Last Updated: May 2025 | Reviewed by Abbie Jacobs
According to recent data from the Centers for Disease Control and Prevention, Ohio women are increasingly turning to nurse-midwives as they look to personalize their birthing experiences. In 2023, certified nurse-midwives (CNMs) attended over 12% of births in Ohio, representing a significant increase from just 7% a decade ago.
Nurse-midwives have become fixtures in hospitals across Ohio, delivering babies and influencing maternal care policy. These policy shifts have included developing accommodations that allow families to stay together after C-sections, and encouraging skin-to-skin contact and breastfeeding as soon after birth as possible. Research consistently shows that women under nurse-midwifery care typically experience fewer unnecessary interventions, lower C-section rates, and shorter hospital stays – all of which lower healthcare costs and improve care quality.
As advanced practice registered nurses (APRNs) skilled in midwifery, nurse-midwives provide women with comprehensive healthcare from adolescence through menopause, including gynecologic services, primary care, family planning, and complete obstetric care.
In Ohio, legislative efforts continue to address practice requirements for APRNs. Current regulations require advanced practice registered nurses, including nurse-midwives, to maintain collaborative agreements with physicians. However, proposed legislation may change these requirements to expand access to care, particularly in rural areas where provider shortages are common.
Steps to Becoming a Certified Nurse-Midwife in Ohio
Registered nurses in Ohio interested in becoming nurse-midwives must have an unencumbered RN license in good standing and national certification in nurse-midwifery to qualify for a state certificate of authority to practice as an APRN through the State of Ohio Board of Nursing:
Step 1. Earn a Qualifying Degree in Nurse Midwifery
The first step toward earning an APRN certificate of authority as a nurse-midwife in Ohio involves completing a nurse-midwifery graduate degree program accredited by the American Commission for Midwifery Education (ACME).
In Ohio, ACME-accredited nurse-midwifery programs are located in Cleveland, Columbus, and Cincinnati. However, even RNs who do not live near these Ohio cities can complete a graduate degree in nurse-midwifery through online programs now widely available.
Institutions offering web-based study allow students to complete all or most of the didactic requirements through distance learning. Many programs also offer part-time options to accommodate working RNs.
Program Options
Not all RNs in Ohio entering a graduate degree program in nurse-midwifery do so with the same level of education. Therefore, several program structures exist to accommodate RNs at different stages:
| 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 Nurse-Midwife/Women’s Health Nurse Practitioner Programs
Many institutions now offer dual-focus programs that allow students to broaden their scope of practice. The nurse-midwife/women’s health nurse practitioner (WHNP) combination has gained significant popularity. A comprehensive program will enable students to complete a wide-ranging course of study in women’s health. Upon graduation, students can take the Nurse-Midwife (CNM) Exam and the Women’s Health Nurse Practitioner Board Certification Exam. According to recent Ohio workforce data, CNMs with dual certification as WHNPs have 15% higher average salaries and expanded practice opportunities.
Admission Requirements
Students enrolling in an accredited nurse-midwifery program must possess a valid and unencumbered RN license, a Bachelor of Science in Nursing (BSN) degree (for most programs), and, depending on the institution:
- Minimum undergraduate GPA (typically 3.0 or higher)
- 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
Master’s Degrees in Nurse-Midwifery: Program Content and Components
All ACME-accredited nurse-midwife programs include two components: a didactic component and a clinical component. Full-time programs typically take about two years to complete, while part-time options may extend to three or four years.
Didactic Requirements
The core of a nurse-midwife program contains coursework in advanced pathophysiology, pharmacotherapeutics, health assessment, and research, along with multiple courses focusing specifically on nurse-midwifery, such as:
- Well-woman care for nurse-midwifery
- Antepartum care
- Intrapartum, postpartum, and newborn care
- Primary care for women
- Integration and professional issues for nurse-midwifery
Clinical Requirements
The clinical requirements of a nurse-midwife program in Ohio may consist of up to 1,000 hours of practice in various clinical settings. These rotations give students opportunities to apply their theoretical knowledge in real-world settings. Most institutions require students to complete clinical experiences across multiple settings to ensure a well-rounded education.
Students in campus-based programs usually complete clinical rotations at pre-determined sites near campus, while online programs partner with facilities throughout the U.S. to help students complete clinical requirements closer to home.
In Ohio, nurse-midwife students may complete clinical requirements at facilities such as:
| Region | Clinical Sites |
|---|---|
| Northeast Ohio | • Cleveland Clinic Women’s Health Institute, Cleveland • University Hospitals MacDonald Women’s Hospital, Cleveland • Summa Health System Women’s Center, Akron |
| Central Ohio | • Ohio State University Wexner Medical Center, Columbus • OhioHealth Grant Medical Center, Columbus • Wellspring Midwifery Care & Birth Center, Columbus |
| Southwest Ohio | • TriHealth Nurse Midwives, Cincinnati • The Christ Hospital Midwifery Practice, Cincinnati • Cincinnati Birth Center, Cincinnati |
Step 2. Take and Pass the National Certification Examinations
After graduating from an ACME-accredited nurse-midwifery program, RNs in Ohio must take and pass the Certified Nurse-Midwife (CNM) exam through the American Midwifery Certification Board.
Graduates of nurse-midwife/women’s health nurse practitioner degree programs may also take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation if they pursue WHNP board and CNM certifications.
Both examinations consist of 175 multiple-choice questions. The CNM exam covers seven domains of midwifery practice:
- Antepartum care (25%)
- Intrapartum care (25%)
- Postpartum care (15%)
- Newborn care (10%)
- Gynecology (15%)
- Primary care (5%)
- Professional issues (5%)
Candidates must take both exams at Prometric testing centers located throughout the U.S. In Ohio, testing centers are available in:
| Region | Testing Center Locations |
|---|---|
| Northeast Ohio | Cleveland/Independence, Akron |
| Central Ohio | Columbus/Gahanna |
| Southwest Ohio | Cincinnati/Norwood, Dayton |
| Northwest Ohio | Toledo |
The CNM exam fee is $500 (as of 2025), and most candidates receive unofficial results immediately upon completion.
Step 3. Apply for APRN Certificate of Authority as a Nurse-Midwife through the State of Ohio Board of Nursing
Candidates who have achieved CNM certification must apply for an APRN certificate of authority as a nurse-midwife by completing the Advanced Practice Registered Nurse (APRN) Application Certificate of Authority (COA) and providing the Board with the following:
- $100 application fee (made payable to Treasurer, State of Ohio)
- Verification of CNM designation (verification should be sent directly to the Board)
- Verification of graduation from a nurse-midwifery program (institution must send a signed and sealed transcript directly to the Board)
- Background check results (both Ohio BCI and FBI checks required for initial applicants)
Physician Collaboration Requirements
All nurse-midwives in Ohio must identify a collaborating physician and enter into a standard care arrangement (SCA) before engaging in practice. The SCA must be signed by the CD and the collaborating physician and retained upon request at each practice site. The specific information that must be included in the SCA can be found here.
Prescriptive Authority Requirements
Licensed CNMs in Ohio seeking prescriptive authority must complete a Certificate to Prescribe Externship Application and send it to the Board, along with a check or money order for $50 (payable to the Treasurer, State of Ohio).
Once approved, Ohio CNMs with prescriptive authority can prescribe:
- Non-controlled medications
- Schedule II-V controlled substances (with some limitations)
- Medical devices and equipment
- Therapeutic devices and treatments
Step 4. Exploring Career Opportunities as a Nurse-Midwife in Ohio and Maintaining Credentials
Nurse-midwives in Ohio have diverse practice options. These APRNs may work in hospitals, women’s health clinics, OB/GYN practices, birth centers, and academic settings. Some also open their own birthing center or midwifery practice, particularly in underserved areas.
Just a few of the locations where nurse-midwives in Ohio may start or advance their career include:
- Cleveland Clinic Women’s Health Institute, Cleveland
- Ohio State University Wexner Medical Center Midwifery, Columbus
- University Hospitals MacDonald Women’s Hospital, Cleveland
- TriHealth Nurse Midwives, Cincinnati
- OhioHealth Physician Group Midwifery, Columbus
- Mount Carmel Midwifery, Columbus
- ProMedica Midwifery Care, Toledo
- Wellspring Midwifery Care & Birth Center, Columbus
- Cincinnati Birth Center, Cincinnati
Ohio faces significant maternal care shortages in rural counties. According to the Ohio Department of Health, 26 counties currently have no OB/GYN providers, and 15 lack hospital obstetric services. CNMs are increasingly filling these gaps, with special incentives available through the Ohio Primary Care Workforce Initiative.
APRN Certificate of Authority Renewal
Nurse-midwives in Ohio must renew their APRN certificate of authority by providing the Board with proof that they have maintained their CNM certification.
Renewal is required by July 1 of all odd-numbered years for $85. Renewal requirements include:
- Completion of the Ohio Board of Nursing renewal application
- Verification of continued national certification
- 24 hours of continuing education (CE)
Renewal forms can be found here.
CNM Renewal Requirements
Nurse-midwives must renew their CNM certification through the American Midwifery Certification Board every five years. The Board’s Certification Maintenance Program allows CNMs to meet continuing education requirements by completing one of the following:
- Option 1: Complete at least three AMCB Certificate Maintenance Modules during each five-year certification cycle and at least 20 contact hours of approved continuing education units; pay annual fees ($50/year)
- Option 2: Retake the AMCB Certification Examination and pay the $500 examination fee instead of the annual fees
WHNP Renewal Requirements
Nurse-midwives in Ohio who also possess WHNP certification must renew it every three years. At the beginning of each maintenance cycle, WHNPs must complete a continuing competency assessment and, based on the assessment results, complete a specific number of continuing education credits.
Salaries for Certified Nurse-Midwives in Ohio
Certified nurse-midwives in Ohio earn competitive salaries that vary by region, experience, and practice setting. According to the U.S. Bureau of Labor Statistics and the Ohio 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) | $85,400 – $98,600 | $92,000 |
| Mid-Career (3-9 years) | $95,800 – $115,700 | $105,800 |
| Experienced (10+ years) | $110,200 – $138,500 | $124,300 |
| Overall Average | $85,400 – $138,500 | $108,750 |
Salaries vary significantly across Ohio’s metropolitan areas:
| Metropolitan Area | Average Annual Salary | Top Earners (90th Percentile) |
|---|---|---|
| Toledo | $132,750 | $162,400 |
| Columbus | $114,800 | $138,650 |
| Cleveland-Elyria | $108,200 | $141,300 |
| Cincinnati | $98,600 | $125,800 |
| Rural Ohio | $96,400 | $118,500 |
The job outlook for certified nurse-midwives in Ohio is highly positive, with a projected 15% growth rate from 2022 to 2032, significantly higher than the average for all occupations. Additionally, approximately 22% of currently practicing Ohio CNMs are expected to retire within the next decade, creating additional job openings.
Several factors influence CNM compensation in Ohio:
| 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 earn 12-15% more on average |
| Education Level | CNMs with doctoral degrees earn 8-10% more than those with master’s degrees. |
| Geographic Location | Urban areas generally offer higher base salaries, while rural areas may offer sign-on bonuses and loan repayment. |
(Salary data reported by the U.S. Bureau of Labor Statistics and the Ohio 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 Ohio
How long does it take to become a certified nurse-midwife in Ohio?
After becoming an RN, it typically takes 2-3 years of full-time study to complete a nurse-midwifery program. Part-time options may take 3-4 years 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
Can certified nurse-midwives practice independently in Ohio?
Ohio law currently requires CNMs to have a collaborative agreement with a physician through a Standard Care Arrangement (SCA). This agreement outlines the scope of practice, consultation procedures, and referral protocols. There is pending legislation (House Bill 177) that may change this requirement to allow independent practice, but as of May 2025, the collaborative requirement remains in place. Despite this requirement, many CNMs in Ohio maintain a high degree of autonomy in their daily practice.
What’s the difference between a CNM and other midwives in Ohio?
In Ohio, several types of midwives practice with different qualifications and legal status:
- Certified Nurse-Midwives (CNMs): Registered nurses with graduate-level education accredited by ACME who are licensed as APRNs with full prescriptive authority.
- Certified Professional Midwives (CPMs): Non-nurse midwives certified by the North American Registry of Midwives. Ohio does not currently license CPMs, so their legal status is unclear.
- Certified Midwives (CMs): Non-nurse midwives with graduate education accredited by ACME. Ohio does not currently license CMs.
- Traditional/Lay Midwives: Midwives without formal certification. Their practice is not regulated in Ohio.
Only CNMs have clear legal recognition, prescriptive authority, insurance reimbursement, and hospital privileges in Ohio.
Do I need labor and delivery experience before applying to 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. Programs in Ohio typically evaluate 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 Ohio?
Ohio nurse-midwives work in diverse settings:
- Hospital-Based Practices (70% of Ohio CNMs): Working within hospital systems, attending births, and providing full-scope midwifery care.
- OB/GYN Practices (15%): Collaborating with physicians in private practice settings.
- Birth Centers (5%): Providing care in freestanding birth centers, which are growing in popularity across Ohio.
- Community Health Centers (5%): Working in Federally Qualified Health Centers (FQHCs) and other public health settings.
- Academic and Other Settings (5%): Teaching, research, public health, and telehealth roles.
Home birth attendance by CNMs in Ohio is legal but relatively rare due to insurance and collaborative agreement challenges.
Are there loan forgiveness programs available for nurse-midwives in Ohio?
Yes, several loan forgiveness programs are available for nurse-midwives practicing in Ohio:
- National Health Service Corps Loan Repayment Program: Up to $50,000 for a two-year commitment at an approved site in a Health Professional Shortage Area.
- Ohio Primary Care Workforce Initiative: Up to $50,000 for practice in designated areas in Ohio for at least two years.
- 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.
Additionally, some hospital systems in underserved areas offer sign-on bonuses and loan repayment assistance as recruitment incentives.
Can I complete a nurse-midwifery program online while living in Ohio?
Yes, numerous ACME-accredited programs offer distance education options accessible to Ohio residents. These programs typically feature:
- Online didactic coursework (synchronous and asynchronous options)
- Limited on-campus intensives (usually 1-2 sessions per year)
- Clinical placements arranged in your local area (with program assistance)
- Virtual simulation experiences and skills validation
Popular online programs among Ohio students include Frontier Nursing University, Georgetown University, Thomas Jefferson University, and the University of Cincinnati, which offers a hybrid format with some courses online and others on campus.
What’s the typical patient load for a full-time CNM in Ohio?
Patient loads vary by practice setting. In Ohio:
- 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 15-20 births monthly due to higher patient volumes and the teaching environment.
Call schedules vary widely, with some practices using 24-hour shifts, others using 12-hour shifts, and some implementing home-call systems.