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 more than 30 years. These advanced practice registered nurses (APRNs), educated and skilled in both 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 (APRN) that practice in hospital obstetric centers, as well as less conventional settings like birth centers, women’s clinics and in the homes of clients.
The NCACNM believes that the high-quality care CNMs deliver is essential to improving the health of North Carolina’s women and babies. According to the American College of Nurse-Midwives, CNMs and certified midwives attended nearly 15,000 births in North Carolina in 2013 alone.
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 that have been accredited by the American Commission for Midwifery Education (ACME).
Although North Carolina is home to just one ACME-accredited nurse-midwifery graduate program, located in Greenville, many of today’s accredited nurse-midwifery programs are offered partially or fully online, with clinical requirements satisfied through local facilities.
A number of nurse-midwifery programs exist for RNs in North Carolina, depending on their current level of education. For example:
- Master of Science in Nursing (MSN) with a focus in Nurse-Midwifery or Master of Science (MS) in Nurse-Midwifery – MSN or MS programs in nurse-midwifery meet the needs of RNs that possess a Bachelor of Science in Nursing (BSN).
- RN-to-MSN Programs – RN-to-MSN programs appeal to RNs that possess an associate’s degree in nursing and need to complete both their BSN and MSN; the combined course of study accelerates the process of achieving both the BSN and MSN.
- Post-Graduate Certificates – Post-graduate certificates in nurse-midwifery allow master’s-prepared RNs or APRNs to become CNMs.
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, which 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.
Graduates of dual focus nurse-midwife/women’s health nurse practitioner programs are skilled in treating women with acute and chronic conditions, as well as providing care to women across the lifespan (to include their childbearing years).
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
- A minimum GRE score
- Letters of recommendation
Program Structure and Design
Most MSN degree programs are two years in duration, with part-time programs lasting about three years. Students can expect their nurse-midwifery program to consist of a competency-based course of study focused on two, main components:
- Didactic coursework
- Clinical rotations
The coursework requirements consist of a core in:
- Health assessment
Just a few of the courses specific to the study of nurse-midwifery include:
- Primary care of women
- Antepartum care
- Perinatal care
- Postpartum care and care of the newborn
- Advanced nurse-midwifery role development
The clinical requirements of an MSN in nurse-midwifery, which typically range between 500 – 1,000 hours, allow students to complement their didactic studies with real-world experiences in a number of settings and 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, just a few of the clinical sites where students may complete a portion of their clinical requirements include:
- NC Women’s Hospital, Chapel Hill
- Women’s Hospital, Greensboro
- UNC OB/GYN at Timberlyne, Chapel Hill
- Center for Women’s Healthcare at Kernersville, Kernersville
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. The CNM consists of the following components and their portion of the examination:
- Antepartum: 19 to 26 percent
- Intrapartum: 17 to 26 percent
- Postpartum: 15 to 18 percent
- Newborn: 7 to 16 percent
- Well-Woman/Gynecologic: 15 to 18 percent
- Women’s Health/Primary Care: 8 to 16 percent
The CNM exam consists of 175, multiple-choice questions. Students must take the exam at one of the Applied Measurement Professionals (AMP) testing centers throughout the U.S. after applying for—and receiving—approval to test through the American Midwifery Certification Board.
There are AMP testing centers located in the following North Carolina cities:
Note: Graduates of a dual specialization degree in nurse-midwifery/women’s health are also eligible to 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 AMP 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.
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, current CNM certification, identification of the physician who will supervise them, and the sites where they intend to practice midwifery.
CNMs practicing in North Carolina must notify the Board (and pay a $100 fee) when they have a change in their physician practice arrangement or if they want to add an additional practice arrangement.
Step 4. Explore Career Opportunities as a Certified Nurse-Midwife in North Carolina
Nurse-midwives in North Carolina enjoy a broad scope of practice and professional opportunities in settings that range from hospitals and integrated health systems, to private OB/GYN practices, and birthing centers:
- Midwifery at Home Women’s Alliance: Chapel Hill, Durham, Raleigh, and the Research Triangle
- New Hanover Regional Hospital, Betty H. Cameron Women’s and Children’s Hospital: Wilmington
- Coastal OB/GYN Specialists & Midwifery: Wilmington
- Duke Regional Hospital, Women’s Health Alliance: Durham
- Charlotte OB/GYN: Charlotte
- Women’s Birth and Wellness Center: Chapel Hill
- Summit Crossing Midwifery: Gastonia
- New Dawn Midwifery: 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 a professional association:
- Midwives of North Carolina: North Carolina Affiliate of the American College of Nurse-Midwives
- North Carolina Friends of Midwives
- North Carolina Nurses Association
North Carolina APRN Registration (Approval to Practice) Renewal Requirements
Nurse-midwives in North Carolina must renew their RN license before they can renew their APRN registration (approval to practice). CNMs must renew their registrations annually (by the last day of their birth month) at the cost of $50.
CNMs can expect to receive a postcard notice about 90 days prior to their registration renewal. CNMs must renew their APRN approval to practice online through the NC Board of Nursing website.
American Midwifery Certification Board Renewal Requirements
The American Midwifery Certification Board requires CNMs to renew their CNM designation every five years through their Certification Maintenance Program.
The Certification Maintenance Program allows CNMs to satisfy their continuing education requirements by successfully completing one of the following:
- Option 1: Complete at least 3 AMCB Certificate Maintenance Modules during each five-year certification cycle and at least 20 contact hours of approved continuing education units; pay annual fees
- Option 2: Retake the AMCB Certification Examination and pay the $500 examination fee in lieu of annual fees
National Certification Corporation Renewal Requirements
Nurse-midwives in North Carolina holding a dual APRN license and dual certification as a nurse-midwife and a women’s health nurse practitioner must also renew their women’s health nurse practitioner (WHNP) designation through the National Certification Corporation every three years.
Renewal is conditional upon the successful completion of a continuing competency assessment and the completion of a specific number of continuing education credit hours based on the results of the assessment.
Salaries for Certified Nurse-Midwives in North Carolina
The 160 certified nurse midwives who practiced in North Carolina in 2015 earned an average salary of $89,100 according to the state’s Department of Commerce. Experienced nurse midwives earned an averaged of $95,980 that year, while new certified nurse midwives earned an average starting salary of $75,340.
Job Prospects are Promising For Certified Nurse-Midwives in North Carolina
The North Carolina Department of Commerce expects the number of jobs for certified nurse-midwives to increase by 28.3% between 2012 and 2022. This rate is more than two-fold higher than the average job growth rate in North Carolina.
The diverse array of jobs posted online in December 2015 for certified nurse-midwives throughout North Carolina help illustrate the growing number of employment opportunities in the state. These postings are featured to showcase the variety of providers who hire CNMs in North Carolina and should not be interpreted as a guarantee of employment:
- Carolinas HealthCare System – Charlotte
- Novant Health – Charlotte
- Duke University and Duke University Health System – Durham
- Cape Fear Valley Health System – Fayetteville
- Maria-Parham Medical Center – Henderson
- Physicians East PA – Greenville
- S. Army 2nd Medical Recruiting Battalion – Raleigh
While North Carolina has enough physicians to meet the needs of the state’s population, they are not distributed well according to a medical education brief by the Cecil G. Sheps Center for Health Research from 2015. This brief noted that North Carolina’s physicians are concentrated in urban areas and counties with academic medical centers. Fourteen counties have had a critical shortage of primary-care physicians since 2004, and Camden and Tyrell Counties currently have no physicians.
Certified nurse-midwives are in a good position to provide obstetric and gynecological care in areas that lack OB-GYN physicians. According to a fact sheet published by the American Congress of Obstetricians and Gynecologists, 31 counties in North Carolina totally lacked OB-GYN physicians in 2014.
Location Dramatically Affects the Salaries of Nurse Midwives in North Carolina
The average salary for certified nurse-midwives in 2015 differed by more than 1.5-fold depending on their location according to the North Carolina Department of Commerce:
- Experienced – $112,090
- Average – $104,160
- Entry-level – $88,310
- Experienced – $104,461
- Average – $97,151
- Entry-level – $82,530
- Experienced – $104,160
- Average – $95,990
- Entry-level – $$82,530
- Experienced – $75,500
- Average – $68,340
- Entry-level – $54,020
Shown below for comparison is an expanded profile of the salaries of certified nurse-midwives in Charlotte-Gastonia-Rock Hill as of 2014 (US Bureau of Labor Statistics):