Midwifery in Washington State is no longer the domain of the alternative culture. It has become an increasingly mainstream choice for expectant mothers in recent years, making Washington state a leader in natural births and birth clinics.
According to a 2012 report from the Centers for Disease Control and Prevention, Washington State ranks among the top eight states in the nation for its number of home births. In fact, in the last five years, the Midwives’ Association of Washington State reported that the number of families choosing childbirth at home has more than doubled.
Washington’s nurse-midwives are advanced practice RNs that provide a highly individualized and cost-effective childbearing experience. Advocates also argue that nurse-midwifery provides a safer alternative to invasive birthing procedures. According to the Midwives’ Association of Washington State, one in three women undergo major surgery while giving birth, a situation the Association refers to as a crisis. The Association believes that nurse-midwifery provides a humane solution to this crisis, but also reports that the supply of licensed midwives in Washington is critically low. This news should actually be encouraging to RNs in Washington with their sights set on becoming nurse-midwives, as it speaks to the growing number of opportunities to serve women and their families.
Washington’s progressive regulatory environment respects and supports the autonomy of certified nurse-midwives, allowing them to act as independent practitioners without the need to maintain a collaborative practice agreement with a physician. As advanced registered nurse practitioners (ARNP), CNMs in the state offer much more than just antepartum, intrapartum and postpartum care, as their services include well-woman care throughout the lifespan, from adolescence to menopause and beyond.
According to the American College of Nurse-Midwives, there were 374 certified nurse-midwives practicing in Washington State as of 2015. In 2013 alone, CNMs attended more than 8,000 births in the state, representing nearly 13 percent of all routine births in Washington that year.
Steps to Becoming a Nurse-Midwife in Washington
RNs in Washington looking to become nurse-midwives must become nationally certified through the American Midwifery Certification Board and earn an Advanced Registered Nurse Practitioner (ARNP) license through the Washington State Nursing Quality Care Assurance Commission. This guide offers an explanation of each step involved in becoming a certified nurse-midwife in Washington:
|Earn a Master’s or Higher Degree in Nurse-Midwifery|
|Take and Pass the National Certification Examination in Nurse-Midwifery|
|Apply for ARNP Licensure as a Nurse-Midwife in Washington|
|Maintain ARNP Licensure and National Certification|
Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery
RNs in Washington seeking initial ARNP licensure in nurse-midwifery must complete a master’s or higher degree through a program accredited by the Accreditation Commission for Midwifery Education (ACME).
Master’s degrees in nurse-midwifery allow RNs with a Bachelor of Science in Nursing (BSN) to fulfill the educational requirements to become nationally certified in nurse-midwifery and licensed in Washington. Institutions may offer these programs as part-time or full-time programs in a flexible online format designed with working RNs in mind. With relatively few nurse-midwifery programs available in the United States, online programs have become standard, catering to advanced practice nursing students in all parts of the country. There are just two nurse-midwifery programs available at campus-locations in Washington, both of which are located in Seattle. This makes online programs a more practical path to becoming a certified nurse-midwife for many RNs in the state.
Many institutions now offer dual specialization degree programs, the most popular of which is the nurse-midwifery/women’s health program. Graduates of these programs are eligible to achieve national certification and ARNP licensure in Washington State as both a certified nurse-midwife (CNM) and a woman’s health nurse practitioner (WHNP).
Program Structure and Components
Nurse-midwifery master’s degrees prepare students to manage women’s healthcare at all stages of life, with a focus on:
- Primary care issues
- Family planning and gynecologic needs
- Postpartum period
- Care of the newborn
The rigorous, core curriculum of these programs includes study in:
- Advanced pathophysiology
- Well woman healthcare
- Pharmacology for the advanced practice nurse
- Legal and ethical issues in advanced practice
- Labor and birth
- Health promotion
- Advanced nurse midwifery
Nurse-midwifery degree programs also consist of guided clinical experiences in various settings, such as hospitals, women’s clinics, OB/GYN practices, and birth centers, among others. Schools that offer online programs in nurse-midwifery often partner with clinical sites throughout the country. This allows students to satisfy the clinical components of their program in clinical locations close to home.
These are among the many clinical sites throughout Washington where students may complete their clinical rotations in nurse-midwifery:
- Providence Everett Medical Center, Pavilion for Women & Children, Everett
- Women’s Healthcare Center, Wenatchee
- Women’s Clinic at Overlake, Bellevue
- Trios Women’s and Children’s Hospital, Kennewick
- Sacred Heart Women’s Health, Spokane
Candidates seeking admission into a nurse-midwifery master’s degree program must possess a current and unencumbered RN license, a Bachelor of Science in Nursing (BSN) and, depending on the institution, one or more of the following:
- Minimum undergraduate GPA
- RN experience
- Admissions essay
- Letters of recommendation
The ACME also accredits bridge programs and post-graduate certificate programs in nurse-midwifery based on the specific educational needs of enrolling students:
- RN-to-MSN Bridge Programs: RN-to-MSN bridge programs are designed for ADN-educated nurses and combine the components of both the Bachelor of Science in Nursing (BSN) and the Master of Science in Nursing (MSN), in one accelerated dual-degree program.
- Post-Graduate Certificate Programs: Post-graduate certificate programs offer post-graduate study and clinical experiences for RNs that possess master’s degrees in nursing and are seeking initial ARNP licensure in nurse-midwifery.
Step 2. Take and Pass the National Certification Examination in Nurse-Midwifery
Graduates of nurse-midwifery master’s programs go on to take the Certified Nurse-Midwife (CNM) examination through the American Midwifery Certification Board.
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.
Candidates must apply with the appropriate certifying agency and receive approval before they can schedule their exam(s) through Applied Measurement Professionals (AMP). Candidates can take the exam through any of the AMP testing centers located throughout Washington:
- East Wenatchee
Step 3. Apply for ARNP Licensure as a Nurse-Midwife in Washington
Upon achieving CNM certification, RNs in Washington seeking initial ARNP licensure as a nurse-midwife must complete the Advanced Registered Nurse Practitioner Application, check the CNM designation (and NP, if applicable), and submit it to the Washington State Nursing Quality Care Assurance Commission, along with the following:
- Official transcripts sent directly from the college or university where the nurse-midwifery program was completed
- Proof of current national certification, sent directly from the American Midwifery Certification Board (and the National Certification Corporation, if applicable)
- Prescriptive Authority Attestation (must be initialed at dated if applying for prescriptive authority)
- Pharmacology Education (only needs to be filled out if applying for prescriptive authority)
Graduates of dual-focus nurse midwife/women’s health nurse practitioner programs have the option of being licensed at the state level in both ARNP roles: Certified Nurse-Midwife (CNM) and Women’s Health Nurse Practitioner (WHNP). When applying, these ARNP license candidates must select both options on the application form.
Step 4. Maintain ARNP Licensure and National Certification
All certified nurse-midwives in Washington must maintain their ARNP license through the Washington State Nursing Quality Care Assurance Commission and their national certification through one or both of the respective certifying bodies.
ARNP License Renewal Requirements – Washington State Nursing Quality Care Assurance Commission
CNMs in Washington must renew their ARNP license every two years on or before their birthday. License renewal is dependent upon the completion of at least 250 hours of independent clinical practice as a certified nurse-midwife and at least 30 contact hours of continuing education during the renewal period.
CNMs with prescriptive authority must also complete at least 15 contact hours in pharmacology.
CNMs may complete their renewals online.
CNM Certification Renewal Requirements – American Midwifery Certification Board
CNMs complete their continuing education requirements by following The American Midwifery Certification Board’s Certification Maintenance Program, which requires 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; and pay annual fees
- Option 2: Retake the AMCB Certification Examination and pay the $500 examination fee in lieu of annual fees
WHNP Certification 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 their performance.
Resources for Nurse-Midwives in Washington
Nurse-midwives in Washington State, whether interested in starting or advancing a career in nurse-midwifery, may find opportunities in hospitals, community health centers, private birth centers, or OB/GYN practices. Some of Washington’s top employers of CNMs include:
- Bellingham Birth Center, Bellingham
- The Birth House, Olympia
- Northwest Hospital and Medical Center, Midwives Clinic, Seattle
- Cascade Birth Center, Everett
- Center for Birth, Seattle
- Evergreen Health, Midwifery Care, Kirkland
- Valley Medical Center, Midwives Clinic, Renton
- WomanCare, Olympia
- Mount Vernon Birth Center, Mount Vernon
- The Birthing Inn, Tacoma
- Puget Sound Birth Center, Kirkland, Renton
A list of recent job posts (sourced December 2015), helps show the type of professional opportunities available in Washington State (shown for illustrative purposes only and should not be interpreted as an assurance of employment):
- Certified Nurse Midwife, Providence Health and Services, Everett
- Certified Nurse Midwife, Group Health Permanente, Tacoma
- Certified Nurse Midwife, CHI Franciscan Health, Federal Way
- Certified Nurse Midwife, Multicare Health System, Bonney Lake
- CNM, Planned Parenthood , Seattle
- CNM, PeaceHealth, Longview
Professional associations in Washington serve as valuable resources for nurse-midwives as they research career opportunities or consider starting their own independent nurse-midwifery practice:
- Midwives’ Association of Washington State
- Washington State Nurses Association
- ARNPs United of Washington State
- Puget Sound Nurse Practitioners Association
Salaries for Certified Nurse-Midwives in Washington
In 2014, the United States Department of Labor, Bureau of Labor Statistics released data showing the average salary for nurse-midwives in Washington to be $95,860. By comparison, in 2015 the Washington State Employment Security Department reported the average salary for the state’s certified nurse-midwives to be $97,199, while the median among these professionals was just 3.2% less at $94,120. This shows a 1.4% increase over a one-year period, representative of higher starting salary offers as employers attempt to remain competitive in their bid to retain more CNMs as the demand for nurse-midwifery services continues to increase.
Occupational Outlook for Certified Nurse-Midwives in Washington
Long-term employment outlook data published by the Washington State Employment Security Department in May of 2015 reveals that job opportunities for certified nurse-midwives in Washington are expected to increase by 19.1% in the 10-year period from 2013 to 2023. It’s projected that half of all job opportunities for nurse-midwives in Washington during this period will develop out of the need to replace CNMs leaving the workforce as they enter retirement.
In King County, particularly Seattle, the number of jobs for certified nurse-midwives is expected to increase by 15.5%. In southwest Washington, which encompasses Wahkiakum, Cowlitz, and Clark Counties, the number of job openings for certified nurse-midwives is expected to increase more than twice as fast as in King County at a rate of 31.5% during the ten-year projection period from 2013 to 2023.
Nearly 170,000 births took place in Washington State in 2006 alone, according to the National Vital Statistics Report from March of 2010. A total of 2.22% of those were out-of-hospital births, with 1.35% being home births and 0.83% taking place in birthing centers. The report went on to state that the number of home births in Washington between 2003 and 2006 increased by 4.7%, which was fairly significant when compared to the national increase of just 3.5%.
Subsequently, in 2009, Washington was ranked 5th in the nation for the highest percentage of home births, with more than 1.5% of all births in the state being home births according to a National Center for Health Statistics Data Brief from January of 2012. Though the vast majority of Washington’s certified nurse-midwives work in hospital obstetric departments, CNMs attend virtually all out-of-hospital births that take place in the state. These statistics reveal that more and more women in Washington are turning to nurse-midwives for antepartum, intrapartum and postpartum care, highlighting the growing number of opportunities for CNMs in the state.
An Analysis of Certified Nurse-Midwife Salaries in Washington According to Location
Here is a look at midwife salaries in Washington by location and experience level as published by the Washington State Employment Security Department in 2015:
- Entry-Level: $85,114
- Average: $97,199
- Median: $94,120
- Experienced: $108,722
- Entry-Level: $84,386
- Average: $92,656
- Median: $92,144
- Experienced: $101,816
For comparative purposes, a complete analysis of nurse-midwife salaries throughout Washington is shown in the table below (data published by the US Bureau of Labor Statistics in 2014):