Certified nurse-midwives have been practicing in Texas since 1972. Since then, a growing proportion of women in the state have been turning to CNMs for antepartum, intrapartum and postpartum care. Countless studies acknowledge outstanding outcomes for births attended by nurse-midwives, and confirm what many women already know: The evidence-based interventions, personal attention, and superb quality of care that nurse-midwives provide makes them ideal healthcare providers for women during the childbearing years and through all ages and stages of life.
As advanced practice nurses, nurse-midwives possess the skills and knowledge necessary to manage all aspects of maternity care for women with healthy pregnancies. Their expertise, however, extends beyond pregnancy and delivery, encompassing all aspects of healthcare for women. Nurse-midwives care for women from adolescence to well beyond menopause, providing gynecological care, obstetrical care, family planning services and much more.
According to the American College of Nurse-Midwives, the majority of nurse-midwives in Texas practice in hospitals, although these healthcare providers also work in freestanding birth centers, ambulatory care settings, and in home birth practices, among others.
As of 2015, the American College of Nurse-Midwives reported that 452 certified nurse-midwives were licensed to practice in Texas. In 2013 alone, these CNMs attended more than 12,000 births—or nearly 5 percent of all vaginal births in the state that year.
Steps to Becoming a Nurse-Midwife in Texas
The Texas Board of Nursing regulates the practice of nurse-midwifery through licensure of advanced practice registered nurses (APRNs). To become a nurse-midwife in Texas, RNs must successfully complete a number of steps to meet all requirements for national certification through the American Midwifery Certification Board and APRN licensure through the Texas Board of Nursing:
Step 1. Earn a Qualifying Master’s Degree or Higher in Nurse-Midwifery
To become an APRN in nurse-midwifery in Texas, RNs must first complete a master’s degree or other graduate degree in nurse-midwifery accredited by the American Commission for Midwifery Education (ACME).
In addition to traditional nurse-midwifery programs, many institutions now offer dual specialization programs in nurse-midwifery/women’s health. These dual specialization programs allow students to expand their knowledge of women’s healthcare and expand their practice and certification options upon graduation.
ACME-accredited degree programs in nurse-midwifery often boast program features designed to appeal to working RNs. For example, part-time programs and programs offered either partially or completely online allow students to earn a master’s in nurse-midwifery at a more relaxed pace. Due to the lack of nurse-midwifery programs in the United States, online programs have become commonplace. For example, there are just two nurse-midwife degree programs in Texas: one in Waco and one in Lubbock.
For RNs who possess a Bachelor of Science in Nursing (BSN), the clear path to APRN licensure is the Master of Science in Nursing (MSN) in nurse-midwifery or the Master of Science (MS) in Nurse-Midwifery.
Candidates for nurse-midwifery programs must possess a Bachelor of Science in Nursing (BSN) and a current and unencumbered RN license. Many institutions also require students to possess:
- Minimum undergraduate GPA
- Letters of recommendation
- Nursing experience
- Admissions essay
In addition to MSN and MS degrees, ACME accredits a number of other graduate programs designed specifically for RNs at different stages of their education. For example:
- RN-to-MSN Degree Programs: RN-to-MSN bridge programs combine all aspects of a Bachelor of Science in Nursing (BSN) and a Master of Science in Nursing (MSN) in one accelerated dual-degree program designed for associate’s degree-prepared RNs.
- Post-Graduate Certificate Programs: Post-graduate certificate programs appeal to RNs who already possess a master’s degree in nursing but want to pursue initial APRN licensure as a nurse-midwife.
Nurse-midwifery and nurse-midwifery/women’s health master’s degree programs prepare nurses to serve as expert providers of healthcare to women across the lifespan. Graduates of these programs are prepared to provide and/or collaborate in the care of women and the healthy newborn in a variety of settings and serve as educators, leaders, consultants, and advocates.
The didactic component of a nurse-midwifery program allows students to incorporate knowledge from nursing and the related sciences into the delivery of advanced nursing care across diverse populations. The core curriculum of these programs includes study in:
- Theoretical foundations of advanced nursing practice
- Nursing in research
- Pharmacological principles
- Advanced health assessment
- Women’s health
- Intrapartum/newborn care
- Evidence-based care in nurse-midwifery
The clinical component of a nurse-midwifery or dual-focus nurse-midwifery/women’s health master’s program consists of up to 1,000 hours of practice, and allows students to receive valuable experience in a variety of clinical settings, such as hospitals, OB/GYN practices, birth centers, and women’s health clinics, and community health settings.
While campus-based programs in nurse-midwifery generally require students to complete their clinical rotations in established settings within close proximity to campus, institutions offering online programs often partner with clinical sites throughout the U.S., thereby allowing students to complete the clinical component of their nurse-midwifery program at sites close to home.
In Texas, nurse-midwifery students may satisfy some of their clinical requirements in settings such as:
- The Woman’s Hospital of Texas, Houston
- Texas Medical Center, Houston
- Texas Children’s Hospital – Pavilion for Women, Houston
- Conroe Regional Medical Center, Conroe
- University of Texas Medical Branch at Galveston, Galveston
- Texas Health Presbyterian Hospital, Plano
- Methodist Mansfield Medical Center, Mansfield
Step 2. Take and Pass the National Certification Examination to Become a CNM
After graduating from am ACME-accredited nurse-midwifery program, RNs in Texas must take and pass the Certified Nurse-Midwife (CNM) examination through the American Midwifery Certification Board to qualify for initial APRN licensure as a nurse-midwife.
Graduates of dual-focus nurse-midwifery/women’s health programs may also take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation to earn the WHNP designation and dual APRN licensure as a nurse-midwife and women’s health nurse practitioner.
Candidates must qualify to take the CNM and WHNP by completing an application and receiving approval from the appropriate certifying body. Once they receive approval to test, candidates must schedule to take the test through one of the Applied Measurement Professionals (AMP) testing centers located throughout the country.
In Texas, candidates may schedule to take their exam at one of the following AMP testing centers:
- El Paso
- Fort Worth
- San Antonio
Step 3. Apply for APRN Licensure as a Nurse-Midwife through the Texas Board of Nursing
To earn initial APRN licensure as a nurse-midwife in Texas, RNs must complete an Application for Licensure as an Advanced Practice Registered Nurse and Prescriptive Authority.
Candidates may also complete an online application. Candidates not applying for prescriptive authority DO NOT need to answer questions 11 and 12.
In addition to a completed application, candidates must:
- Submit an official transcript related to their advanced practice nursing education
- Enclose evidence of current national certification as a CNM
- Enclose an application fee of $100 or $150 if applying for APRN licensure with prescriptive authority
Candidates may only check ONE APRN specialty on the application. Candidates pursuing specialization as a women’s health nurse practitioner must complete a separate application.
Prescriptive Authority for Controlled Substances
Nurse-midwives in Texas requesting the authority to prescribe controlled substances must possess full licensure as an APRN with prescriptive authority and must meet all requirements (along with the delegating physician) as set forth by the Texas Medical Board (TMB). Nurse-midwives can contact the TMB at 512-305-7030.
After the TMB issues a controlled substances permit, nurse-midwives must apply for a DEA registration number.
Step 4. Explore Nurse-Midwife Career Options in Texas and Maintain Credentials
Certified nurse-midwives in Texas must maintain both their national certification(s) and APRN licensure as a nurse-midwife to practice midwifery in the State of Texas.
APRN License Renewal Requirements (Texas Board of Nursing)
Maintaining an APRN license in nurse-midwifery in Texas requires the completion of at least 20 contact hours of targeted continuing nursing education in nurse-midwifery on a biennial basis. CNMs that complete these contact hours satisfy both their RN and APRN license requirements.
CNMs with prescriptive authority must also complete at least five additional contact hours in pharmacotherapeutics.
Nurse-midwives must renew their RN and APRN licenses online.
CNM Renewal Requirements (American Midwifery Certification Board)
The American Midwifery Certification Board features a Certification Maintenance Program, which 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. The number of continuing education credits required for renewal is dependent upon the result of the assessment.
Resources for Nurse-Midwives in Texas
From large hospital systems to small midwifery practices, Texas nurse-midwives have a vast array of opportunities when starting or advancing their careers. Just a few of the locations in Texas where nurse-midwives may find job opportunities include:
- The Women’s Specialists of Houston, Houston
- Austin Area Birthing Center, Austin
- Birth & Women’s Center, Dallas
- Women’s Care Center, Houston
- West Houston Birth Center, Houston
- Corpus Christi Birth Center, Corpus Christi
- House of Birth, Sherman
- Childbirth Services, Tyler
Although the following job posts (sourced in December 2015) are for illustrative purposes only, they do provide job hunters with a good idea of the types of nurse-midwives jobs available to CNMs in Texas:
- Certified Nurse-Midwife, Texas Health Physicians Group, Kaufman
- Certified Nurse-Midwife, Texas Children’s Hospital, Houston
- Nurse-Midwife/Women’s Health Nurse Practitioner, UT Health Science Center at Houston, Houston
- Nurse-Midwife, Parkland Health & Hospital System, Dallas
- APRN Nurse-Midwife, Department of the Army, El Paso
Certified nurse-midwives in Texas interested in branching out on their own and starting a birth center or other private midwifery practice may find professional associations in Texas to be valuable sources of information and assistance:
- Association of Texas Midwives
- North Texas Midwives
- Consortium of Texas Certified Nurse-Midwives
- Texas Nurse Practitioners
- North Texas Nurse Practitioners
Salaries for Certified Nurse-Midwives in Texas
According to the National Vital Statistics Report published by the Centers for Disease Control and Prevention (CDC) in 2010, a total of 5,964 out-of-hospital births took place in Texas between 2005 and 2006. The location of those births was split nearly equally between those that took place in-home and those that took place in birthing centers. That year 49% were home births, while 51% occurred within freestanding birthing centers.
Although the majority of births in Texas are still hospital births, the number of women choosing an out-of-hospital birthing experience has increased in recent years. In fact, between 2003 and 2006, the percentage of home births in Texas increased by 2.8%, which was just minimally below the national increase of 3.5%. Statistics such as these reveal an increase in the number of women choosing nurse-midwifery services over traditional medical practice, and this shift is likely to lead to positive career opportunities for certified nurse-midwives in Texas.
In 2014, occupational data researched and published by the Texas Workforce Commission indicated that the average midwife salary in Texas was $103,441, (average hourly wage of $49.73). Starting salary offers ranged between $73,362 and $87,194 with an average starting salary of $79,206 and a statewide median salary of $102,544. Salaries for experienced CNMs ranged between $116,709 and $128,336, with the average among the most experienced CNMs in Texas being $115,565 as of 2014.
Job Forecast for Certified Nurse-Midwives in Texas
In 2012, the Texas Workforce Commission projected that the demand for certified nurse-midwives would increase by 35% in the 10-year period between 2012 and 2022.
About 50% of job opportunities available during that time is expected to be a direct result of growth and demand for midwifery services, while the other half is expected to be related to job replacement factors, mainly retirement. In comparison, in 2012, the US Bureau of Labor Statistics projected that the need for certified nurse-midwives nationally would increase by an average of 29% over that same time period.
Clearly, the preference for midwifery services is growing at a much faster rate in Texas than it is in much of the rest of the country. The data below provides a look at occupational growth rates for nurse-midwives in Texas by city (2012-2022):
- Gulf Coast WDA (Harris County), including Houston: 20%
- Dallas County WDA: 33.3%
Certified Nurse-Midwife Salaries in Texas by Location
Quite often salary is affected by geographic location, as occupational demand tends to vary within different regions of the
state. Shown here is a list of nurse-midwife salaries in Texas by location, based on data published by the Texas Workforce Commission in 2014:
- Entry-Level: $79,206
- Median: $102,544
- Average: $103,441
- Experienced: $115,565
Austin-Round Rock-San Marcos
- Entry-Level: $68,827
- Median: $88,421
- Average: $92,726
- Experienced: $104,666
- Entry-Level: $100,859
- Median: $113,859
- Average: $114,629
- Experienced: $121,534
- Entry-Level: $100,859
- Median: $113,859
- Average: $114,629
- Experienced: $121,534
- Entry-Level: $70,658
- Median: $100,318
- Average: $97,074
- Experienced: $110,261
A full analysis of midwife salaries across Texas is shown in the table below for comparative purposes (data published by the U.S. Department of Labor, Bureau of Labor Statistics, in 2014):