How to Become a Certified Nurse Midwife: Salary & Career Outlook

The demand for nurse midwives is growing across the country — but what is a nurse midwife? Among the trained professionals known as advanced practice registered nurses (APRNs), nurse midwives specialize in providing traditional care for mothers and their partners and babies.

Midwifery is based in ancient traditions, with the first midwives learning from their neighbors and family members how to assist with childbirth and provide other medical assistance to women. By the 20th century, however, the practice and regulation of midwives differed around the world. In the U.S., for example, the work of traditional midwives nearly disappeared as medical professionals took responsibility for women’s health.

What remained in this country were midwives focused on providing better birth outcomes in rural and low-income areas. For nearly a century in the U.S., nurse midwives have helped women during labor and delivery and evaluated mothers and their babies following childbirth.

The U.S. National Library of Medicine notes the country’s first midwives were English-trained public health registered nurses who provided family health services and maternity care at nursing centers in the Appalachian Mountains in the 1920s. The U.S. began training nurse midwives in 1932. Today’s nurse midwives often work alongside other medical professionals to provide care to women and their partners and families.

Modern certified nurse midwives receive training at colleges and universities, generally holding a master’s or doctoral degree, and must be state-certified. Although becoming a registered nurse (RN) may not be required for all nurse midwife roles, individuals who are certified nurse midwives (CNMs) typically are RNs with years of experience. CNM is the most common type of midwife.

A nurse midwife provides gynecological, prenatal, birth, and postpartum care for women and babies, with a focus on individualized assistance that addresses each patient’s unique needs. Nurse midwives also can assist women and their partners with family planning. Nurse midwives’ work ranges from helping women choose the right contraception to delivering babies and then evaluating mothers and their babies following childbirth.

As an accessible and affordable option for maternal care, nurse midwives play an important role in enhancing healthcare for women in underserved regions such as rural and inner-city areas. Research has revealed better birth outcomes in health systems that include midwives in maternal care.

Anyone interested in how to become a nurse midwife — whether pursuing a first-time role in healthcare or switching career paths within the medical profession — should know that the steps involved include getting an education with a strong background in science and becoming an RN. Some nurse midwives are RNs in hospital labor and delivery units who decide to further specialize.

Professionals interested in switching careers, including those already in the healthcare field, should consider the role’s requirements, determine which of them they may already meet, and look into programs that can help them meet the rest.

Nurse midwife education requirements generally include a master’s or doctoral degree. Nurse midwives’ college or university training typically includes both classroom and clinical instruction in a program accredited by an organization such as the Commission on Collegiate Nursing Education.

The first step in a nurse midwife’s education is a bachelor’s. To prepare for master’s-level work, undergraduate college students may choose courses that deal with topics such as the following:

• Nutrition
• Algebra
• Statistics
• Lifespan development
• English composition
• Sociology
• Psychology

Most nurse midwife positions require at least a master’s in midwifery or nursing, and many require a higher-level degree such as Doctor of Nursing Practice (DNP). Students generally pursue these degrees in accredited programs that include in-class and clinical experience and cover the following subject areas:

• Advanced health assessment
• Pathophysiology
• Pharmacology
• Other courses focused on nurse midwife responsibilities, such as sexual and reproductive health

Requirements for APRNs, including nurse midwives, vary by state. However, they generally include an RN license. Licensure requires knowledge of these subjects:

• Nursing skills
• Record and note taking
• Human anatomy and physiology
• Biological sciences
• Public and community health
• Pharmacology
• Medical law and ethics
• Health assessment

All RNs must hold state licenses that indicate they have the skills and competencies required to perform the job.

In addition to education and training requirements set by each state’s medical board, applying for a license requires passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

The American Nurses Credentialing Center accredits the NCLEX-RN, which is a six-hour, multiple-choice exam. NCLEX-RN exam topics include those related to providing quality care, administering appropriate medication, and mitigating risk. Each state has its own requirements for licensing renewal and continuing education hours.

Nurse midwives must pass the American Midwifery Certification Board examination within two years of earning a master’s or doctoral degree — and they are allowed four attempts to do so. The computerized, multiple-choice exam lasts four hours.

The exam covers the following six content areas aimed at showing competency in providing care as a certified nurse midwife:

• Antepartum, or just prior to childbirth
• Intrapartum, or during labor
• Postpartum, or following childbirth
• Newborns
• Well women care
• Primary care

Nurse midwives must recertify every five years through the Certificate Maintenance Program, a process that includes continuing education.

A certified nurse midwife’s job description primarily includes tasks associated with assisting pregnant women and their partners before, during, and after childbirth. Certified nurse midwives also may assist female and male patients — including those who identify as women as well as transgender, gender nonconforming, and intersex individuals — with reproductive health concerns and sexually transmitted diseases.

Nurse midwives provide a continuum of care, with tasks ranging from gynecological exams to education on breastfeeding, nutrition, and disease prevention. Nurse midwives focus on healthy living for women, their partners, and their babies through consultation, collaboration, and referral when appropriate.

Nurse midwives may serve as primary maternal care providers for women, but they also work with female patients prior to and following pregnancy. Among the duties of a nurse midwife in assisting women and their partners and babies are the following:

• Gynecological exams — identifying concerns related to the reproductive and urinary systems
• Family planning — offering care related to contraceptive methods and evaluation of health, readiness, and risks related to pregnancy
• Prenatal care — conducting checkups and screenings for women and their unborn babies during pregnancy
• Childbirth — delivering babies, managing emergency situations, repairing lacerations, and assisting physicians in cesarean, or C-section, births
• Wellness care — educating patients about healthy nutrition and disease prevention, evaluating for common health concerns, and providing guidance about aging and menopause and their effects on physical, mental, and sexual health
• Sexual and reproductive health guidance — offering screening and tests, and counseling on healthy sexual behaviors

Nurse midwives must have the dedication to provide patients with outstanding care and support. The BLS cites the following specific skills as valuable for nurse midwives and other APRNs:

Nurse midwives and other APRNs must be able to effectively communicate with patients and other healthcare providers to provide appropriate care. Good communication skills are key in evaluating patients’ conditions, discussing care with other medical staff, and attending professional conferences.

To quickly determine the best action to take in treating patients, nurse midwives must have the ability to assess health changes. Critical thinking also helps nurse midwives make decisions about care, on their own and in consultation with others.

Nurse midwives should be caring and show empathy toward patients. This skill is particularly important since many of their patients are experiencing one of the most important moments in their lives: giving birth.

Even small changes in a condition or treatment can dramatically affect a patient’s health. Nurse midwives must be thorough in exams and in determining appropriate courses of action and following proper procedures.

Nurse midwives must have the ability to interact well with patients and families to educate them about healthcare. They also need to show good teamwork with other medical professionals in establishing and providing treatment.

APRNs, including nurse midwives, often serve in leadership roles. They need skills to direct and train others in providing care to patients.

A nurse midwife may need to evaluate and treat a broad range of health concerns. The ability to find answers to help provide the best care is critical.

Those interested in a nurse midwife role can get help with their job search through these interview resources:

• Betterteam suggests questions for employers to ask prospective nurse midwives.
• The Kentucky Association of Nurse Practitioners and Nurse-Midwives shares approaches to take before the interview to ensure the best performance.
• Nursing Interview Questions, Nurse Midwifery Job Interview Questions, provides interview prep tips and offers typical interview questions.
• Popular Interview Questions offers options to consider in answering nurse midwife interview questions.

The median annual nurse midwife salary in May 2019, according to the BLS, was $105,030. The lowest 10% of salaries in 2019 were less than $69,000, and the highest 10% were more than $158,990. Nurse practitioner salaries can vary depending on education and experience level, location, and place of employment.

Nurse midwives’ median annual salary outpaces that of the BLS’s category for all healthcare diagnosing or treating practitioners. That group of professions had a May 2019 median salary of $82,380.

The median salary for all U.S. occupations at that time was $39,810.

Nurse midwife salaries vary significantly by state. According to the BLS, the top-paying states for nurse midwives, listed with their median salaries in May 2019, are:

• California — $154,500
• Minnesota — $121,980
• New York — $120,380
• Mississippi — $119,640
• Maryland — $118,240

Nurse practitioners and nurse midwives are both among the careers included in the professional category known as APRNs. But there are differences between a nurse practitioner and a nurse midwife, with nurse midwives’ role centered on care for women.

Nurse midwives provide women’s healthcare, offering services such as gynecological exams, family planning services, and prenatal care. They deliver babies, manage emergencies and repair lacerations during labor, and assist physicians during cesarean births. Nurse midwives may act as primary maternity care providers.

They also provide wellness care, educating women about healthy lifestyles, proper nutrition, and disease prevention for patients and their babies. Additionally, nurse midwives address the sexual and reproductive health issues of their patients’ partners.

Like nurse midwives, nurse practitioners often work with a specific population, but their focus might be anything from adult and geriatric health, to pediatric health, to psychiatric and mental health.

Nurse practitioners provide primary or specialty care, working with patients and their families. Their scope of responsibilities varies by state, but they generally assess patients and determine approaches to address acute needs as well as long-term health improvement. As with nurse midwives, some nurse practitioners prescribe medication, and they consult with physicians and other medical professionals as needed.

When comparing a nurse midwife vs. an OB-GYN, note that the professions do have similarities. Nurse midwives and OB-GYNs both provide care related to prenatal services, labor and delivery, and contraception. The roles have key differences, however.

As APRNs, nurse midwives are not medical doctors, but they often can prescribe contraception, and most hold master’s or doctoral degrees.

Nurse midwives work in hospitals and birth centers and may provide home birth, offering holistic care during pregnancy and after childbirth. While they often are part of a labor and delivery team that includes an OB-GYN, nurse midwives typically focus on maternal care that relies on special medical interventions only when absolutely necessary.

Unlike nurse midwives, OB-GYNs — working in obstetrics and gynecology — are medical doctors. They graduated from accredited medical schools and completed four years of residencies covering the following areas:

• Gynecology
• Obstetrics
• Ultrasonography
• Gynecological oncology
• Preventive care

This education is among the requirements of the American Board of Obstetrics and Gynecology (ABOG). The ABOG and states set standards for OB-GYN care. OB-GYNs received training to perform surgeries such as cesarean deliveries and episiotomies. They can manage pregnancy-related complications, providing medical interventions such as inducing labor or assisting deliveries using forceps or suction.

OB-GYNs generally work in hospitals, clinics, or private or group practices. Some OB-GYNs pursue additional education to specialize in areas such as infertility or fetal medicine.

From providing a much-needed affordable option for women’s care to offering holistic services shown to enhance birth outcomes, the work of nurse midwives can play an important part in improving healthcare for women.

Becoming a nurse midwife offers the opportunity to make a difference in maternal healthcare and pursue a career in a growing, dynamic field.

Indeed Career Guide, “What You Need to Know About a Career as a Nurse Midwife”

U.S. Bureau of Labor Statistics, Occupational Employment Statistics, Nurse Midwives