Range (2025) | Notes |
|---|---|---|
| Charlotte-Concord-Gastonia, NC-SC | $113,540 – $121,400 | Highest compensation in NC, approximately 10% above the state average |
| Cary, NC | $118,911 | 12.1% above state average |
| Raleigh-Cary, NC | $110,436 – $120,720 | Compensation closely aligned with the statewide mean |
| Chapel Hill, NC | ~$100,710 | Below the state average despite academic medical center presence |
| Rural Western NC | ~$102,600 | Lower base pay, but loan forgiveness opportunities available |
The Charlotte-Concord-Gastonia metropolitan area offers the highest compensation for CNMs in North Carolina. The Raleigh-Cary area provides competitive wages in a major metropolitan market with strong growth in healthcare employment.
Career Advancement and Compensation Factors
Several factors significantly influence CNM compensation in North Carolina:
| Factor | Impact on Compensation |
|---|---|
| Practice Setting | Hospital-employed CNMs typically earn 8-12% more than birth center or private practice positions |
| Experience Level | CNMs with 5+ years of experience average $15,000-$20,000 more annually than new graduates |
| Dual Certification | CNM/WHNP dual certification adds approximately $8,000-$12,000 to base salary |
| Geographic Location | Urban areas offer higher base pay; rural areas provide loan forgiveness opportunities |
| Educational Level | DNP-prepared CNMs earn 5-8% more than MSN-prepared colleagues |
| Independent Practice Authority | October 2024 implementation may increase compensation as CNMs gain autonomy |
Employment Outlook and Growth Projections
The employment outlook for certified nurse-midwives in North Carolina remains positive despite challenges. The U.S. Department of Labor projects 35-40% national growth for APRNs from 2024-2034, though CNM-specific growth is projected at 7%. North Carolina anticipates approximately 18 annual CNM openings with 1.4% yearly growth.
North Carolina’s healthcare expansion initiatives and increasing recognition of midwifery care’s benefits position the state for continued growth opportunities. However, 41 counties still lack any CNM presence, and North Carolina received a D+ grade from the March of Dimes 2025 Report Card on maternal/infant health—unchanged from 2024.
Rural areas of North Carolina face particular challenges in obstetric care access, with 31 counties lacking obstetrician-gynecologists. This shortage creates substantial opportunities for CNMs to improve healthcare access while building rewarding careers in underserved communities through loan forgiveness programs.
Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2024. Additional data from Salary.com (December 2025) and ZipRecruiter (January 2026). Workforce data from NC Health Professions Data System (UNC Sheps Center, October 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 January 2026.
Frequently Asked Questions About Becoming a Certified Nurse-Midwife in North Carolina
How long does it take to become a certified nurse-midwife in North Carolina?
Becoming a CNM in North Carolina typically takes 6-8 years total, including:
- 2-4 years for a BSN degree
- 1-2 years recommended clinical experience
- 2-3 years for graduate nurse-midwifery education
- 1-3 months for certification and licensure processes
- 24 months/4,000 hours of practice experience as a CNM (for independent practice authority)
North Carolina’s requirement for 24 months and 4,000 hours of practice experience is an important distinction for achieving full independent practice authority. New CNMs can practice immediately under collaborative agreements while accumulating this experience.
What is the scope of practice for CNMs in North Carolina?
In North Carolina, certified nurse-midwives are authorized to provide the following services:
- Comprehensive pregnancy care (preconception through postpartum)
- Management of normal labor and delivery
- Gynecological care throughout the lifespan
- Primary care for women
- Newborn care for the first 28 days of life
- Prescription of medications, including controlled substances (Schedules II-V)
- Ordering of diagnostic tests and medical devices
October 2024 Update: Under permanent rules effective October 1, 2024, experienced CNMs (24+ months/4,000+ hours) may practice independently without physician oversight. Less experienced CNMs practice under collaborative agreements with specific practice parameters defined by their collaborating provider.
Are there any ACME-accredited nurse-midwifery programs in North Carolina?
2025-2026 Update: Yes, East Carolina University in Greenville offers the only ACME-accredited nurse-midwifery program in North Carolina. ECU’s program holds continued accreditation through July 31, 2026, and offers both a Master of Science in Nursing (MSN) with a concentration in nurse-midwifery and a post-graduate certificate option for nurses already holding an MSN.
No new ACME-accredited programs have opened in North Carolina since 2024, and ECU remains the sole ACME-accredited program in both North and South Carolina. Additionally, many nationally recognized online and hybrid programs accept North Carolina residents and help arrange clinical placements throughout the state at facilities like UNC Health, Duke Health, Atrium Health, Novant Health, and the new birth centers opened in 2024.
Can CNMs in North Carolina prescribe medications?
Yes, CNMs in North Carolina have full prescriptive authority, including the ability to prescribe controlled substances (Schedules II-V). Under rules codified in October 2024 (21 NCAC 33 .0117):
- Independent CNMs may prescribe all medications within their scope of practice
- CNMs under collaborative agreements must have drug authority specified in their written agreement
- All CNMs prescribing controlled substances must obtain a DEA registration
- Continuing education requirement: minimum 1 CE hour annually on controlled substances
This prescriptive authority is part of the APRN registration process through the North Carolina Board of Nursing Midwifery Joint Committee.
Do I need labor and delivery experience before applying to NC midwifery programs?
What settings do nurse-midwives typically work in throughout North Carolina?
2025 Update: North Carolina nurse-midwives work in diverse settings:
- Hospital-Based Practices (65% of NC CNMs): Working within hospital systems like UNC Health (12+ midwives at Chapel Hill), Duke Health, Atrium Health, Novant Health (15+ midwives), and WakeMed (7 midwives).
- Private Practices (20%): Collaborating with physicians in OB/GYN and family practice settings throughout the state.
- Birth Centers (10%): Providing care in freestanding birth centers, including three new centers opened in 2024: North Carolina Birth Center (Chapel Hill), Haven Women’s Health & Birth Center (Cary), and Aya Birth & Community Wellness (Durham—NC’s first Black-owned birth center).
- Other Settings (5%): Academic positions, public health departments, and home birth practices.
Home birth attendance by CNMs in North Carolina is legal when practicing within the parameters of their collaborative practice agreement (for those requiring one) or independently for experienced CNMs, though relatively few CNMs choose this practice setting due to insurance and liability considerations.
Are there loan forgiveness programs available for nurse-midwives in North Carolina?
Yes, several loan forgiveness programs are available for nurse-midwives practicing in North Carolina:
- National Health Service Corps Loan Repayment Program: Up to $50,000 for a two-year commitment at an approved Health Professional Shortage Area site.
- North Carolina Loan Repayment Program (NCLRP): This program provides up to $100,000 for a four-year service commitment in rural and underserved areas of the state.
- Public Service Loan Forgiveness (PSLF): For CNMs employed by qualifying non-profit organizations or government agencies.
- Nurse Corps Loan Repayment Program: Up to 85% of educational loans for work in Critical Shortage Facilities or eligible nursing schools.
These programs are particularly valuable given that 41 of North Carolina’s 100 counties currently have no CNMs, and 20 counties qualify as maternity care deserts.
What’s the typical patient load for a full-time CNM in North Carolina?
Patient loads vary by practice setting. In North Carolina:
- Hospital-based CNMs typically manage 8-12 monthly births plus 60-80 prenatal and gynecologic visits.
- Birth center midwives usually have lower birth volumes (4-8 monthly) but provide more comprehensive care throughout pregnancy and postpartum.
- Private practice CNMs in collaborative settings typically average 10-15 births per month, with varying numbers of office visits.
- Academic medical centers often have midwives attend 12-18 births monthly due to higher patient volumes and teaching responsibilities.
Call schedules vary widely, with some practices using 24-hour shifts, others using 12-hour shifts, and some implementing home-call systems.
How has the October 2024 independent practice rule affected CNM employment in North Carolina?
The October 2024 implementation of permanent independent practice rules represents a historic shift for North Carolina CNMs. Key impacts include:
- CNMs with 24+ months/4,000+ hours can now practice without physician oversight
- New CNMs continue to practice under collaborative agreements while gaining experience
- Healthcare systems are actively expanding CNM teams: Novant Health plans to double its midwife team, and UNC Health expanded from 5 to 12+ midwives
- Three new birth centers opened in 2024, creating additional employment opportunities
- Pending H514/S537 legislation could further expand APRN authority if enacted
Despite these advances, 41 counties still lack CNMs, and rural practice opportunities remain underserved, offering excellent career prospects for midwives willing to serve these communities.