According to an August 2015 article in The Tennessean, birthing centers are gaining in popularity throughout the state, which is good news for nurse-midwives who call Tennessee home.
For example, a new boutique birth center, Baby + Co., which recently opened its doors in Nashville, appeals to women seeking natural births without the use of invasive procedures and epidurals. The owners of this new birth center chose Nashville because hospitals in the city already offer midwife-assisted deliveries, so women here are familiar with the concept. For example, St. Thomas Health has six nurse-midwives on staff, while Vanderbilt University Medical Center has two-dozen nurse-midwives working in its women’s health center.
Nurse-midwives are advanced practice nurses who not only provide women with comprehensive maternity care, but also primary care, gynecologic care, preconception care, family planning services, and even care of the newborn during the first 28 days of life. In Tennessee, these healthcare providers have the authority to prescribe medications, order laboratory tests, and provide health education and counseling to women of all ages, thus serving as valuable members of the healthcare team.
The American College of Nurse-Midwives reported that 204 CNMs were licensed to practice in Tennessee as of 2015. These healthcare practitioners attended nearly 4,600 births in 2013 alone, representing about 9 percent of all births in Tennessee that year.
Steps to Becoming a Nurse-Midwife in Tennessee
The Tennessee Board of Nursing licenses certified nurse-midwives as advanced practice nurses (APNs). RNs in Tennessee with aspirations of becoming nurse-midwives must ensure they meet Board requirements for APN certification, which involves completing the following steps:
Step 1. Earn a Qualifying Master’s Degree or Higher in Nurse-Midwifery
To become a nurse-midwife in Tennessee, RNs must complete a master’s degree or higher in nurse-midwifery through one of the schools offering programs accredited by the American Commission for Midwifery Education (ACME).
Master’s Degrees in Nurse-Midwifery and Nurse-Midwifery/Women’s Health
Bachelor’s prepared RNs can satisfy the educational requirements for initial APN certification and national certification as a certified-midwife by completing an ACME-accredited Master of Science in Nursing (MSN) with a concentration in nurse-midwifery or a Master of Science (MS) in Nurse Midwifery.
Though most graduate nursing students hold a BSN, RNs in Tennessee with different levels education may also earn initial APN state certification and national certification as a nurse-midwife by completing an ACME-accredited program that accommodates their current level of education. For example:
- RN-to-MSN Programs: RN-to-MSN programs combine both bachelor and master degree components for RNs who currently possess associate’s degrees. These accelerated programs take into account a student’s previous education and work experience, both of which accelerate the process of achieving both a BSN and an MSN.
- Post-Graduate Certificate Programs: Post-graduate certificate programs in nurse-midwifery appeal to master’s-prepared RNs pursuing initial APN state certification as a nurse-midwife or currently certified APNs pursuing an additional APN specialty as a nurse-midwife.
Many master’s degrees in nurse-midwifery have begun offering students the option of pursuing dual specialization, the most popular being the nurse-midwife/women’s health. Graduates of nurse-midwife/women’s health master’s degrees are eligible to achieve both Certified Nurse-Midwife (CNM) and Women’s Health Nurse Practitioner (WHNP) national certification and pursue dual APN state certification in Tennessee.
Popular options for today’s graduate students in nurse-midwifery include part-time scheduling and online coursework, both of which appeal to today’s working RNs. Due to the lack of nurse-midwifery programs in the U.S. (there is just one in Tennessee, located in Nashville), online programs allow students to complete all require coursework at their location of choice.
Nurse-Midwifery Program Details
Nurse-midwifery master’s degrees provide students with advanced preparation in the assessment and management of the changing health patterns in women across the lifespan, with emphasis on antepartum, intrapartum and postpartum care and general gynecological care.
The coursework of these programs emphasizes a wellness paradigm and uses a scientific, evidence-based rationale for practice. Didactic coursework includes:
- Nursing research
- Advanced pathophysiology
- Advanced health assessment
- Clinical pharmacology
- Advanced health promotion across diverse cultures
- Primary care of women
- Intrapartum, postpartum, and neonatal
The clinical component of these programs, which often exceeds 1,000 hours of practice, allows students to earn valuable, hands-on experience in a wide variety of settings, including hospitals, community health clinics, birth centers, and OB/GYN practices. Institutions offering online nurse-midwifery programs often partner with clinical sites throughout the U.S, which allow students to complete their clinical practicum at sites close to home, regardless of their geographic locations.
In Tennessee, students may satisfy their clinical requirements at sites such as these:
- Baptist Memorial Hospital for Women, Memphis
- Women’s Hospital at Centennial, Nashville
- Tennessee Women’s Care, Hermitage
- Erlanger Women’s East, Chattanooga
- Memorial Ooltewah Women’s Center, Ooltewah
Admission Requirements
To qualify for admission into a master’s degree in nurse-midwifery or nurse-midwifery/women’s health, candidates must possess a valid RN license and a bachelor’s degree from an accredited college or university. Depending on the program, students may also need to possess:
- A personal statement
- Letters of reference
- Minimum undergraduate GPA
- RN experience
Step 2. Take and the Pass the National Certification Examinations
To earn APN certification as a nurse-midwife in Tennessee, the Board of Nursing requires candidates to take and pass the Certified Nurse-Midwife (CNM) exam through the American Midwifery Certification Board.
Graduates of a nurse-midwifery/women’s health program may also choose to take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation in order to add the WHNP credential.
Once approved to take the appropriate examination, candidates must schedule exam dates through Applied Measurement Professionals (AMP).
AMP testing centers are located throughout the U.S. In Tennessee, AMP testing centers are located in:
- Chattanooga
- Johnson City
- Knoxville
- Memphis
- Nashville
Step 3. Apply for APN Certification through the Tennessee Board of Nursing
Once candidates achieve national CNM certification, they would then apply for APN state certification through the Tennessee Board of Nursing, which requires the completion of the Advanced Practice Nurse Application.
Applicants also seeking APRN certification as a women’s health nurse practitioner must complete a separate application.
In addition to a completed, signed, and notarized application, candidates must:
- Submit a 2×2 passport photograph
- Have page 4 of the application completed by the Dean, Director, or Chairman of the nurse-midwife program
- Request an official nursing transcript from the institution (must be sent directly to the Board)
- Provide official verification of current CNM certification
- Complete the mandatory practitioner profile questionnaire (included in application)
- Submit the certificate fee of $210
- Complete an Application for Prescriptive Authority (part 4 of the application), if seeking prescribing privileges)
- Note: Nurse-midwives in Tennessee must complete a Notice and Formulary every time they change prescription formulary, practice site, or supervising physician. Nurse-midwives must also apply for and obtain a DEA number before prescribing controlled substances.
Step 4. Now That You’re a Nurse-Midwife in Tennessee
Throughout their careers, certified nurse midwives must ensure their RN license, CNM certification, and APN certification remain current through renewal and continuing education.
APN Certificate Renewal – Tennessee Board of Nursing
Nurse-midwives must renew their APN certificate on a biennial basis. The cost of renewal is $110. Nurse-midwives in Tennessee complete the APN certificate renewal process online through the Tennessee Department of Health License Renewal and Information Update Service.
Tennessee’s APNs are required to show proof of current CNM certification. APNs in Tennessee with prescribing privileges must also complete at least two contact hours of continuing education in controlled substance prescribing practices during each renewal period.
CNM Renewal Requirements – American Midwifery Certification Board
The American Midwifery Certification Board’s Certification Maintenance Program allows CNMs to satisfy their continuing education requirements by 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
WHNP Renewal Requirements – National Certification Corporation
The National Certification Corporation requires WHNPs to take a continuing competency assessment at the beginning of each three-year maintenance cycle and complete a specific number of continuing education credits hours based on the results of the assessment.
Resources for Nurse-Midwives in Tennessee
Tennessee is home to a wide array of institutions where nurse-midwives may begin or advance their careers:
- West End Women’s Health Center, Old Hickory
- West Tennessee Women’s Center, Jackson-Madison County General Hospital, Jackson
- Mary’s Birth and Midwifery Center, Knoxville
- Hope Clinic for Women, Nashville
- Vanderbilt One Hundred Oaks: Women’s Health, Nashville
Tennessee’s many professional associations may also be ideal sources of information for nurse-midwives interested in starting their own birthing center or private midwifery business:
- Tennessee Midwives Association
- Tennessee Nurses Association
- Middle Tennessee Advanced Practice Nurses
- Greater Memphis Area Advanced Practice Nurses
Salaries for Certified Nurse-Midwives in Tennessee
As of 2014, the median nurse midwife salary in Tennessee was $68,976, according to occupational data published by the Tennessee Department of Labor & Workforce Development. The starting salary for nurse-midwives in Tennessee averaged $57,185 in 2014, while more experienced nurse-midwives in the state earned an average of $77,907 that year.
Growing Interest in Nurse-Midwifery Leads to More Opportunities for Tennessee’s CNMs
In 2010, the Centers for Disease Control and Prevention (CDC) released the National Vital Statistics Report, which revealed some interesting trends in home birthing. In 2006, approximately 0.95% of all births in Tennessee were out-of-hospital births. Of those births, 0.55% took place in a home setting, 0.35% took place in freestanding birth centers, and 0.02% took place in a clinic or doctor’s office.
One of the most interesting facets of this report is that the percentage of home births in Tennessee increased by 5.8% between 2003 and 2006. Nationally, between 2004 and 2005, the number of out-of-hospital births increased by 3% and the number of at-home births increased by 5%. Statistics like these indicate a growing interest in midwifery services and bodes well for career opportunities for Tennessee’s CNMs.
The Tennessee Department of Labor & Workforce Development has projected that employment opportunities for nurse-midwives will increase by 30% between 2012 and 2022, while the overall average projected job growth rate in the state is just 11% over the same ten-year period. It’s worth noting, though, that employment opportunities for nurse-midwives vary by location.
Shown below is the expected increase in demand between 2012 and 2022 by location:
- Bledsoe, Bradley, Hamilton, McMinn, Marion, Meigs, Polk, Rhea, and Sequatchie Counties: 27% (includes Chattanooga)
- Cheatham, Dickson, Houston, Humphreys, Montgomery, Robertson, Stewart, Sumner, and Williamson Counties: 41% (includes Clarksville)
- Fayette and Shelby: 37% (includes Memphis)
Nurse Midwife Salaries in Tennessee by Location
In Tennessee, the average starting salary statewide for a nurse midwife is $57,185. However, in the Nashville-Davidson-Murfreesboro area, the average starting salary is slightly higher at $58,841. Salaries among certified nurse-midwives in Tennessee by location are shown here as reported by the Tennessee Department of Labor & Workforce Development in 2014
Statewide
- Starting: $57,185
- Median: $68,976
- Experienced: $77,907
Nashville-Davidson-Murfreesboro
- Starting: $58,841
- Median: $68,652
- Experienced: $75,558
