How to Become a Certified Nurse Midwife (CNM)

Certified Nurse Midwives are advanced practice registered nurses (APRNs) trained in midwifery. They handle prenatal care, childbirth, postpartum recovery, and gynecologic and primary care for women across the lifespan, blending nursing and obstetric expertise.

What Is a Certified Nurse Midwife?

A CNM is an APRN trained in both nursing and midwifery. To earn the credential, you first become a registered nurse, then complete graduate-level midwifery education and pass national certification.

A Certified Midwife (CM) is also trained at the graduate level but without a nursing background. CNMs and CMs take the same certification exam through the American Midwifery Certification Board (AMCB) and share a similar scope of practice. The difference is licensure: CNMs are licensed in all 50 states, while CMs are recognized in only a handful. A third credential, Certified Professional Midwife (CPM), follows a separate non-nursing apprenticeship path and is not equivalent to either.

History of Midwifery in the U.S.

Midwifery in America is ancient but was nearly eliminated by the 20th century. In colonial America, childbirth was women-centered, and midwives (often apprenticed from elder midwives, including many Black and Indigenous women) were the primary birth attendants. The 1800s brought a medicalization of birth: influential physicians and policies such as the 1910 Flexner Report pushed hospital births and undercut midwives. By 1980, midwives attended only about 1.1% of U.S. births.

Nurse-midwifery emerged as a formal field in the 1920s with the Frontier Nursing Service in 1925, though early programs often excluded women of color. A resurgence began in the 1960s and 1970s as the women's health movement and figures like Ina May Gaskin popularized out-of-hospital birth. The ACNM was founded in 1955, and education and licensure expanded steadily. By 2021, midwives attended 12% of U.S. births, a figure confirmed in a 2023 GAO report. CNMs are now central to addressing maternal health disparities, with lower cesarean and episiotomy rates than many obstetric teams.

What a Certified Nurse Midwife Does

CNMs practice full-scope midwifery and women's health. They manage prenatal care, support labor and delivery (from unmedicated births to assisting in cesareans), and handle postpartum and newborn care including lactation support. They also provide gynecologic care (annual exams, Pap smears, breast exams), family planning, STD screening, and general primary care such as blood pressure management, nutrition counseling, and immunizations. They care for healthy newborns up to 28 days old.

Daily responsibilities include patient assessment and history-taking, physical and obstetric exams, ordering and interpreting labs and ultrasounds, prescribing and managing medications, building care plans, and patient education. In hospitals, CNMs may serve as first assistants in surgery or work alongside obstetricians. In most states they hold prescriptive authority and can independently prescribe medications and treatments. The work emphasizes evidence-based, low-intervention birth, and it demands strong communication, empathy, and stamina, since deliveries can happen at any hour.

How to Become a Certified Nurse Midwife

1. Earn a Bachelor of Science in Nursing (BSN)

Start by becoming a registered nurse, which typically means a BSN program covering health sciences and clinical rotations. You need a bachelor's degree or higher for CNM training. Choose obstetrics electives or clinical placements where you can.

2. Pass the NCLEX-RN and get licensed

After nursing school, pass the NCLEX-RN to become a licensed RN, then apply for licensure in your state. An active RN license is required before you start graduate midwifery education.

3. Gain nursing experience

Many prospective CNMs work one to two years in labor and delivery or other maternal-newborn settings to build practical skills with births, prenatal care, and newborns. Some graduate programs prefer or require this experience; others accept students without it, especially when the program includes extensive clinical training. Requirements vary by school.

4. Complete a graduate midwifery program

Enroll in an ACME-accredited nurse-midwifery program. You have two main pathways: a Master of Science in Nursing (MSN) in nurse-midwifery or a Doctor of Nursing Practice (DNP) with a midwifery focus. MSN programs take two to three years; BSN-to-DNP programs take three to four. Coursework covers advanced health assessment, pharmacology, prenatal care, labor and birth management, postpartum and neonatal care, and women's health. You also complete extensive clinical rotations (usually more than 500 hours) under certified midwives or obstetricians.

5. Pass the AMCB certification exam

After graduation, pass the national Certified Nurse-Midwife exam administered by the AMCB. This comprehensive exam is required to practice and is the recognized credential for both CNMs and CMs. The exam fee runs about $500, and you submit transcripts and proof of RN license with your application.

6. Apply for state licensure

Apply to your state's regulatory body (usually the Board of Nursing) for a license to practice as a nurse-midwife, submitting proof of CNM certification, RN license, and education. All 50 states and D.C. license CNMs, though the license title varies. Some states require a collaborative agreement with a physician or a separate prescriptive authority application, so check your state's specifics.

7. Maintain certification and licensure

Renew AMCB certification every five years through the Certificate Maintenance Program (continuing education or re-examination), and renew your state license as required, typically every one to two years with continuing education credits.

How Long It Takes

From the start of college to full certification and licensure, becoming a CNM typically takes about six to eight years, depending on your pace and whether you work between steps.

Cost

Each educational stage carries its own tuition and fees, so plan ahead. The National Health Service Corps offers loan repayment for serving in underserved areas, and organizations including the ACNM and March of Dimes offer scholarships for midwifery students. Many CNM students work as RNs during graduate school to offset costs, especially when enrolled part-time or online.

What Nurse Midwives Earn

CNMs earn competitive salaries that reflect their advanced training. Nationally, they average roughly $120,000 to $130,000 per year, with the U.S. Bureau of Labor Statistics reporting a median around $129,650. Pay depends on location, work setting, experience, and education.

Average salary

The average annual salary for CNMs is about $131,000. New graduates often start lower (roughly $80,000 to $90,000 in some areas), while experienced midwives or those in high-cost cities earn well above $130,000. CNMs are among the top-earning nursing professionals, second only to nurse anesthetists in many surveys. The top 10% can make upward of $170,000, while entry-level positions sit around $75,000 to $80,000.

Salary by state

California is the highest-paying state, averaging about $183,740, followed by Hawaii ($161,820) and Massachusetts ($154,080). Oregon and Maine report averages near $139,000 to $140,000. At the low end, Idaho averages around $78,530, with South Carolina and Florida near $95,000 to $100,000. These gaps reflect cost of living, demand, and scope-of-practice differences.

Salary by work setting

CNMs in outpatient care centers such as birth centers and clinics earn the most, around $164,000. Those in hospitals average about $136,000, and those in physicians' offices around $127,000. Midwives in public health or academia often earn in the $100,000 to $120,000 range but may gain more predictable hours. When weighing a job offer, look at the full package: some employers add loan repayment, signon bonuses, or overtime.

Job Outlook and Demand

The outlook is strong. The BLS projects employment of nurse anesthetists, nurse midwives, and nurse practitioners will grow about 35% from 2024 to 2034, much faster than average. Because the absolute number of nurse-midwives is small, percentage growth for the CNM role specifically varies by source, but demand consistently outpaces supply.

CNMs are already sought after in hospitals, birthing centers, and clinics. Rural communities and urban underserved areas face maternity-provider shortages, and health systems are recruiting midwives to expand access and staff collaborative practices alongside obstetricians. The growth of birth centers and midwife-led units adds openings, and rising patient interest in low-intervention birth keeps demand climbing.

Demand is strongest in states with a robust midwifery environment, such as those with full practice authority and active birth centers. New York, California, and Washington often have multiple openings at any time. Some states with historically restrictive laws are expanding midwifery practice, which may open new opportunities as regulations evolve.

Globally, midwives are recognized as vital to maternal and neonatal health. In the U.K., Canada, the Netherlands, and New Zealand, midwives attend a large share of births, managing normal pregnancies and referring complications to physicians. Research shows midwife-led care produces equal or better outcomes for low-risk pregnancies, with lower intervention rates and high satisfaction. The WHO has called for strengthening midwifery worldwide to reduce maternal and infant mortality, and a projected global shortage of midwives means CNMs interested in international or mission work will find opportunities abroad.

Professional Organizations and Resources

U.S. midwifery is supported by professional associations, certifying bodies, and accrediting agencies that set education standards, award credentials, advocate for the profession, and offer continuing education and networking.

Is This the Right Path for You?

A CNM career puts you at the center of one of life's most significant experiences and lets you build lasting relationships guiding women through pregnancy, birth, and beyond. The work is holistic and patient-centered. With average salaries in the $120,000 to $130,000 range (top earners above $170,000), strong job growth, and full practice authority in many states, CNMs enjoy both financial stability and professional autonomy across hospitals, birth centers, and private practice.

The work is also demanding. Labor and delivery do not keep office hours, so expect nights, weekends, and oncall shifts. Most births are joyful, but emergencies and difficult outcomes happen and require resilience and support. Obstetrics carries real liability risk, and the job is physically taxing: long hours on your feet, assisting in labor, and back-to-back shifts. If you value meaningful connection, autonomy, and can handle an unpredictable schedule, few careers in healthcare are more fulfilling.