Certified Nurse-Midwives (CNMs) are Advanced Practice Registered Nurses (APRNs) who provide full-scope primary care to women across the lifespan, including prenatal care, labor and delivery, postpartum care, gynecologic services, and family planning. CNMs attend approximately 10% of all births in the United States and practice in hospitals, birth centers, homes, and outpatient clinics.

This guide walks you through every step of the process, from earning your BSN and RN licensure to completing an ACME-accredited nurse-midwifery graduate program, passing the AMCB certification exam, obtaining state APRN licensure, and maintaining your credentials through continuing education. We have also compiled verified data for all 51 states we track so you can compare requirements side by side.

What Does a Certified Nurse-Midwife Do?

Certified Nurse-Midwives are Advanced Practice Registered Nurses (APRNs) who specialize in providing full-scope primary care for women across the reproductive lifespan. CNMs are trained to manage normal pregnancies and births independently, identify complications early, and collaborate with physicians when higher-risk care is needed.

The scope of CNM practice includes:

• Prenatal care: Comprehensive pregnancy management including health assessments, screening, education, and care coordination.
• Labor and delivery: Managing labor, performing vaginal deliveries, and providing immediate newborn care. CNMs attend approximately 10% of all U.S. births.
• Postpartum care: Maternal recovery support, breastfeeding assistance, mental health screening, and follow-up care.
• Gynecologic care: Annual exams, cervical cancer screening, STI testing and treatment, and management of common gynecologic conditions.
• Family planning: Contraceptive counseling and management, including IUD insertion and implant placement.
• Menopausal management: Hormone therapy counseling, bone health screening, and wellness care for women through menopause and beyond.

CNMs practice in a variety of settings, including hospitals, birth centers, private practices, community health clinics, and patients' homes. Many CNMs work in collaborative practices alongside obstetricians, family physicians, and other healthcare providers.

According to the U.S. Bureau of Labor Statistics, which groups nurse-midwives with nurse anesthetists and nurse practitioners in its APRN category, the median annual salary for nurse-midwives specifically is approximately $120,000--$125,000 per year. Salaries vary based on geographic location, practice setting, and experience level, with higher earnings in states with high demand and full practice authority.

Step 1: Education Requirements

Bachelor of Science in Nursing (BSN)

The first step toward becoming a CNM is earning a Bachelor of Science in Nursing (BSN) from an accredited nursing program. A BSN typically takes four years to complete and includes coursework in anatomy, physiology, pharmacology, pathophysiology, health assessment, and clinical nursing rotations. Some students enter accelerated BSN programs (12--18 months) if they already hold a bachelor's degree in another field.

RN Licensure

After earning a BSN, you must pass the NCLEX-RN examination to obtain your registered nurse (RN) license. Clinical nursing experience is strongly recommended before entering a nurse-midwifery program -- most programs prefer applicants with at least one to two years of experience in labor and delivery, postpartum, or women's health nursing, though this is not always a strict requirement.

Graduate Degree from an ACME-Accredited Program

CNM candidates must complete a graduate degree (Master of Science in Nursing or Doctor of Nursing Practice) with a specialization in nurse-midwifery from a program accredited by the Accreditation Commission for Midwifery Education (ACME). ACME is the only accrediting body recognized for nurse-midwifery education programs in the United States. Graduate programs typically take 2--3 years of full-time study.

Nurse-midwifery graduate programs include:

• Advanced health assessment and diagnostic reasoning
• Advanced pharmacology and prescribing
• Advanced physiology and pathophysiology
• Antepartum, intrapartum, and postpartum care
• Newborn care
• Gynecologic and primary care for women
• Professional issues, ethics, and health policy
• Research methods and evidence-based practice

Clinical Requirements

ACME-accredited programs require extensive clinical rotations where students provide direct patient care under supervision. Clinical requirements include a minimum of 10 continuity of care experiences (following a patient through prenatal care, birth, and postpartum) and births attended as primary provider. Students must demonstrate competency in all areas of midwifery practice before graduation.

Step 2: AMCB Certification

After graduating from an ACME-accredited nurse-midwifery program, you must pass the national certification exam administered by the American Midwifery Certification Board (AMCB). Passing this exam earns you the Certified Nurse-Midwife (CNM) credential.

Key certification facts:

• Eligibility: You must be a graduate of an ACME-accredited nurse-midwifery education program and hold a current RN license.
• Format: Computer-based examination.
• Credential earned: Certified Nurse-Midwife (CNM).
• Recertification: AMCB requires recertification every 5 years through continuing education or reexamination.
• Recognition: AMCB certification is required or accepted for APRN licensure in all U.S. states and territories.

Preparation resources include AMCB's published content outline, practice exams, and review courses offered by the American College of Nurse-Midwives (ACNM) and other continuing education providers.

Practice Authority: Full Practice vs. Physician Collaboration

Practice authority is one of the most significant regulatory issues for CNMs. Full Practice Authority (FPA) means a CNM can evaluate patients, diagnose conditions, order and interpret diagnostic tests, initiate and manage treatments, and practice independently without mandatory physician oversight or a collaborative agreement. States without FPA require some form of physician collaboration, supervision, or written agreement for CNMs to practice.

Of the 51 states we track, 26 grant full practice authority to CNMs and 25 require some form of physician collaboration. States with full practice authority include:

States requiring physician collaboration or supervision:

Prescriptive Authority

Prescriptive authority allows CNMs to prescribe medications, including controlled substances in many states. The scope of prescriptive authority varies by state -- some grant independent prescribing while others require a collaborative agreement with a physician. Of the 51 states we track, 51 grant prescriptive authority to CNMs.

APRN Compact

The APRN Compact is an interstate agreement that allows APRNs, including CNMs, to hold one multistate license with the privilege to practice in other compact member states without obtaining additional state licenses. This is similar to the Nurse Licensure Compact (NLC) for RNs but applies specifically to advanced practice nurses.

Of the 51 states we track, 0 participate in the APRN Compact. The compact is still in early stages of implementation, and the number of participating states continues to grow. Check individual state pages for the most current information on compact participation and implementation status.

State-by-State Nurse-Midwife Requirements

Requirements vary significantly by state, particularly regarding practice authority, prescriptive authority, and collaborative agreement requirements. Click any state name to see its complete licensing guide with step-by-step instructions, fees, CE details, and more.

Data sourced from official state boards of nursing and the AMCB. Requirements change frequently -- always verify with your state board before applying.

Continuing Education Requirements

Maintaining your CNM certification and state APRN license requires ongoing continuing education. Requirements exist at two levels: AMCB national certification and state APRN licensure.

AMCB Recertification

The AMCB requires recertification every 5 years. CNMs can recertify through one of two pathways:

• CE Module Pathway: Completion of AMCB-approved continuing education modules and CE contact hours within the 5-year certification cycle.
• Reexamination Pathway: Passing the AMCB certification exam again.

State APRN License Renewal

States that issue APRN licenses typically have their own CE requirements for license renewal, which may differ from AMCB's recertification requirements. Across the 51 states we track, the average CE requirement is 24.2 hours per renewal cycle. Some states accept AMCB-approved CE toward state license renewal; others require state-specific coursework, such as training in opioid prescribing, pharmacology updates, or state laws and regulations.

Tips for managing CE requirements efficiently:

• Track your CE hours year-round and keep documentation organized for both AMCB recertification and state renewal.
• Attend the ACNM Annual Meeting or regional midwifery conferences, which offer concentrated CE opportunities and professional networking.
• Look for CE activities that satisfy both AMCB and state requirements simultaneously to reduce duplication.
• Stay current with pharmacology CE, as many states require specific pharmacology hours for APRNs with prescriptive authority.

Frequently Asked Questions

Sources

The information in this guide is compiled from official sources. We recommend verifying current requirements directly with these organizations before making career or educational decisions:

• American College of Nurse-Midwives (ACNM) -- Professional Organization for CNMs
• American Midwifery Certification Board (AMCB) -- CNM Certification
• Accreditation Commission for Midwifery Education (ACME) -- Accredited Program Directory
• U.S. Bureau of Labor Statistics -- Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners
• Individual state boards of nursing -- see each state page for direct links to official regulatory authorities.