The American College of Nurse-Midwives (ACNM) reports that 68 certified nurse-midwives were licensed to practice in Oklahoma as of 2015. With the US Department of Labor estimating the total number of RNs in the state to be 26,390, this comes to just 0.26 percent of Oklahoma’s total RN workforce. However, Oklahoma’s CNMs have a significant impact that goes well beyond their numbers, having attended four percent – 2,156 – of all births that took place in the state in 2013 alone.
With a growing interest in a gentler, more whole-person centered approach to women’s health and childbearing, Oklahoma’s medical community ripe for an influx of qualified certified nurse-midwives in the coming years. Just as certified nurse-midwives are becoming increasingly popular nationwide – with a projected job growth rate of 29 percent over the ten-year period leading up to 2022 – they are also becoming more popular in Oklahoma.
The NewsOK article, “Nurse Midwifery Gains Importance,” identifies several reasons for this growing demand. For one, these healthcare professionals fill the gap left by a shortage of physicians, particularly in rural areas of the state. With their extensive clinical training and graduate-level education, certified nurse-midwives are able to provide obstetric and gynecologic care comparable to that of a physician, but with statistically fewer cases of invasive procedures such as episiotomies and C-sections, and often with better outcomes. Many patents also report that they find nurse-midwives to be more approachable and personable than their physician counterparts.
Steps to Becoming a Certified Nurse-Midwife in Oklahoma
In Oklahoma, certified nurse midwives are recognized as advanced practice registered nurse (APRN) and licensed by the Oklahoma Board of Nursing to work independently without a collaborative practice agreement in place with a physician.
Oklahoma RNs with unencumbered licenses in good standing would take these steps to become nationally certified in nurse-midwifery and licensed to practice in the state:
|Complete a Qualifying Graduate Program in Nurse-Midwifery|
|Become Nationally Certified in Nurse-Midwifery|
|Apply for APRN Licensure with the Oklahoma Board of Nursing|
|Explore Career Opportunities and Maintain Credentials|
Step 1. Complete a Qualifying Graduate Program in Nurse-Midwifery
The Oklahoma Board of nursing requires prospective nurse-midwives to complete a graduate program that is approved by the Accreditation Commission for Midwifery Education (ACME).
With just 39 accredited nurse-midwifery programs available throughout the nation, schools are increasingly offering their programs online. Nurse-midwife students often prefer the convenience and flexibility of ACME-accredited online programs, which are designed to accommodate the busy schedules of working RNs.
It is becoming increasingly common for graduate programs in nurse midwifery to offer students the option of a dual specialization in women’s health. Structured as a Nurse Midwife/Women’s Health Nurse Practitioner (NM/WHNP) program, this dual-focus track fulfills the education requirements necessary to become credentialed as a certified nurse midwife (CNM) and/or board certified women’s health nurse practitioner (WHNP-BC).
Like certified nurse midwives, women’s health nurse practitioners are also considered to be an APRN category.
Graduate Program Admission Standards
Common admission standards for nurse-midwife graduate programs include:
- GRE General Test
- Statement of purpose, video essay, or personal essay
- Letters of recommendation
- Current RN license
- BSN or completion of nursing prerequisite courses
- Minimum GPA
Although most candidates for nurse-midwife graduate programs hold a BSN, ACME also accredits RN-to-MSN bridge programs in nurse midwifery/women’s health for those who hold associate’s degrees in nursing.
Structure of the Nurse Midwifery Program
Students will encounter didactic and clinical education as part of their graduate program. The didactic segment is between 40-60 semester credits and covers advanced practice theory for nurse midwifery. The clinical education segment takes place in a healthcare setting where students implement what they have learned.
Important advanced topics in nurse midwifery that are covered in the didactic segment of these programs can include:
- Advanced physiology and pathophysiology
- Psychology for pregnancy
- Women’s reproductive health
- Advanced health assessment
- Complicated pregnancies and deliveries
- Legal issues and ethics in maternal healthcare
- Advanced integrated midwifery
- Nurse midwifery for the antepartum, intrapartum, and postpartum woman
- Mother and infant biostatistics
- Multicultural midwifery
- Pharmacotherapeutic management – required for prescriptive authority
Students who are completing an online graduate program in nurse midwifery work with a faculty advisor to identify local sites where this portion of the education can take place. Colleges and universities make a concerted effort to establish clinical agreements with hospitals and other healthcare facilities throughout the nation. Their goal is to ensure online students can find a nearby clinical location and avoid commuting or relocating as much as possible.
Examples of potential clinical sites in Oklahoma might include:
- Integris Baptist Medical Center in Oklahoma City
- Saint Francis Hospital in Tulsa
- Saint Anthony’s Hospital in Oklahoma City
- Norman Regional Hospital
- AllianceHealth Deaconess in Oklahoma City
- Saint Francis Hospital South in Broken Arrow
- University of Oklahoma Medical Center and Children’s Hospital in Oklahoma City
- Commanche County Memorial Hospital in Lawton
- Lakeside Women’s Hospital in Oklahoma City
Having earned a master’s degree in nurse-midwifery graduates can apply to take the national exam required to become a certified nurse-midwife.
Step 2. Become Nationally Certified in Nurse-Midwifery
The Oklahoma Board of Nursing recognizes the American Midwifery Certification Board (AMCB), sponsor of the Certified Nurse- Midwife Examination, as granting the national certification necessary for advanced practice registered nurse (APRN) licensure in the state.
Graduates of dual-focus Nurse Midwife/Women’s Health Nurse Practitioner (NM/WHNP) programs may go on to take the Women’s Health Care Nurse Practitioner Board Certification Exam through the National Certification Corporation (NCC) if they would like to add the WHNP-BC credential.
After registering with the sponsoring organization, candidates can register with Applied Measurement Professional (APM) for a testing date and location. APM administers both exams at H&R Block Centers in the cities of Tulsa and Oklahoma City.
Both exams are computer-based and multiple-choice.
Certified Nurse Midwife Exam
Prospective nurse midwives can prepare for this exam by reviewing the AMCB’s Candidate Handbook. The exam is comprised of 175 multiple-choice questions, with a time limit of four hours. The test covers the topics of:
- Antepartum – 19-26 percent
- Intrapartum – 17-26 percent
- Postpartum – 15-18 percent
- Gynecology – 15-18 percent
- Women’s health and primary care – 8-16 percent
- Newborn – 7-16 percent
Successful examiners will receive a Certificate in Nurse Midwifery (CNM) from the AMCB. Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Women’s Health Care Nurse Practitioner (WHNP) Exam
Prospective women’s health nurse practitioners can prepare for this exam by studying the NCC’s WHNP Candidate Guide. The exam is comprised of 150 scored multiple-choice test questions and up to 25 unscored pretest questions, with a time limit of three hours. Subjects covered on the test are:
- Gynecology – 35-40 percent
- Obstetrics – 25-30 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Pharmacology – 5-10 percent
Upon passing the exam nurses will earn the NCC’s WHNP-BC credential. Candidates can register for this exam online through the NCC’s website.
Step 3. Apply for APRN Licensure with the Oklahoma Board of Nursing
After completing an approved graduate program in nurse midwifery and becoming nationally certified, candidates are qualified to apply for APRN licensure as a certified nurse midwife and/or women’s health NP.
Candidates can complete their application online through the Oklahoma Board of Nursing’s online portal. If applying for two APRN licenses (certified nurse midwife and women’s health NP), candidates will need to submit two applications.
To be eligible for prescriptive authority, nurse midwives and other APRNs must meet these conditions:
- Complete an Agreement for Physician Supervising Advanced Practice Prescriptive Authority form
- Obtain a permit from the Oklahoma Bureau of Narcotics and Dangerous Drug Control
- Obtain a number from the Drug Enforcement Agency (DEA)
Candidates also make their application for prescriptive authority through the board’s online portal.
Step 4. Explore Career Opportunities and Maintain Credentials
APRN-CNM applicants can find out when the board has approved their application by verifying their license online. Once the license status is active, licensees can then start pursuing their advanced career goals.
Significant employers in the field of nurse-midwifery located throughout Oklahoma include:
- Women’s and Children’s Services at Integris Baptist Medical Center in Oklahoma City
- Saint Francis Hospital in Tulsa
- Joyful Beginnings Childbirth Center at Saint Anthony’s Hospital in Oklahoma City
- Family Birth Center at Norman Regional Hospital
- AllianceHealth Deaconess’ Birth Center in Oklahoma City
- Henley-Hills Center for Women and Children at Commanche County Memorial Hospital in Lawton
- University of Oklahoma’s Women’s and Newborn Center in Oklahoma City
- Lakeside Women’s Hospital Labor and Delivery Center in Oklahoma City
- Special Delivery Birth Center in Tulsa
- Helmerich Women’s Center in Tulsa
- Community Midwifery Services in Norman
- Birth Choice in Lawton
- Joyful Beginnings Birthing Center in Oklahoma City
- Champion Women’s Health Specialists in Oklahoma City
- The Women’s Health Group in Tulsa
Certified nurse midwives can get a sense of Oklahoma’s professional environment from the following list of job vacancy announcements. These were collected from a survey taken throughout the state in December 2015 and are provided here as illustrative examples only:
- Nurse Midwife/Women’s Health NP with the Oklahoma State Department of Health in Stillwater
- Nurse Practitioner in Women’s Health with Medical Doctor Associates in Oklahoma
- Labor and Delivery Nurse at Lakeside Women’s Center of Oklahoma City
- Women’s Services Nurse at Canadian Valley Hospital in Yukon
- Certified Nurse Midwife with AllianceHealth Deaconess in Oklahoma City
Renewing the APRN License with the Oklahoma Board of Nursing
Nurse midwives and women’s health NPs can renew their license online. APRN renewal is done at the same time as RN license renewal, which both must be renewed biannually in even-numbered years. Nurse midwives and women’s health NPs must maintain their national certification through the AMCB and/or NCC.
If desired they can renew their prescriptive authority, which is also completed online. This is done on a three-year cycle, and requires the completion of one of the following:
- 45 hours of continuing education in pharmacotherapeutic management
- Three semester credits of education in pharmacotherapeutic management
Applicants must also renew their supervising physician prescriptive authority agreement.
Renewing National Certification with the American Midwifery Certification Board (AMCB)
Certification from the AMCB is on a five-year renewal cycle. All CNM certificate holders will enroll in the AMCB’s Certificate Maintenance Program and complete one of the following options:
- Re-take the Certified Nurse Midwife Exam
- Complete three certificate maintenance modules and 20 hours of continuing education
Renewing National Certification with the National Certification Corporation (NCC)
Certification from the NCC is offered on a three-year renewal cycle. To complete this, all WHNP-BC certificate holders must enroll in the NCC’s maintenance program and take the Continuing Competency Assessment. Depending on the results, certificate holders would then be instructed to complete between 10-50 hours of continuing education per cycle.
Salaries for Certified Nurse-Midwives in Oklahoma
Nurse midwives in Oklahoma with salaries that fell within the 10th percentile (typically entry-level) earned an average salary that was more than $11,400 higher than the national average for CNMs in this bracket according to the state’s Employment Security Commission.
Nurse midwives new to the field in Oklahoma earned an average of $77,355 as of 2014. The median salary among nurse midwives in Oklahoma was $94,078 that year, while nurse midwives with salaries within the 90th percentile earned an average of $120,099.
The Number of Certified Nurse-Midwives is Dramatically Increasing in Oklahoma
The number of jobs for nurse midwives is expected to increase by 31% nationwide between 2012 and 2022 according to the US Bureau of Labor Statistics. An analysis of the number of licenses issued to certified nurse-midwives in Oklahoma strongly suggests that this trend is also true in Oklahoma.
In its annual report for fiscal year 2014, the Oklahoma Board of Nursing analyzed the number of licenses issued to certified nurse-midwives over a five-year period. The Board reported that 70 CNMs were licensed to practice in Oklahoma as of FY 2014.
The number of licensed certified nurse-midwives in Oklahoma increased by 22.8% between FY 2010-14. This report also stated that this increase was higher than that for any other type of APRN in Oklahoma over this time frame.
Nine new CNM licenses were issued in Oklahoma in FY 2014. This represents an increase of 125% in the number of new licenses issued over the past five years.
Fifty-four of Oklahoma’s licensed certified nurse-midwives had the authority to prescribe medication in fiscal year 2014. Oklahoma County had the largest number of CNMs with prescriptive authority, while Tulsa and Cherokee Counties tied for second. The only other county in Oklahoma that employed certified nurse-midwives with prescriptive authority was Pontotoc County.
The Distribution of Certified Nurse-Midwives throughout Oklahoma
The Board identified the counties that Oklahoma’s certified nurse-midwives practiced in as of FY 2014. Ten of these licensed CNMs were practicing out of state, while more than half of Oklahoma’s licensed certified nurse-midwives practiced in these three counties:
- Oklahoma County 21.4%
- Tulsa County 17.1%
- Cherokee County 11.0%
Counties with between 4% and 8% of Oklahoma’s certified nurse-midwives included:
- Pontotoc County
- Rogers County
- Cleveland County
These counties only had one licensed certified nurse-midwife practicing in them as of 2014:
- Adair County
- Custer County
- Jackson County
- Love County
- Texas County