Last Updated: May 2025 | 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 includes not just care for the childbearing woman but 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 shown that midwifery care is associated with fewer interventions, lower cesarean rates, and higher patient satisfaction scores than 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 2023, 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.
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).
North Carolina is home to an ACME-accredited nurse-midwifery program at East Carolina University in Greenville. Additionally, many of today’s accredited nurse-midwifery programs are offered partially or fully online, with clinical requirements satisfied through local facilities in North Carolina.
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
A number of schools have begun offering dual specialization nurse-midwifery degrees, such as the nurse-midwifery/women’s health nurse practitioner program. This program provides students with a more comprehensive course of study and an opportunity to earn dual certification as a certified nurse-midwife (CNM credential) and 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, with part-time programs lasting about three years. Students pursuing a career as a Certified Nurse-Midwife in North Carolina can expect their program to include a competency-based curriculum focused on didactic and clinical components: didactic coursework and clinical rotations.
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 |
| 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 |
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 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 in North Carolina or throughout the U.S.
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.
Application Requirements
North Carolina requires a supervisory relationship with a physician as a condition for practice. Therefore, applicants must provide the Board with:
- Proof of graduation from an accredited nurse-midwifery program (official transcripts)
- Verification of current CNM certification (sent directly from AMCB)
- Identification of the physician who will supervise the CNM
- Documentation of the sites where they intend to practice midwifery
- Application fee ($100)
CNMs practicing in North Carolina must notify the Board (and pay a $100 fee) when their physician practice arrangement changes or they want to add an additional arrangement.
Collaborative Practice Requirements
In North Carolina, CNMs practice under a collaborative practice model with physician supervision. This relationship must be formalized in a written agreement that specifies:
- The scope of the CNM’s practice
- Arrangements for consultation and referral
- Methods for reviewing and approving care provided
- Prescriptive authority parameters (if applicable)
Essential Practice Experience Requirement: North Carolina requires at least 24 months and 4,000 hours of practice experience as a CNM. If you have less than this, you must practice in collaboration with a designated collaborating provider. This is a critical requirement that distinguishes North Carolina from many other states.
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. This includes the ability to:
- Prescribe medications, including controlled substances (Schedules II-V)
- Order diagnostic tests and medical devices
- Implement treatments within their scope of practice
CNMs with prescriptive authority must obtain a DEA registration to prescribe controlled substances.
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.
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. |
Potential employers of CNMs in North Carolina include:
- Triangle Area
- Duke Regional Hospital, Women’s Health Alliance: Durham
- UNC Health Care: Chapel Hill
- Women’s Birth and Wellness Center: Chapel Hill
- WakeMed Health & Hospitals: Raleigh
- Triad Area
- Cone Health: Greensboro
- Novant Health: Winston-Salem
- 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
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 less supervised practice. New CNMs with less experience will need to practice in collaboration with a designated collaborating provider until they meet this threshold. This requirement ensures patient safety while allowing new CNMs to gain valuable experience.
Salaries for Certified Nurse-Midwives in North Carolina
Certified nurse-midwives in North Carolina earn competitive salaries that vary by region, experience, and practice setting. According to the U.S. Bureau of Labor Statistics and the North Carolina Department of Job and Family Services, the statewide salary breakdown for CNMs in 2024 is:
| Experience Level | Annual Salary Range | Average Annual Salary |
|---|---|---|
| Entry Level (0–2 years) | $82,500 – $95,400 | $88,900 |
| Mid-Career (3–9 years) | $92,300 – $112,600 | $102,500 |
| Experienced (10+ years) | $107,800 – $132,400 | $120,100 |
| Overall Average | $82,500 – $132,400 | $103,800 |
Salaries vary significantly across North Carolina’s different regions:
| Metropolitan Area | Average Annual Salary | Top Earners (90th Percentile) |
|---|---|---|
| Charlotte-Concord-Gastonia | $112,500 | $134,600 |
| Raleigh-Durham-Chapel Hill | $108,300 | $130,200 |
| Greensboro-Winston-Salem | $101,800 | $126,500 |
| Asheville | $98,900 | $122,700 |
| Wilmington | $97,500 | $120,300 |
The employment outlook for nurse-midwives in North Carolina is highly positive. The U.S. Department of Labor projects a 22.3% increase in CNM positions in North Carolina through 2028, significantly higher than the average job growth rate of 5% for all occupations in the state.
Several factors influence CNM compensation in North Carolina:
| Factor | Impact on Compensation |
|---|---|
| Practice Setting | Hospital-employed CNMs typically earn higher base salaries than those in birth centers or private practice |
| Additional Certifications | CNMs with dual certification as WHNPs earn approximately 12-15% more on average |
| Education Level | CNMs with doctoral degrees (DNP, PhD) earn approximately 8-10% more than those with master’s degrees |
| Geographic Location | Urban areas generally offer higher base salaries, while rural areas may offer loan repayment and incentive programs |
In rural areas, North Carolina faces significant challenges in providing adequate obstetric and gynecological care. According to a report from the American College of Obstetricians and Gynecologists, 31 counties in North Carolina have no OB/GYN physicians. This shortage creates significant opportunities for CNMs to increase access to women’s healthcare services in underserved areas. North Carolina remains one of the most promising states to begin a career as a Certified Nurse-Midwife.
(Salary data reported by the U.S. Bureau of Labor Statistics and the North Carolina Department of Job and Family Services. Job growth data provided by Projections Central, a resource funded by the U.S. Department of Labor’s Employment and Training Administration. Conditions may vary by region. Information current as of May 2025.)
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 an RN typically takes 2-3 years of full-time study to complete a nurse-midwifery program. The entire process from beginning nursing education to CNM licensure usually takes 6-8 years, including:
- 2-4 years for 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 (or collaborative practice if less)
North Carolina’s requirement for 24 months and 4,000 hours of practice experience is an important distinction that can extend the timeline compared to other states.
What is the scope of practice for CNMs in North Carolina?
In North Carolina, certified nurse-midwives are authorized to provide the following services under physician supervision:
- 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
- Ordering of diagnostic tests and medical devices
CNMs practice collaboratively with supervising physicians who define the specific practice parameters. Less experienced CNMs (with fewer than 24 months/4,000 hours) must practice under closer collaboration.
Are there any ACME-accredited nurse-midwifery programs in North Carolina?
Yes, East Carolina University in Greenville offers an ACME-accredited nurse-midwifery program. This program provides 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. Additionally, many nationally recognized online and hybrid programs accept North Carolina residents and help arrange clinical placements throughout the state.
Can CNMs in North Carolina prescribe medications?
Yes, CNMs in North Carolina have prescriptive authority, including the ability to prescribe controlled substances (Schedules II-V) when specified in their collaborative practice agreement with a supervising physician. To prescribe controlled substances, CNMs must also obtain a DEA registration. 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?
While not always required, most nurse-midwifery programs strongly prefer candidates with 1-2 years of experience in labor and delivery, mother-baby units, or women’s health. This experience provides valuable clinical context for advanced practice education. Like many others, the East Carolina University program evaluates applications holistically, so exceptional candidates without this specific experience may still be considered, especially if they have other relevant healthcare experience. Check with specific programs for their exact requirements.
What settings do nurse-midwives typically work in throughout North Carolina?
North Carolina nurse-midwives work in diverse settings:
- Hospital-Based Practices (65% of NC CNMs): Working within hospital systems, attending births, and providing full-scope midwifery care.
- Private Practices (20%): Collaborating with physicians in OB/GYN and family practice settings.
- Birth Centers (10%): Providing care in freestanding birth centers, which are growing in popularity across North Carolina.
- 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, 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.
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 average 10-15 births monthly 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.