Certified nurse midwives (CNMs) are advanced practice registered nurses who provide comprehensive healthcare services focused on pregnancy, childbirth, postpartum care, newborn care, and reproductive health across the lifespan. CNMs provide prenatal care (monitoring pregnancy health, ordering and interpreting diagnostic tests, managing pregnancy complications), attend and manage labor and delivery (including vaginal births in hospitals, birth centers, and home settings), provide postpartum care (monitoring maternal recovery, supporting breastfeeding, managing postpartum complications), perform well-woman gynecologic care (annual exams, contraceptive counseling and prescribing, STI screening and treatment, menopause management), and provide primary care services for women in many practice settings. CNMs deliver approximately 10 percent of all vaginal births in the United States, and research consistently demonstrates that midwifery care produces outcomes comparable to physician care for low-risk pregnancies, with lower rates of cesarean section, lower rates of intervention (episiotomy, labor induction), and higher patient satisfaction scores.
Education Pathway
BSN (4 years): Complete a Bachelor of Science in Nursing and pass the NCLEX-RN® to become a registered nurse. Clinical Nursing Experience (1 to 2+ years): Most CNM programs require or strongly prefer nursing experience, particularly in labor and delivery, postpartum, or women’s health settings. Working as an RN in these areas provides the clinical foundation that midwifery education builds upon. Graduate Program (2 to 3 years): Complete a master’s (MSN) or doctoral (DNP) degree in nurse-midwifery from a program accredited by the Accreditation Commission for Midwifery Education (ACME). The curriculum includes advanced health assessment, pharmacology, pathophysiology, midwifery management of pregnancy (antepartum, intrapartum, and postpartum care), gynecologic care, newborn care, primary care, and extensive clinical practicum (the minimum required clinical hours are substantial, typically 600 to 1,000+ hours of supervised midwifery practice). Certification: After graduating, pass the American Midwifery Certification Board (AMCB) exam to earn the CNM credential. CNMs are licensed in all 50 states, though scope of practice and prescriptive authority vary by state.
Direct-Entry Pathways: Some midwifery programs accept students who hold a bachelor’s degree in a non-nursing field and provide an accelerated pathway to the CNM credential (typically 3 to 4 years, combining nursing fundamentals with midwifery education). These direct-entry programs are less common than traditional BSN-to-CNM pathways but provide an option for career changers who are drawn to midwifery without prior nursing experience.
What CNMs Do
Prenatal Care: CNMs provide comprehensive prenatal care from the first confirmation of pregnancy through delivery. Each prenatal visit involves monitoring fetal growth and development, checking maternal vital signs and weight, screening for complications (gestational diabetes, preeclampsia, fetal growth restriction), ordering and interpreting laboratory tests and ultrasounds, providing nutrition and exercise counseling, addressing emotional and psychosocial needs, and educating expectant parents about what to expect during labor, delivery, and the postpartum period. The midwifery model of care emphasizes spending more time with each patient than the typical physician visit allows, building a trusting relationship that supports the patient through one of the most transformative experiences of their life.
Labor and Delivery: Managing labor and delivery is the defining clinical skill of midwifery. CNMs monitor the progress of labor, assess fetal wellbeing through heart rate monitoring, provide pain management (including both non-pharmacologic techniques and epidural orders where authorized), make clinical decisions about when to intervene and when to allow labor to progress naturally, perform deliveries (including perineal repair for lacerations), manage the third stage of labor (delivery of the placenta), and initiate neonatal assessment and breastfeeding support. CNMs manage normal births independently and collaborate with obstetrician-gynecologists when complications arise that require medical or surgical intervention (cesarean section, forceps delivery, management of hemorrhage or other emergencies). The ability to recognize when a birth is progressing normally and when intervention is needed is the core clinical judgment of midwifery practice.
Beyond Birth: CNMs provide gynecologic and primary care services throughout the lifespan: annual well-woman exams, Pap smears and cervical cancer screening, contraceptive counseling and management (including IUD insertion and removal, hormonal contraception, and fertility awareness methods), STI screening and treatment, menopause management (hormone therapy, symptom management, bone health), preconception counseling, and infertility evaluation. Some CNMs maintain a full-scope primary care practice for women, managing not only reproductive health but also chronic conditions like hypertension, diabetes, and mental health concerns.
Salary and Job Outlook
The median annual salary for nurse midwives is approximately $120,000 according to the Bureau of Labor Statistics (reported in the combined category with nurse anesthetists and nurse practitioners). Salaries range from approximately $90,000 for entry-level positions to $150,000+ for experienced CNMs in high-demand areas, hospital-based practices, or birth centers with high volume. The profession is projected to grow 38 percent through 2032 (combined NP/CRNA/CNM category), driven by increasing demand for midwifery care, expanding scope of practice legislation, growing evidence supporting the midwifery model for low-risk births, and persistent obstetrician shortages in rural and underserved areas. Graduate program tuition averages $40,000 to $100,000 for the MSN, with DNP programs costing more.
Advantages and Challenges
Advantages: The profound experience of attending births and supporting families through pregnancy and parenthood, the evidence-based midwifery model that prioritizes physiologic birth and patient autonomy, full prescriptive authority in most states, the expanding scope of practice and growing demand, the ability to practice in diverse settings (hospitals, birth centers, home births, clinics), strong salary relative to education investment, and the deep patient relationships that develop over months of prenatal care.
Challenges: The unpredictable schedule of birth (babies arrive when they are ready, which means on-call nights, weekends, and holidays are standard), the emotional intensity of birth (most births are joyful, but complications, fetal loss, and maternal emergencies take a significant emotional toll), scope of practice limitations in some states (requiring physician collaboration or supervision), the physical demands of attending long labors, professional tensions with obstetricians in some practice settings, and the risk of burnout from the combination of on-call scheduling and emotional intensity.
Getting Started
Middle school: Explore biology, health, and women’s health topics. High school: Take science courses, volunteer in healthcare settings, and learn about reproductive health. Undergraduate: Complete a BSN, work as an RN in labor and delivery or women’s health, and apply to ACME-accredited nurse-midwifery programs.
Birth Center and Home Birth Practice: While most CNMs practice in hospitals, a distinctive aspect of the profession is the option to attend births in freestanding birth centers and home settings. Birth centers are healthcare facilities designed specifically for low-risk births, providing a home-like environment with clinical support available. Home birth midwifery serves patients who choose to deliver in their own homes, with the midwife bringing portable equipment and providing continuous one-on-one care throughout labor. Both settings are associated with lower rates of medical intervention (cesarean section, episiotomy, labor induction) compared to hospital births for low-risk pregnancies, and research demonstrates comparable safety outcomes when appropriate risk screening and transfer protocols are in place. Practicing in these settings requires strong clinical judgment (recognizing when a situation exceeds the scope of out-of-hospital care and requires hospital transfer), independence (you may be the sole provider present), and the ability to manage emergencies with limited resources. Not all CNMs practice in these settings, and most work in hospitals, but the option to attend births outside the hospital is a unique and defining feature of the midwifery profession.
Midwifery and Health Equity: Midwifery has a critical role to play in addressing maternal health disparities in the United States. The U.S. has the highest maternal mortality rate among developed countries, and Black women are approximately 3 times more likely to die from pregnancy-related complications than white women. Research suggests that expanding access to midwifery care, particularly for communities of color and in underserved areas, could reduce these disparities. The midwifery model of care, with its emphasis on patient-centered, continuous, relationship-based care and lower intervention rates, has been shown to improve outcomes for populations that have historically experienced disrespectful or inadequate maternity care. CNMs who practice in community health centers, public hospitals, and underserved communities are directly addressing some of the most urgent health equity challenges in American healthcare. See our health equity page.
References
Bureau of Labor Statistics. “Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners.” BLS, 2025. https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm. Accessed March 2026.
American College of Nurse-Midwives (ACNM). “About Midwives.” ACNM, 2025. https://www.midwife.org/. Accessed March 2026.