Transform Lives: Virginia CNM 2026 Guide

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Understanding the CNM Designation in Virginia

In Virginia, Certified Nurse-Midwives are classified as Advanced Practice Registered Nurses (APRNs) and licensed as nurse practitioners through the Virginia Board of Nursing. This classification distinguishes CNMs from other midwifery designations and, as of July 2025, grants them full independent practice authority after completing 1,000 hours of supervised clinical experience.

It’s essential to understand how Virginia distinguishes between different types of midwives:

Certified Nurse-Midwives (CNMs) – Hold a master’s or higher degree, national certification through the American Midwifery Certification Board (AMCB), and are licensed as nurse practitioners through the Virginia Board of Nursing. CNMs can practice independently without collaborative agreements after completing 1,000 supervised clinical hours.
Direct Entry Midwives (DEMs) – Have less formal education and training, generally have no nursing credentials, and must work under the supervision of a certified medical professional or another independently practicing midwife.

This distinction reflects the advanced training and qualifications of CNMs, positioning them as experts in facilitating births and providing gynecological and obstetric care throughout a woman’s life.

2025 Legislative Changes Transform Virginia Midwifery Practice

Virginia made history in 2025 with the passage of groundbreaking legislation that positions the state as a national leader in midwifery practice:

Independent Practice Authority: CNMs may now practice without a collaborative practice agreement after completing 1,000 hours of supervised clinical experience. Unlike other nurse practitioners, CNMs don’t need to apply for a special “autonomous practice” designation—only documentation of completed hours is required.

Full Reimbursement Parity: HB 1923 mandates 100% reimbursement parity from private insurers and Medicaid for all midwife types, ensuring CNMs receive equal payment for equal services.

Expanded Hospital Privileges: HB 1904 allows CNMs to serve on 24-hour on-call duty rosters for general care newborn nurseries, addressing critical staffing shortages in rural hospitals.

These changes, effective July 1, 2025, significantly enhance career opportunities and practice autonomy for Virginia CNMs.

Steps to Become a Certified Nurse-Midwife in Virginia

These steps offer a clear path for Virginia RNs interested in becoming certified nurse-midwives, from education and national certification in nurse-midwifery to nurse practitioner specialty licensing as an accredited nurse-midwife through the Virginia Board of Nursing:

	Earn a Qualifying Master’s Degree or Higher in Nurse-Midwifery
	Complete the AMCB National Certification Exam
	Apply for Nurse Practitioner Licensure in Virginia as a CNM
	Begin a Career as a Certified Nurse-Midwife in Virginia
	Salaries for Certified Nurse-Midwives in Virginia
	FAQs

Step 1. Earn a Qualifying Master’s Degree or Higher in Nurse-Midwifery

To meet the requirements for national certification through the American Midwifery Certification Board (AMCB) and nurse practitioner licensure as a nurse-midwife through the Virginia Board of Nursing, registered nurses with licenses in good standing must complete a master’s or higher degree through a program recognized by the Accreditation Commission for Midwifery Education (ACME). While several flexible online master’s degree programs are available to accommodate working RNs, Shenandoah University is currently the only school physically located in Virginia with a qualifying ACME-accredited program.

Shenandoah University Program Update: Shenandoah University’s nurse-midwifery program received continued ACME accreditation through July 31, 2035, following its most recent review in July 2025. The program, initially accredited in June 1997, continues to demonstrate excellence with a 100% AMCB certification pass rate for 2023 and 2024 graduates.

Program Options for Aspiring Nurse-Midwives

Program Type	Designed For	Typical Duration
MSN/MS Programs	RNs with Bachelor of Science in Nursing (BSN) degrees	2-3 years full-time
RN-to-MSN Programs	RNs with associate’s degrees in nursing	3-4 years full-time
Post-Graduate Programs	RNs with an MSN wanting to add CNM certification	1-2 years full-time
DNP Programs	RNs seeking the highest level of clinical preparation	3-4 years full-time

Admission Requirements
Typical entry requirements for graduate programs in nurse-midwifery are similar to those of most graduate-level nursing programs nationwide. These often include:

Letters of recommendation
Current RN license in good standing
Personal essay, video essay, or statement of purpose
BSN or completion of nursing prerequisite courses
GRE General Test (some programs waive this requirement)
Minimum 3.0 GPA
1-2 years of clinical nursing experience (often in labor and delivery or women’s health)

Program Structure and Components
All ACME-accredited programs meet the ACNM requirements for taking the CNM certification exam. These include:

40-60 credits of didactic curriculum
Specialized Midwifery courses requiring a minimum of 600 clinical hours and as many as 720
- The hours vary due to the unpredictable nature of birth
Completion of an Evidence-Based Practice Project or thesis

Midwifery programs cover a variety of topics that encompass the general knowledge that an advanced practice nurse requires:

Advanced Pharmacology and Therapeutics
Advanced Pathophysiology
Advanced Health Assessment
Health Promotion and Disease Prevention
Research Methods and Evidence-Based Practice
Healthcare Policy and Ethics

Coursework specific to the major would typically include:

Antepartum Care and Complications
Intrapartum and Postpartum Care
Women’s Reproductive Health
Newborn Care
Advanced Integrated Midwifery
Primary Care for Women
Multicultural Midwifery
Legal Issues and Ethics in Maternal Healthcare
Professional Issues in Nurse-Midwifery

While the classroom will encompass most of the theoretical discussion needed to prepare someone for a career in nurse-midwifery, clinical experience is required to transition into full practice. The Virginia Board of Nursing requires at least 720 hours of supervised residency under a licensed practitioner or APRN to qualify for licensure. An advisor will assist students of online programs with finding an appropriate clinical environment. Participating facilities in Virginia include:

The Virginia Hospital Center, Arlington
Sentara Norfolk General Hospital, Norfolk
Carilion Roanoke Memorial Hospital, Roanoke
Winchester Medical Center, Winchester
Augusta Health, Fishersville
University of Virginia Medical Center, Charlottesville
VCU Medical Center, Richmond

Clinical observations will put students in direct contact with pregnant women and provide students with a first-hand look at women’s needs during the birthing process, including:

Comprehensive antepartal care
Prenatal care
Applied obstetrics
Ambulatory care
Labor and delivery management
Postpartum care
Well-woman gynecology
Primary care for women across the lifespan

Step 2. Successfully Complete the Exam for National Certification in Nurse-Midwifery

A master’s degree in midwifery qualifies candidates to sit for the AMCB National Certification Examination. The AMCB’s qualifications are subject to change at any time, and an up-to-date copy can be found here. As of January 2026, a candidate must uphold all of the following requirements to be eligible to take the exam:

Maintain licensure as a Registered Nurse in one of the 50 states, a U.S. territory, or the District of Columbia
- Proof consists of a copy of the licensure that is valid on the date of the examination
Satisfactory completion of a graduate degree program that has met the institutional requirements prescribed by ACME
Verification by the director of a nurse-midwifery program confirming that institutional requirements are met
Attestation by the director of the nurse-midwifery program that the candidate is performing at the level of a safe, beginning practitioner

Applicants to the exam must apply within 24 months of completing their program. The application is available here. It can be completed online, but applicants may request a hard copy of the form to be submitted alongside their required credentials. Those required credentials include:

Proof of licensure
$550 examination fee
$125 processing fee
- This fee is forfeited if an applicant’s exam needs to be rescheduled or if an applicant is late to their examination. In either event, the applicant will need to be reassessed.
Your application (if a hard copy is submitted)

All of these materials should be submitted to:

AMCB
849 International Drive, Suite 120
Linthicum, MD 21090

Applicants will schedule their examination online through PSI Testing. In Virginia, there are testing centers available in:

Alexandria
Fredericksburg
Norfolk
Richmond
Roanoke
Charlottesville

Addresses and specific directions to these testing centers are available here.

Studying for and Passing the Exam
Candidates can use the Candidate Handbook as a study guide leading up to the exam. It features an overview of the exam as well as an overview of the topics that will be covered. These include:

Antepartum: 19-26 percent
Intrapartum: 17-26 percent
Postpartum: 15-18 percent
Newborn: 7-16 percent
Well Women/Gyn: 15-18 percent
Women’s Health/Primary care: 8-16 percent

The exam consists of approximately 175 multiple-choice questions, and candidates have four hours to complete it. A score of approximately 75% is needed to pass, though this can vary slightly with each administration. Results are typically available immediately after the examination is completed.

Step 3. Apply for Nurse Practitioner Licensure in Virginia as a Certified Nurse-Midwife

Upon successfully completing the exam and becoming certified, CNMs will be eligible to seek licensure as nurse practitioners specializing in nurse-midwifery in Virginia. The Virginia Board of Nursing offers two pathways for APRN licensure: examination (for new graduates) and endorsement (for those already licensed in another state).

Application by Examination

First-time APRN applicants in Virginia must apply through the examination pathway, which requires:

Proof of licensure as a registered nurse in Virginia or proof of multistate licensure privilege
A graduate degree in nursing with specialization as a nurse-midwife
Submit evidence of current specialty certification (CNM certification)
Submit a registration fee of $125
Completion of an online application through the Virginia Board of Nursing website

Application by Endorsement

For CNMs already licensed in another state, Virginia offers an endorsement pathway, which requires:

Verification of current licensure and good standing in another jurisdiction
Proof of current AMCB certification
Documentation of meeting Virginia’s practice requirements
Payment of applicable fees

Prescriptive Authority in Virginia

As nurse practitioners, CNMs have prescriptive authority for Schedule II through VI controlled substances. The Virginia Board of Nursing’s requirements for prescriptive authority include:

Completion of educational courses in pharmacology or pharmacotherapeutics equivalent to at least 30 contact hours
For new CNMs: Either 1,000 hours of APRN practice plus 15 CE units OR 30 pharmacology contact hours within five years
CNMs who have completed 1,000 supervised clinical hours may prescribe independently without a practice agreement
DEA registration ($888, renewed every three years) is required for controlled substance prescribing

Independent Practice Pathway

New in 2025: CNMs may practice independently without a collaborative practice agreement after completing 1,000 hours of supervised clinical experience. This can be documented through:

Clinical hours completed during your graduate program (typically 600-720 hours)
Additional supervised hours in your first position
Attestation from a supervising CNM or physician confirming completion of hours

CNMs with fewer than 1,000 hours must maintain practice agreements with either a physician or a CNM who has practiced independently for at least two years.

Financial Considerations and Fees

Becoming a CNM involves various financial investments beyond educational costs. According to the Virginia Board of Nursing fee schedule, prospective APRNs should anticipate:

APRN application fee: $125
Biennial APRN license renewal: $80 (plus $25 if late)
License reinstatement (if needed): $150 ($200 after suspension or revocation)
Duplicate license: $15
Duplicate wall certificate: $25
Transcript of application (if required): $35
Returned check fee: $50

All fees must be paid by check or money order to the Treasurer of Virginia if submitted by mail or by credit/debit card for online payments. It’s important to note that all fees are nonrefundable, emphasizing the importance of ensuring application correctness and completeness.

Once the Virginia Board of Nursing grants nurse practitioner licensure, CNMs may begin practicing nurse-midwifery in the state. The process typically takes 30-45 days to process a complete application package.

Step 4. Begin a Career as a Certified Nurse-Midwife in Virginia and Keep Credentials Current

Once licensed, CNMs in Virginia practice under the framework of advanced practice nursing with enhanced autonomy as of July 2025. The Virginia Board of Nursing specifies:

Minimum clinical practice requirements (720 supervised hours during education)
Authorization to provide comprehensive women’s health care
Independent practice after 1,000 supervised clinical hours
Full prescriptive authority, including controlled substances
Ability to serve on hospital on-call duty rosters

Growing Demand and Workforce Shortages

Virginia faces significant maternity care access challenges that create opportunities for CNMs. According to the March of Dimes 2024 report, 37.6% of Virginia counties are classified as maternity care deserts with no hospital or birth center offering obstetric care. An additional 8.3% have only low or moderate access. The state has experienced several hospital labor and delivery closures in recent years, including LewisGale Hospital Montgomery in Blacksburg (April 2024) and Sentara Halifax Regional Hospital, intensifying the need for CNM services.

Virginia is home to several certified birth centers recognized by the Commission for the Accreditation of Birth Centers (CABC). These include New Life Birth Center in Rocky Mount and BirthCare & Women’s Health in Alexandria. Notable recent additions include Gather Grounded Midwifery in Chesterfield, which opened in August 2023 as central Virginia’s first Black-owned birthing center.

Hospitals, medical centers, and clinics that employ CNMs in Virginia include:

Carilion Clinic, Blacksburg
Mary Washington Healthcare, Stafford
Planned Parenthood South Atlantic, Multiple locations
University of Virginia Health System, Charlottesville
Virginia Hospital Center, Arlington
Sentara Norfolk General Hospital, Norfolk
Carilion Roanoke Memorial Hospital, Roanoke
Winchester Medical Center, Winchester
Augusta Health, Fishersville
Bon Secours Health System, Multiple locations
Inova Health System, Northern Virginia
VCU Health, Richmond

Loan Repayment and Workforce Incentive Programs

Virginia offers several financial incentive programs for CNMs willing to practice in underserved areas:

Virginia State Loan Repayment Program (VA-SLRP): Maximum award of $140,000 for a four-year service commitment in federally designated Health Professional Shortage Areas. Virginia now pays the full match with no community contribution required. Application window: January 1–March 31 annually.

Virginia Nurse Practitioner/Nurse-Midwife Scholarship Program: State-funded program ($1.936 million annually) supporting NP/CNM students who commit to practicing in medically underserved areas. Preference given to minority students and those pursuing family practice, OB/GYN, and pediatrics.

Nursing Preceptor Incentive Program: Offers up to $5,000 for APRNs (including CNMs) who provide 250 hours of clinical education rotation. Annual allocation of $3.5 million administered by the Virginia Health Workforce Development Authority.

NURSE Corps Loan Repayment (Federal): Pays 60% of qualifying loans after two years at a critical shortage facility, with an additional 25% for year three (up to 85% total).

Keeping Nurse Practitioner Licensure Current through the Virginia Board of Nursing
Licensees will be required to renew their license every two years during the month of their birth, along with:

$80 renewal fee
Proof of continued CNM certification through AMCB
Attestation of having met continuing competency requirements

Virginia requires that nurse practitioners complete at least 40 hours of continuing education during each two-year renewal period. For CNMs with prescriptive authority, at least 8 hours must be in pharmacology or pharmacotherapeutics.

If a license lapses, one of the following will be required for reinstatement:

Completion of a minimum of three credit hours of post-licensure academic education relevant to nursing practice
A board-approved refresher course in nursing
Completion of a related, evidence-based research study
Completion of publication as the author or co-author
Teaching or developing a nursing-related course resulting in no less than three semester hours of college credit
Teaching or developing nursing-related continuing education courses for up to 30 contact hours
15 contact hours of workshops, seminars, or conferences alongside 640 hours of active practice as a nurse
30 contact hours of workshops, seminars, conferences, or courses relevant to the practice of nursing

Keeping the CNM Credential Current through the American Midwifery Certification Board (AMCB)
All those who hold the CNM credential through the American Midwifery Certification Board (AMCB) must enroll in the AMCB’s five-year Certificate Maintenance Program. During each five-year renewal cycle, CNMs must complete one of the following:

Re-take and pass the Certified Nurse-Midwife Examination
Complete 20 hours of continuing education and three certificate maintenance modules

The AMCB certificate maintenance program ensures that CNMs stay current with best practices and advances in midwifery care. The AMCB website provides more information about specific requirements and acceptable continuing education activities.

Salaries for Certified Nurse-Midwives in Virginia

According to the U.S. Bureau of Labor Statistics’ May 2024 data, certified nurse-midwives in Virginia enjoy competitive salaries that reflect their advanced education and specialized skills. With the new 2025 legislation mandating full reimbursement parity, CNM compensation is expected to increase further.

Location	Annual Mean Wage	Hourly Mean Wage	Annual Median Wage	Hourly Median Wage	Employment
Statewide	$113,360	$54.50	$108,190	$52.01	160
Richmond Metropolitan Area	$114,780	$55.18	$112,360	$54.02	40
Virginia Beach-Norfolk-Newport News	$108,130	$51.99	$104,360	$50.17	30
Washington-Arlington-Alexandria	$121,360	$58.35	$114,360	$54.98	90

The salary data indicates that CNMs in the Washington-Arlington-Alexandria area earn the highest average wages in Virginia, reflecting the region’s high demand and cost of living. Northern Virginia accounts for approximately 56% of statewide CNM employment, offering the most opportunities for new graduates.

The demand for nurse-midwives continues to grow in Virginia, with an expected occupational growth rate of 26% through 2032, significantly higher than the state average of 15% for all occupations. This exceptional job outlook reflects the increasing recognition of CNMs’ value to maternal and women’s healthcare, combined with ongoing workforce shortages and expanding practice authority.

(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2024. Figures represent state data, not employer-specific information. Job growth data provided by Projections Central, a resource funded by the U.S. Department of Labor’s Employment and Training Administration. Conditions in your area may vary. Information accessed January 2026.)

FAQs About Becoming a CNM in Virginia

What is the difference between a Certified Nurse-Midwife (CNM) and a Certified Professional Midwife (CPM) in Virginia?

In Virginia, a Certified Nurse-Midwife (CNM) is an advanced practice registered nurse with graduate-level education in midwifery who is licensed through the Virginia Board of Nursing. CNMs can practice independently after completing 1,000 supervised clinical hours, prescribe medications including controlled substances, and work in various healthcare settings. A Certified Professional Midwife (CPM) is a direct-entry midwife with specialized training in out-of-hospital births but without nursing education. As of July 2025, CPMs have expanded practice authority under new legislation, but still have more restricted scopes compared to CNMs.

Can I complete a nurse-midwifery program online while living in Virginia?

Yes, there are several ACME-accredited nurse-midwifery programs that offer online didactic coursework with arranged clinical placements in your local area. While Shenandoah University is the only physical school in Virginia with an ACME-accredited program, Virginia residents can attend programs like Frontier Nursing University, Georgetown University, or other distance-accessible programs online while completing clinical requirements at approved sites throughout Virginia.

What is the scope of practice for Certified Nurse-Midwives in Virginia?

CNMs in Virginia have a broad scope of practice that includes providing primary healthcare to women throughout their lifespan, with a special emphasis on pregnancy, childbirth, and gynecologic care. They can provide prenatal care, attend births in hospitals, birth centers, or homes, offer postpartum care, conduct well-woman exams, provide family planning services, treat common gynecological conditions, and prescribe medications, including controlled substances. As of July 2025, CNMs with 1,000 supervised clinical hours can practice independently without physician oversight.

Do Certified Nurse-Midwives in Virginia need a collaborative agreement with a physician?

As of July 2025, Virginia CNMs who have completed 1,000 hours of supervised clinical experience do not need a collaborative practice agreement with a physician. This represents a major change from previous requirements. New CNMs with fewer than 1,000 hours must maintain practice agreements with either a physician or a CNM who has practiced independently for at least two years. The 1,000-hour requirement can be met through graduate program clinical hours (600-720 hours) plus supervised hours in your first position.

How long does it take to become a Certified Nurse-Midwife in Virginia?

Becoming a CNM in Virginia typically takes 6-8 years of education and experience. This includes 2-4 years for a BSN, 1-2 years of nursing experience (recommended or required by most programs), and 2-3 years in a graduate nurse-midwifery program. The process may be shorter for those pursuing accelerated or bridge programs, or longer for those attending part-time while working.

What loan repayment programs are available for CNMs in Virginia?

Virginia offers several financial incentive programs for CNMs. The Virginia State Loan Repayment Program (VA-SLRP) provides up to $140,000 for a four-year service commitment in Health Professional Shortage Areas. The Virginia Nurse Practitioner/Nurse-Midwife Scholarship Program offers state funding for students who commit to practicing in underserved areas. The Nursing Preceptor Incentive Program provides up to $5,000 for APRNs who provide clinical education. Federal programs like NURSE Corps Loan Repayment can pay up to 85% of qualifying loans for practice in critical shortage facilities.