As a rural state, Wyoming currently lacks the proper number of nurse-midwives required to provide essential antepartum, intrapartum, and postpartum care to expectant mothers as well as general well-woman gynecological care. In fact, more than 200,000 residents reside in areas the Wyoming Department of Health has identified as providing inadequate access to primary care. Further, the National Women’s Law Center reported that in 2014 only 72% of expectant mothers in Wyoming received prenatal care in their first trimester.
The U.S. Department of Health and Human Services reported that babies of mothers who do not receive prenatal care are three times as likely to have a low birth weight and five times as likely to die in infancy. Not only has nurse-midwifery in practice been shown to reduce the instances of low birth weight, but the American College of Nurse-Midwives has documented numerous other benefits, including reducing the use of costly, unnecessary, and invasive procedures, reducing health care cost during pregnancy and delivery, and increasing access to care, especially for high-risk women. These benefits are especially relevant for women living in rural Wyoming, who may not have immediate access to care during pregnancy.
Certified nurse midwives are licensed as advanced practice registered nurses (APRN), and in Wyoming, are allowed to diagnose and treat patients without physician oversight. This gives CNMs in the state the opportunity to practice independently. Nurse-midwives may also find employment in the 14 hospitals in the state, numerous physician’s private practices, and freestanding birth centers and women’s health clinics.
Steps to Becoming a Nurse-Midwife in Wyoming
Registered nurses in Wyoming with licenses in good standing may become certified nurse-midwives by earning national certification through the American Midwifery Certification Board and becoming licensed as advanced practice registered nurses (APRN) through the Wyoming State Board of Nursing:
Step 1. Earn a Master’s Degree in Nurse-Midwifery
Becoming a certified nurse-midwife starts by completing a master’s degree or higher through a program accredited by the Accreditation Commission for Midwifery Education (ACME). There are 39 nurse-midwifery programs accredited by ACME throughout the country, including 6 fully online options and 17 hybrid programs.
RN candidates that hold a bachelor’s degree are eligible to apply directly to a conventional master’s program in nurse-midwifery. RNs who have not completed their BSN degrees have the opportunity to complete course requirements for both bachelor’s and master’s degrees through an ACME-accredited RN-to-MSN bridge program in nurse-midwifery.
For many working RNs, online options offer a preferred degree of flexibility. Hybrid nurse-midwife master’s programs involve online coursework as well as intensive on-campus courses for between one and two weeks a semester. Both fully online and hybrid programs allow students to complete required clinical hours in hospitals and private practices that are located in Wyoming and the surrounding states.
In order to be accepted into these programs, most ACME accredited schools require:
- A BSN
- RN license and minimum one year practicing experience
- Minimum GPA
- Personal statement
- Letters of recommendation from previous instructors
Program Structure and Dual-Focus Options
All MSN programs in nurse-midwifery are made up of at least 40-60 hours of traditional coursework and 700-1000 clock hours of clinical practicums.
Dual-focus nurse-midwife/women’s health nurse practitioner (NM/WHNP) programs have become popular among nurses interested in a broader scope of practice that would involve serving as a primary care provider for women throughout the lifespan. Graduates of these dual-focus programs may elect to pursue the Women’s Health Nurse Practitioner – Board Certified (WHNP-BC) credential in addition to their Certified Nurse Midwife (CNM) credential.
Nurse-midwife MSN programs often include the following courses:
- Theoretical Concepts for Advanced Practice Nursing
- Advanced Human Pathophysiology
- Health Informatics and Innovations in Technology
- Advanced Pharmacology and Therapeutics
- Nurse-Midwifery Care During Labor and Birth
- Advanced Health Assessment
Additionally, NM/WHNP programs would include the following courses:
- Well Woman Health Care
- The Childbearing Family
- Primary Care for Women
- Women’s Health Issues
- Advanced Health Assessment
Both CNM and NM/WHNP programs require an extensive amount of clinical hours in order to familiarize students with patients in all stages of pregnancy, labor and delivery. These clinical hours will take place in a variety of places, including hospitals, physician’s clinics, and freestanding birth centers.
Step 2. Register for and Pass the National Certification Examination in Nurse-Midwifery
RNs who have recently graduated from a master’s or post graduate program in nurse-midwifery are eligible to sit for the American Midwifery Certification Board’s (AMCB) Certification Examination in Midwifery and earn the CNM credential.
If the candidate has completed a dual focus program with an emphasis in women’s health, they are also eligible to also sit for the National Certification Corporation’s Women’s Health Nurse Practitioner Exam and earn the WHNP-BC credential if they so choose.
After successfully passing the exams, candidates will be eligible to apply for APRN licensure through the Wyoming State Board of Nursing.
Both exams can be scheduled directly through the third-party exam proctor, Applied Measurement Professionals (AMP). During scheduling, the candidate will receive a date and time to take the exams at one of three testing centers located in Casper, Cheyenne, or Green River, Wyoming.
Certified Nurse Midwife Certification
All candidates for the CNM certification must take the American Midwifery Certification Board’s Certification Examination in Midwifery within 24 months of completing a midwifery program.
The AMCB has published a candidate handbook which is intended to prepare RNs for the exam, including an outline of questions covered in the categories for study purposes. The test is four hours long, administered on a computer, and is divided into six categories of questions:
- Antepartum- 19%-26%
- Intrapartum- 17%-26%
- Postpartum- 15%-18%
- Newborn- 7%-16%
- Well Woman/Gynecology- 15%-18%
- Women’s Health/Primary Care- 8%-16%
Applicants can apply online or send a hard copy application directly to the following address:
American Midwifery Certification Board
849 International Drive, Suite 120
Linthicum, Maryland 21090
With the application, candidates must include:
- A $500.00 examination fee
- A copy of the candidates’ RN certification
- A signed letter from the program director confirming completion of midwife program
Candidates can schedule a test date and time through AMP online.
Nurses who pass this exam will receive the CNM credential.
Women’s Healthcare Nurse Practitioner Certification
RNs who have completed an MSN with an emphasis in Women’s Health are eligible to take the Women’s Health Care Nurse Practitioner Exam, allowing them to receive the NM/WHP title.
The NCC publishes a candidate guide which includes sample questions and scoring information. The test is three hours long, administered on a computer, and divided into five categories of questions:
- Gynecology- 35%-40%
- Obestrics- 25%-35%
- Primary Care- 10%-15%
- Diagnostic testing and physical assessment- 10%-15%
- Pharmacology- 5%-10%
Candidates can schedule a test date and time through AMP online.
Nurses who pass this exam will receive the NM/WHP credential.
Step 3. Apply for an APRN License as a Certified Nurse Midwife through the Wyoming State Board of Nursing
After passing the required certification exam, CNM candidates for advanced practice registered nurse licensure must apply through the Wyoming State Board of Nursing.
Graduates of dual-focus programs in nurse midwifery/women’s health who have passed the WHNP-BC certification exam can also elect to be recognized as women’s health NPs by selecting the appropriate option when applying
Candidates must print the APRN application and mail it to the state board along with:
- A copy of their social security card
- One other form of lawful presence (birth certificate, driver’s license)
- Official transcript from an accredited midwifery program
- Documentation verifying national certification
- License fee of $120
- Background check fee of $60
Mail the application and included documents and fees to:
Wyoming State Board of Nursing
130 Hobbs Avenue, Suite B
Cheyenne, WY 82002
Step 4. Start Practicing and Keep Certification Current
After receiving notification of APRN licensure, certified nurse midwives are qualified to begin practicing in the state.
As APRNs, nurse-midwives in Wyoming are licensed to practice within hospitals, physician’s clinics, and independent birth and women’s wellness centers, while others choose to establish independent practices.
The following employers had job vacancies for certified nurse-midwives as of December 2015 (Shown for illustrative purposes only and not meant to imply the assurance of employment or the availability of jobs):
- Labor and Delivery Nurse at Randstad Healthcare (Worland, WY)
- OB Nurse at Banner Health (Wheatland, WY)
- Labor and Delivery Nurse (Cody, WY)
CNM Certification Maintenance
CNM certificates are maintained through online modules provided by the AMCB.
Three modules must be completed every five years. Continuing education modules are made up of online exams as well as twenty contact hours per module. Contact hours offered in the form of continuing education units are accepted in the form of seminars, classes, and conferences offered by the following organizations:
- ACNM (American College of Nurse Midwives)
- ACCME (Accreditation Council for Continuing Medical Education)
- AMA (American Medical Association)
- AAFP (American Academy of Family Physicians)
- AANP (American Academy of Nurse Practitioners)
- NPWH (National Association of Nurse Practitioners in Women’s Health)
- ACPE (Accreditation Council for Pharmacy Education)
To fulfill continuing education requirements, CNMs will create a portal on the AMCB website and pay a yearly maintenance fee of $55.
WHNP-BC Certification Maintenance
The WHNP-BC certification requires renewal every three years. The National Certification Corporation offers modules of continuing education in the following topics:
- Maternal newborn
- Women’s health care
- High risk neonatal
- Electronic fetal monitoring and assessment.
For a fee of $100, WHNP-BC create a continuing education plan through the NCC. The plan will allow nurses to track their progress in completing continuing education units, which can vary individually based on plan.
APRN License Maintenance
In Wyoming, all APRN licenses expire every two years on December 31st of even years. Licenses must be renewed through the Wyoming RN Board. State renewal requirements mandate that APRNs complete one of two options:
- Hold a current national certification, such as a CNM or NM/WHP title
- Complete 60 contact hours of continuing education and 400 hours of employment in specialty area of advanced practice
The American Association of Nurse Practitioners offers free continuing education credits through their website.
Certified Nurse Midwives and Women’s Health Practitioners may renew their APRN licenses by renewing their designated certifications on a regular cycle.
Salaries for Certified Nurse-Midwives in Wyoming
Just seventeen certified nurse-midwives were licensed to practice in Wyoming as of 2014 according to the American Association of Colleges of Nursing. The salary aggregation site Indeed.com tracked the salaries of certified nurse-midwives over the course of a year. According to their findings, certified nurse-midwives in Wyoming were offered an average starting salary of $68,000 in 2015.
The number of jobs for nurse midwives is increasing at a rate much higher than many other occupations throughout the country. The US Bureau of Labor Statistics estimates that the number of certified nurse-midwives will increase by 31% nationwide between 2012 and 2022.
A Growing Number of Opportunities for CNMs in Wyoming’s OB-GYN Shortage Areas
Certified nurse-midwives in Wyoming can practice to the full scope of their training without restrictions or the need for a collaborative physician agreement. This puts the state’s CNMs in a position to provide obstetric and gynecholgical care in areas that lack OB-GYN physicians. Wyoming’s certified nurse-midwives delivered 432 babies in 2012—5.71% of the total births in the state that year, according to the American College of Nurse Midwives.
The American Congress of Obstetricians and Gynecologists analyzed the number of OB-GYN physicians and their locations in its 2014 fact sheet on Wyoming. While the number of OB-GYNs approached the national rate on a population basis, these physicians are concentrated in certain parts of Wyoming. These counties had a ratio of OB-GYNs per 10,000 women that was higher than the national average:
- Laramie County
- Campbell County
- Teton County
In contrast, more than 40% of the counties in Wyoming did not have a single OB-GYN practicing in them. These counties included:
- Big Horn County
- Carbon County
- Crook County
- Hot Springs County
- Johnson County
- Lincoln County
- Niobrara County
- Sublette County
- Washakie County
- Weston County
Certified Nurse-Midwife Salaries in Wyoming’s Major Cities
The employment site Indeed.com provides an average of the salaries listed in job vacancy announcements in a given geographical area over the course of a year. According to the site’s analysis, the average starting salaries for certified nurse-midwives in Wyoming’s major metro areas as of 2015 were:
- Casper – $80,000
- Cheyenne – $71,000
- Laramie – $70,000