Vermont’s nurse-midwives celebrate the joys of helping women transition to the role of mother, while also serving the general health and gynecological needs of women, from adolescence through menopause.
One notable employer of certified nurse-midwives in Vermont, Fletcher Allen Health Care in Burlington, employs fifty CNMs, all of whom provide patients with care ranging from well woman OB/GYN and family planning to obstetrics, antepartum, and birth services.
Nurse-midwives at Fletcher Allen Health Care, like other nurse-midwives across the state, view birth as a natural process, working to give women an alternative to invasive procedures in a state where the caesarean-section rate remains at nearly 30 percent. Vermont nurse-midwives support the best practices for health by putting the birthing process back in the hands of women.
And if recent statistics by the American College of Nurse-Midwives are any indication, it is clear that women in Vermont feel the same way. For example, in 2013 alone certified nurse-midwives attended nearly 1,300 births in Vermont—that’s nearly 29 percent of all routine births in the state that year.
Licensed as advanced practice registered nurses (APRN), nurse-midwives in Vermont often practice independently. Certified nurse-midwives in the state enjoy a regulatory environment that supports and respects the autonomy of CNMs, as Vermont is an independent practice state where there is no requirement to maintain a collaborative agreement with a physician.
Steps to Becoming a Nurse-Midwife in Vermont
The Vermont Board of Nursing licenses certified nurse-midwives (CNM) as advanced practice registered nurses (APRN). RNs in Vermont interested in becoming nurse-midwives need to meet the license requirements for APRN licensure as set forth by the Board, which requires completing the following steps:
Step 1. Earn a Qualifying Graduate Degree in Nurse-Midwifery
APRN nurse-midwives in Vermont must complete a nurse-midwifery master’s degree or other graduate degree accredited by the Accreditation Commission for Midwifery Education (ACME).
Since there are so few nurse-midwife programs available in the US, Many ACME-accredited master’s degree programs are available online. This allows students to complete a nurse-midwifery program, regardless of their geographic location. This is particularly beneficial for Vermont RNs interested in becoming certified nurse-midwives, as there are no campus locations in the state that offer nurse-midwifery graduate programs.
Aspiring nurse-midwives may also choose dual-focus programs to expand their scope of practice. One of the most popular dual specialization master’s degrees is the nurse-midwifery/women’s health nurse practitioner master’s option. These programs allows graduates to pursue national certification as both a Certified Nurse-Midwife (CNM) and a Women’s Health Nurse Practitioner (WHNP) and achieve recognition in both APRN specializations at the state level in Vermont.
CNMs in Vermont who also possess the WHNP certification may enjoy a broader scope of practice and more professional opportunities.
Accredited Programs for Non-Bachelor’s Prepared RNs in Vermont
Although bachelor’s prepared RNs in Vermont may complete a conventional master’s in nurse-midwifery to qualify for APRN nurse-midwife licensure, RNs who possess associate’s degrees are not qualified for these programs. However, there are a number of accredited RN-to-MSN programs designed specifically for associate’s-prepared RNs who must complete both a Bachelor of Science in Nursing (BSN) and a Master of Science in Nursing (MSN). These accelerated programs allow RNs to complete both their BSN and MSN in less time than it would take to complete a traditional BSN and MSN.
Post-graduate certificate programs in nurse-midwifery are a smart alternative for RNs in Vermont who already possess master’s degrees in nursing, allowing master’s-prepared RNs to complete classroom study and clinical rotations in nurse-midwifery as to achieve initial APRN licensure.
Nurse-Midwifery Program Features
Nurse-midwifery programs prepare students for practice in the field while also providing them with a framework for clinical leadership and policy.
The didactic coursework of these programs provides students with a solid foundation in the scientific basis for clinical practice, allowing them to provide safe nurse-midwifery care using sound clinical judgment. Coursework includes study in:
- Advanced health and physical assessment
- Advanced physiology and pathophysiology
- Advanced pharmacology for primary care
- Antepartum and postpartum management
- Concepts for advanced nursing practice
- Reproductive healthcare
- Nurse-midwifery management of the intrapartum period
- Reproductive healthcare management
Nurse-midwife programs offer strong clinical experiences focused on evidence-based practice. Students complete clinical rotations in settings ranging from hospitals to birth centers to private OB/GYN practices and beyond.
In Vermont, students may complete part of their clinical requirements at clinical sites such as:
- The Women’s Health Center, Springfield
- Central Vermont Women’s Health, Berlin
- Copley Hospital, Morrisville
- UVM Medical Center Obstetrics and Midwifery, Burlington
- UVM Medical Center Maternal Fetal Medicine, Burlington
Institutions with campus-based nurse-midwifery programs partner with clinical sites close to campus, while many institutions with online nurse-midwifery programs partner with schools throughout the U.S., which allow students to complete their clinical rotations at sites close to home.
Admission Requirements for Nurse-Midwifery Programs
Schools offering nurse-midwifery graduate programs require candidates to possess:
- Current and unencumbered RN license
- A BSN from an accredited college or university
- Minimum undergraduate GPA
- RN work experience
- Admissions essay
Step 2. Take and Pass the National Certification Examination
RNs in Vermont who have successfully graduated from an ACME-accredited master’s program in nurse-midwifery go on to take and pass the Certified Nurse-Midwife (CNM) examination through the American Midwifery Certification Board.
RNs who have successfully graduated from an accredited dual-focus program in nurse-midwifery/women’s health may also take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation, if desired.
Candidates must apply to take the CNM examination (and the WHNP exam, if applicable) and receive approval from the certifying agency before they can schedule their examination through one of the Applied Measurement Professionals (AMP) testing centers located throughout the U.S. In Vermont, there is an AMP testing center located in Burlington.
Step 3. Apply for an APRN License in Nurse-Midwifery through the Vermont Board of Nursing
Once candidates have achieved the CNM designation, they must apply for APRN licensure as a nurse-midwife through the Vermont Board of Nursing. In addition to the Advanced Practice Registered Nurse Application, candidates must submit the following to the Board:
- Application fee of $75
- Passport-size (2×2) photo
- Copy of driver’s license or government-issued ID or passport
- Official transcripts of nurse-midwifery program sent directly from the institution
- Copy of current CNM certification
- Practice Guidelines
- Collaborative Agreement (for APRNs in the transition to practice period) OR the APRN Attestation of Completion of Transition to Practice (for APRNs who have fulfilled the required hours); the transition to practice period in Vermont is 2,400 hours and two years for the primary credential and 1,600 hours and 1 year for the secondary credential
Step 4. Maintain APRN Licensure and National Certification in Nurse-Midwifery
Vermont nurse-midwives must ensure they practice with a valid RN license, APRN license, and CNM certification.
APRN Renewal Requirements- Vermont Board of Nursing
Nurse-midwives in Vermont must renew their APRN license biennially on odd-numbered years by completing the APRN Renewal Application and submitting a processing fee of $215.
To renew an APRN license, nurse-midwives in Vermont must show documentation of the completion of at least 400 hours (50 days) of practice in the previous 2 years and proof of current CNM certification. Nurse-midwives who have not yet completed their transition to practice period must also submit their current collaborating provider agreement.
CNM Renewal Requirements – American Midwifery Certification Board
The American Midwifery Certification Board has a Certification Maintenance Program, which allows CNMs to satisfy their continuing education requirements by completing one of the following options:
- 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 Vermont
Nurse-midwives in Vermont may practice in any number of settings, including hospitals, birth centers, and private OB/GYN practices, among others. Some of the top employers of nurse-midwives in Vermont include:
- University of Vermont Medical Center, Burlington
- Porter Medical Center, Middlebury
- Northeast Vermont Regional Hospital, St. Johnsbury
- Central Vermont Medical Center, Berlin
- Copley Hospital, Morrisville
- Fletcher Allen Health Care, Burlington
- Gifford Medical Center, Randolph
- Northwestern Medical Center, St. Albans
Vermont’s professional associations often provide nurse-midwives with useful resources when starting or advancing their careers, or when establishing an independent practice:
Salaries for Certified Nurse-Midwives in Vermont
In 2014, salary data published by the Vermont Department of Labor revealed the average nurse midwife salary in the state to be $93,390. The median salary was noted to be just 0.3% higher than the average at $93,680.
The US Bureau of Labor Statistics estimates that the number of certified nurse-midwives in the US will increase by 31% in the years between 2012 and 2022, a trend that speaks to the positive career outlook for nurse-midwives in Vermont as well.
According to the Vermont Department of Health, in 2009, a total of 195 babies were delivered at Gifford Medical Center in Randolph, Vermont. Of those 80 were delivered by a medical physician and 115 were delivered by a certified nurse midwife. There was also a nearly equal division of services at Northeastern Vermont Regional Hospital as well with 54% of babies delivered by medical physicians and 46% delivered by certified-nurse midwives. In addition, 35% of births at Brattleboro Memorial Hospital in Brattleboro were midwife-attended as well.
Trends in Nurse-Midwifery Observed in Vermont
In January of 2012, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) Data Brief was published detailing the prevalence of home birthing in the United States. The report revealed that Vermont had the 3rd highest percentage of at-home births in the nation in 2009 with 1.91% of all births in the state taking place in a home setting that year. It’s interesting to note that between 2003 and 2006 the frequency of at-home births in Vermont actually dropped by 7.8%. However, by 2009, the trend had reversed as Vermont was ranked 3rd highest in the nation for homebirths.
It’s important to recognize that midwives are actively involved in women’s healthcare whether in-hospital or out-of-hospital, and in fact, the majority of babies in Vermont delivered by nurse-midwives are delivered in hospitals. In 2009, according to the Vermont Department of Health, certified nurse-midwives in Vermont delivered about 1,300 babies. Below is a breakdown of the percentage of midwife-attended births by facility in 2009:
- Fletcher Allen Health Care: 21.5%
- Southwestern Vermont Medical Center: 12.2%
- Brattleboro Memorial Hospital: 9.7%
- Gifford Medical Center: 8.8%
- Northeastern Vermont Regional Hospital: 7.3%
- Copley Hospital: 7.2%
- Central Vermont Medical Center: 5.5%
- Porter Medical Center: 3.8%
- North Country Hospital & Health Center: 3.6%
Nurse Midwife Salaries in Vermont by Location
In 2013, the American College of Nurse-Midwives (ACNM) reported salary data similar to that of the Vermont Department of Labor. The ACNM reported an average salary among nurse-midwives in Vermont of $94,370, while the Vermont Department of Labor reported an average salary of $93,390. Here is a look at salary by location and experience level throughout Vermont (Vermont Department of Labor, 2013):
- Average: $93,390
- Median: $93,680
- Entry-Level: $77,760 to $84,270
- Experienced: $104,740 to $116,520
- Average: $91,990
- Median: $96,970
- Entry-Level: $63,170 to $80,220
- Experienced: $108,560 to $116,760
Southern Vermont Balance of State
- Average: $90,820
- Median: $90,680
- Entry-Level: $80,730 to $84,490
- Experienced: $96,760 to $107,060