As more women in Oregon turn to nurse-midwives for general well-woman care and a gentler, more whole-person approach to childbearing, demand has created new opportunities for CNMs in hospital obstetric departments, birthing centers and independent women’s health clinics. In fact, the Oregon Employment Department projects that the number of certified nurse-midwives licensed to practice in the state will increase by 37 percent over the ten-year period leading up to 2022 – a rate of increase that is significantly higher than the national average for these specialists.
In an environment that reveres the practice of nurse-midwifery, it should come as no surprise that Oregon consistently ranks among the top five states in the nation with the highest percentage of nurse-midwife attended births. In 2013 alone, certified nurse-midwives attended 17.8 percent of all births in the state according to the American College of Nurse-Midwives.
The Portland Tribune profiled nurse-midwives at the Oregon Clinic in a 2015 article about their profession, revealing that a number of nurse-midwives at this location all have a doctorate degree in their field, beyond the requisite master’s. Those featured in the article point to the more individualized care certified nurse-midwives provide the women in their care, often starting at the antepartum period and continuing with women’s wellness exams throughout the lifetime. The growing popularity of nurse midwifery in Oregon also means that this clinic has had the opportunity to hire additional staff.
The fact that insurance companies reimburse nurse-midwifery care just as they would with obstetricians has contributed to the growing demand for certified nurse-midwives. Oregon’s nurse-midwives earn the forth-highest average annual salary in the United States for their profession, at $113,480 in 2014 according to the US Department of Labor.
Steps to Becoming a Certified Nurse-Midwife in Oregon
Oregon’s registered nurses with unencumbered licenses in good standing can become certified nurse-midwives by meeting the requirements for national certification in nurse-midwifery and advanced practice registered nurse (APRN) licensure through the Oregon State Board of Nursing. Classified as nurse midwife-nurse practitioners (NMNP) through the Oregon State Board of Nursing, certified nurse-midwives in the state can practice independently and enjoy full prescriptive authority without entering into any collaborative practice agreements with a physician.
Oregon RNs interested in becoming nationally certified in nurse-midwifery and licensed as NMNPs through the state Board would follow these four steps:
|Complete an Approved Nurse-Midwife Graduate Program|
|Become Nationally Certified in Nurse-Midwifery|
|Apply for APRN Licensure as an NMNP with the Oregon State Board of Nursing|
|Begin a New Career in Nurse-Midwifery and Maintain Credentials|
Step 1. Complete an Approved Nurse-Midwife Graduate Program
To be eligible for an APRN license as a nurse midwife nurse practitioner (NMNP) through the Oregon State Board of Nursing, candidates must earn a master’s or higher degree in nurse midwifery approved by the Accreditation Commission for Midwifery Education (ACME).
There is one ACME-approved nurse midwifery program in Portland, and 38 others throughout the United States. In an effort to appeal to a broad audience, many national graduate programs in nurse-midwifery are offered partially or completely online. These are becoming increasingly popular as many RNs prefer to keep working while they complete their degree online.
Common admission standards for nurse-midwife graduate programs include:
- Minimum GPA of 3.0
- GRE General Test
- Current RN license
- BSN or completion of nursing prerequisite courses
- Personal essay, video essay, or statement of purpose
- Letters of recommendation
While most candidates for nurse-midwife graduate programs hold a BSN, ACME also accredits RN-to-MSN bridge programs in midwifery for those that hold associate’s degrees in nursing.
Dual Focus Nurse-Midwife/Women’s Health Care Nurse Practitioner Programs
Some nurse-midwifery graduate programs are structured to include dual specialization in a related field such as women’s health. These accredited graduate programs result in a master’s degree in Nurse Midwifery/Women’s Health Nurse Practitioner (NM/WHNP).
Completing this type of program will fulfill the education requirements for national certification as a certified nurse-midwife (CNM) and board certification as a women’s health care nurse practitioner (WHNP-BC). Additionally, the Oregon State Board of Nursing would recognize graduates of these programs in both specialties when applying for APRN licensure:
- Nurse Midwife Nurse Practitioner (NMNP)
- Women’s Health Care Nurse Practitioner (WHCNP)
Content and Structure of a Master’s Program in Nurse-Midwifery
Graduate programs in nurse midwifery, as well as those with an additional focus in women’s health, can be divided into two segments that can be completed concurrently:
- Didactic education segment – between 40-60 semester credits
- Clinical education segment – at least 500 hours in nurse midwifery (additional 500 hours in women’s health for those in dual-focus programs)
This segment develops advanced theoretical concepts and key practice techniques, focusing on subjects like:
- Nurse midwifery for the antepartum, intrapartum, and postpartum woman
- Research methods for advanced-practice nurses
- Ethics in maternal healthcare
- Advanced physiology
- Disease prevention and health promotion
- Psychology for pregnancy
- Women’s reproductive health
- Complicated deliveries and pregnancies
To be eligible for prescriptive authority, APRNs must study the following subjects as part of their graduate education:
- Physical assessments
The clinical segment is where students translate their didactic knowledge into practice. Online programs work with students from around the time of initial enrollment to identify local clinical sites throughout Oregon. These programs share the goal of establishing clinical partnerships at convenient locations to minimize commuting and relocating.
Examples of potential clinical sites in Oregon may include:
- Oregon Health and Science University (OHSU) in Portland
- Providence Portland Medical Center
- Adventist Health in Portland
- Salem Hospital
- PeaceHealth Sacred Heart Medical Center in Eugene
- Saint Charles Health System in Bend
- Providence BirthPlace in Medford
- PeaceHealth Sacred Heart Medical Center RiverBend in Springfield
- Samaritan Albany General Hospital
With a master’s degree in nurse-midwifery or women’s health/nurse-midwifery, graduates can apply to take the national exams required to become certified nurse midwives or dually certified as nurse midwives/women’s health nurse practitioners.
Step 2. Become Nationally Certified in Nurse-Midwifery
The Oregon State Board of Nursing recognizes national certification through the American Midwifery Certification Board (AMCB) – sponsor of the Certificate in Nurse Midwifery (CNM) – as meeting the certification requirements for advanced practice licensure as a nurse midwife-nurse practitioner (NMNP) in the state.
Graduates of dual-focus nurse midwife/women’s health nurse practitioner programs may additionally elect do become dually certified through the National Certification Corporation (NCC) – sponsor of the Women’s Health Care Nurse Practitioner (WHNP-BC) credential.
To become nationally certified by the AMCB and/or NCC, candidates will need to pass each organization’s certifying exam. Candidates would register directly with the respective certifying organization, and upon doing so, they may then register with Applied Measurement Professional (APM) for an exam date and location. APM proctors both exams at H&R Block Centers located in the cities of:
- Klamath Falls
Both exams are computer-based and multiple choice.
Certified Nurse Midwife Exam
CNM candidates can prepare for this exam by reviewing the Candidate Handbook. The test is comprised of 175 questions with a time limit of four hours. The topics covered on the exam are:
- 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
Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Successful examinees will receive a Certificate in Nurse Midwifery (CNM) from the AMCB.
Women’s Health Care Nurse Practitioner (WHNP) Exam
Candidates can prepare for this exam by studying the WHNP Candidate Guide. The test is comprised of 150 scored questions, and may contain up to 25 unscored pretest questions. The time limit is 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, examinees 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 as an NMNP with the Oregon State Board of Nursing
After earning national certification, CNMs can submit an application packet for advanced practice licensure as a nurse midwife-nurse practitioner (NMNP) to the following address:
Oregon State Board of Nursing
17938 SW Upper Boones Ferry Road
Portland, OR 97224
Candidates with additional board certification in women’s health (WHNP-BC) may elect to apply for advanced practice licensure with the Oregon State Board of Nursing as a women’s health care nurse practitioner (WHCNP). Applying for both classifications would require candidates to send two application packets.
The board can usually process and determine if an application packet is complete within three weeks of receipt.
Prescriptive and Dispensing Authority
According to Oregon law, all nurse practitioners in the state must also apply for prescriptive authority with the Oregon State Board of Nursing. To be eligible for this, applicants must meet these conditions:
- Read the Prescriptive Authority in Oregon Handbook
- Have completed the required graduate-level education
- Register with the DEA (Drug Enforcement Agency)
If candidates are eligible for prescriptive authority they can also fill out an Application for Dispensing Authority, which allows them to dispense medicine to their patients.
Step 4. Begin a New Career in Nurse-Midwifery and Maintain Credentials
Applicants can determine if their license has been granted by looking themselves up on the Oregon State Board of Nursing’s online license verification system. Once the license has been activated, CNMs licensed as nurse midwife-nurse practitioners (NMNP) through the Oregon State Board of Nursing can begin pursuing their new career goals, which may include:
- Looking for promotional opportunities within their current place of employment
- Searching for job possibilities at the location where they completed their clinical education
- Starting their own birth center
- Joining with colleagues to form a local women’s health clinic
Examples of potential practice models and significant employers in Oregon include:
- OHSU’s Neonatal ICU, Center for Women’s Health, Family Birth Center, or Mother Baby Unit in Portland
- Birth Center at Asante Ashland Community Hospital
- Adventist Health’s Family Birth Place in Portland
- Samaritan Albany General Hospital’s Women’s Center
- Family Birth Center in
- Silverton Health’s Family Birth Center in Salem
- Salem Health’s Family Birth Center
- PeaceHealth’s Neonatal Intensive Care Unit in Springfield
- Family Birthing Center with Saint Charles Health System in Bend
- Asante Family Birth Center in Medford
- Alma Midwifery Services in Portland
- Andaluz Waterbirth Center in Portland
- Bella Vie Gentle Touch Birth Center in Salem
- Aurora Birth Center
The following listing shows actual job vacancies from across Oregon as listed in December of 2015. (These are shown as illustrative examples to provide prospective medical professionals with a sense of Oregon’s working environment, but do not constitute a job offer or assurance of employment.):
- Dually certified Nurse Midwife and Women’s Health NP with Kaiser Permanente Northwest in Hillsboro
- Certified Nurse Midwife with Women’s Healthcare Associates in Portland
- Women’s Health NP with Women’s Healthcare Associates in Portland
- Certified Nurse Midwife with Providence Medical Group Southern in Medford
- Nurse Midwife at Emanuel Medical Center in Portland
Renewing the APRN License with the Oregon State Board of Nursing
To be eligible for renewal, APRNs must maintain their appropriate national certification with the AMCB and/or NCC.
APRN licenses expire at the same time as RN licenses, both of which must be renewed before the end of the nurse’s birthday. Renewal is on a two-year cycle, with even-numbered birth years being renewed in even-numbered years, and vice-versa with odd-numbered birth years. Nurse midwife NPs and women’s health NPs can renew their licenses online starting 90 days before they expire.
Renewing Prescriptive and Dispensing Authority with the Oregon State Board of Nursing
Because nurse midwives and women’s health NPs must maintain their national certification, continuing education to renew their prescriptive authority is not required. If nurse midwife NPs and women’s health NPs continue to meet the eligibility for dispensing authority, they may also submit a renewal application for this privilege.
Maintaining National Certification with the American Midwifery Certification Board (AMCB)
To keep their national certification current certified nurse-midwives must enroll in the AMCB’s Certificate Maintenance Program. This involves completing one of the following every five years:
- Re-examination examination
- Three certificate maintenance modules and 20 hours of continuing education
Maintaining National Certification with the National Certification Corporation (NCC)
Women’s health NPs can maintain their national certification by enrolling in the NCC’s three-year maintenance program. This involves the completion of the NCC Continuing Competency Assessment, which will determine how many hours of continuing education (between 10-50 hours) are necessary over the three-year period.
Salaries for Certified Nurse-Midwives in Oregon
Nurse midwives in Oregon are extremely well paid according to the US Bureau of Labor Statistics. In fact, Oregon’s nurse midwives had the fourth highest salary in the country as of 2014. Salary data for 2015 from the Oregon Employment Department indicated that the average salary of certified nurse-midwives was at least 12% higher than the national average at all percentiles.
Certified nurse-midwives in Oregon earned an average salary of $113,474 as of 2015. Nurse midwives with salaries in the 90th percentile earned an average of $150,862—16.8% higher than the national average for nurse midwives in this category. CNMs in Oregon with salaries that fell within the 10th percentile (typically entry-level) earned 27.7% more than the national average at $84,178.
Job Growth Rates and Employment Trends for CNMs in Oregon
The Oregon Employment Department reported that the number of jobs for certified nurse-midwives in Oregon is expected to grow at a much faster rate than that for occupations as a whole in Oregon. The Department predicts a growth rate of 37.4% between 2012 and 2022. The growth rate for nurse midwife jobs is expected to be even higher in three regions of Oregon:
- Eastern Oregon—100%
Oregon’s Employment Department provided an analysis of the employers of certified nurse-midwives as of 2015. The Department reported that 171 nurse midwives were employed in the state that year. More than 98% of the nurse midwives in Oregon worked in the health care and social assistance field.
The category with the highest level of employment for nurse midwives in Oregon was ambulatory health care services. There were 152 nurse midwives employed in this industry. Ninety-six of these nurse midwives worked in the offices of health care practitioners other than MDs, while 56 were employed in the offices of physicians. Sixteen of Oregon’s nurse midwives worked in general medical and surgical hospitals.
Two jobs for nurse midwives in Oregon were advertised during December 2015. These listings are shown for informational purposes only and do not constitute a guarantee of employment:
- Northwest Women’s Clinic PC—Portland
- Providence Health & Services—Medford
Regional Salaries for Certified Nurse Midwives in Oregon
The Oregon Employment Department provides salary data from 2015 for two regions in the state. Nurse midwives in Rogue Valley with salaries the 10th percentile earned about $14,000 more than the average in the state for this bracket:
- 90th Percentile—$149,157
- 10th Percentile—$73,964
- 90th Percentile—$107,247
- 10th Percentile—$98,155