How to Become a Certified Nurse Midwife (CNM)

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Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery

The Accreditation Commission for Midwifery Education (ACME) remains the sole accrediting agency for midwifery programs in the U.S. Graduates of ACME-accredited nurse-midwifery programs are eligible to take the nurse-midwife national certification examination administered by the American Midwifery Certification Board (AMCB), a requirement for advanced practice licensure as a certified nurse-midwife in all jurisdictions.

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Program Options for Different Types of Graduate Students

All nurse-midwifery programs result in a graduate degree or post-graduate certificate. Depending on their current educational background, RNs may qualify to take the following ACME-accredited nurse-midwifery programs:

Program Type	Designed For	Typical Duration
MSN/MS Programs	RNs with Bachelor of Science in Nursing (BSN) degrees	2-3 years full-time
RN-to-MSN Programs	RNs with associate’s degrees in nursing	3-4 years full-time
Post-Graduate Programs	RNs with an MSN wanting to add CNM certification	1-2 years full-time
DNP Programs	RNs seeking the highest level of clinical preparation	3-4 years full-time

Other options available to those pursuing graduate degrees in nurse-midwifery include:

Partially or Fully Online Format: Many institutions offer partially or entirely online ACME-accredited nurse-midwifery programs, with clinical rotations completed at approved sites near students’ homes. The distance learning option provides working RNs and those not near an accredited nurse-midwifery program with a convenient alternative to campus-based programs.
Dual Specialization: Many institutions have begun offering students the option of taking a dual specialization program. One of the most popular programs today is the nurse-midwifery/women’s health nurse practitioner program, which provides students with a more comprehensive course of study in women’s health. Graduates of these programs are eligible to become nationally certified and state licensed as both a Certified Nurse-Midwife (CNM) and a Women’s Health Nurse Practitioner, Board Certified (WHNP-BC).

Admission Requirements

A traditional MSN or MS in Nurse-Midwifery is about two years in length. Part-time programs are about three years in length. In addition to possessing an RN license and a bachelor’s degree in nursing, candidates are often required to possess:

Minimum undergraduate GPA (typically 3.0 or higher)
One or more years of clinical nursing experience (often in labor and delivery or women’s health)
Letters of recommendation from professional references
Personal statement outlining career goals
Current, unencumbered RN license
Prerequisite coursework in statistics and health assessment

Program Structure

Nurse-midwife graduate programs prepare RNs to provide quality care to women throughout the lifespan through didactic coursework and immersive clinical rotations. Students of nurse-midwifery programs participate in a full range of clinical experiences in settings like birth centers and hospitals. The clinical component of a nurse-midwifery program may be as long as 1,000 hours, while didactic coursework typically consists of 40-60 credit hours.

All ACME-accredited nurse-midwife master’s programs consist of core coursework in these topics:

Advanced Pathophysiology
Clinical Pharmacotherapeutics
Midwifery Management: Health Assessment and Gynecology
Professional Issues in Midwifery
Primary Care of Women
Midwifery Management during Pregnancy
Care of the Women during Labor, Birth, Postpartum, and Care of the Newborn

Step 2. Qualify for the Certified Nurse-Midwife (CNM) Credential through Examination

Graduates of nurse-midwifery programs must pass the certified nurse-midwife examination through the American Midwifery Certification Board (AMCB) to earn the CNM credential and qualify for advanced practice state licensure in all jurisdictions. All U.S. states and jurisdictions recognize the certified nurse-midwife exam and resulting CNM credential as the required route to licensure.

Certification in nurse-midwifery protects the public by ensuring that practicing nurse-midwives have met the stringent criteria for CNM recognition established by the AMCB.

Certification Examination Components

The AMCB national certification examination in nurse-midwifery tests the knowledge and clinical judgment needed to practice as a certified nurse-midwife. The examination consists of 175 multiple-choice questions based on current practice standards established in nursing, medical, and midwifery literature.

The content areas of the certification examination include:

Content Area	Percentage of Exam
Antepartum	19-26 percent
Intrapartum	17-26 percent
Postpartum	15-18 percent
Well-Woman/Gynecologic	15-18 percent
Women’s Health/Primary Care	8-16 percent

Candidates can read a more detailed review of the examination content and test preparation recommendations by reviewing the AMCB Candidate Handbook.

Applying for and Scheduling the Certification Examination

Candidates must pass the CNM examination within 24 months of completing their nurse-midwifery program. Examinees may attempt the examination a total of four times.

All candidates must apply to take the exam through the AMCB by completing the Application for Testing and Subsequent Certification as a CNM and submitting it to the AMCB, along with the $500 examination fee.

Once the AMCB has received the application and exam fee, candidates will receive notification by mail within two weeks. Candidates must then schedule to take the examination at an Applied Measurement Professionals (AMP) testing center. Candidates may schedule their examination online through the AMP website or by calling AMP at 800-345-6559. There are about 125 AMP testing centers located across the country.

Upon passing the exam, successful candidates will receive a certification number and CNM credential expiration date from the AMCB.

Step 3. Apply for Advanced Practice State Licensure as a Certified Nurse-Midwife

CNMs must be state-licensed through their state Board of Nursing to practice nurse-midwifery, usually as advanced practice registered nurses (APRN). The application process generally includes:

Completing an APRN-CNM application
Paying the state license fee
Submitting proof of graduation from an ACME-accredited nurse-midwifery program
Submitting proof of current CNM certification

While some states grant qualified nurse-midwives full prescriptive authority, allowing them to practice autonomously to the full extent of their training and education, others require practicing nurse-midwives to enter into a collaborative practice agreement with a physician (in general practice or when seeking prescriptive authority). Depending on the state, applicants may need to provide the Board with a signed collaborative practice agreement when they apply for licensure.

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Practice Authority Type	Description	States (Examples)
Full Practice Authority	CNMs can practice independently without physician supervision	Alaska, Colorado, Connecticut, Hawaii, Maine
Reduced Practice Authority	CNMs have some independence but with certain restrictions	Alabama, Delaware, Illinois, Kansas, Maryland
Restricted Practice Authority	CNMs require physician supervision for some or all of their practice	Florida, Georgia, North Carolina, South Carolina, Texas

Step 4. Maintain CNM Certification and State Licensure through Continuing Education

All nurse-midwives in the U.S. must maintain their CNM designation to remain licensed by the state. The AMCB features a Certification Maintenance Program, which provides CNMs with two options for maintaining their CNM designation at the conclusion of their five-year certification cycle:

Maintenance Option	Requirements
Option 1: Continuing Education	Complete at least 3 AMCB Certificate Maintenance Modules during each five-year certification cycle and at least 20 contact hours of approved continuing education units; pay annual fees
Option 2: Reexamination	Retake the AMCB Certification Examination and pay the $500 examination fee in lieu of annual fees

While some states view the successful renewal of the CNM certification as meeting continuing education requirements, others require CNMs to complete a specific number of continuing education credits in addition to those needed to maintain the CNM credential. Most states renew advanced practice licensure for CNMs annually or biennially upon completion of a renewal application and payment of a renewal fee.

Professional Organizations and Continuing Education

Membership and participation in midwifery professional associations, at either the state or national level, may provide CNMs with ample opportunity to network with other nurse-midwifery professionals and satisfy their continuing education opportunities through classes, seminars, and conventions, among others:

Frequently Asked Questions About Becoming a Certified Nurse-Midwife

How long does it take to become a Certified Nurse-Midwife?

The total time to become a CNM typically ranges from 6-8 years: 4 years for a BSN, 1-2 years of nursing experience (recommended by most graduate programs), and 2-3 years for a master’s degree in nurse-midwifery. Accelerated or part-time options may shorten or extend this timeline.

What’s the difference between a CNM and other types of midwives?

A Certified Nurse-Midwife (CNM) is an advanced practice registered nurse with graduate education in midwifery. Other types include Certified Midwives (CMs) who have midwifery education but aren’t nurses, and Certified Professional Midwives (CPMs) who specialize in out-of-hospital births. CNMs have the broadest scope of practice, can prescribe medications, and can practice in all 50 states.

Can Certified Nurse-Midwives practice independently?

Practice authority varies by state. Some states grant CNMs full practice authority, allowing independent practice without physician supervision. Other states require collaborative agreements with physicians or restrict certain aspects of practice, particularly prescriptive authority.

What are the clinical requirements for nurse-midwifery programs?

ACME-accredited nurse-midwifery programs typically require 500-1,000 clinical hours. Students must attend a minimum number of births, conduct prenatal and postpartum visits, perform gynecological exams, and provide newborn care under the supervision of experienced preceptors.

Can I become a CNM with an Associate Degree in Nursing?

Yes, but you’ll need additional education. RNs with associate degrees can pursue RN-to-MSN bridge programs, including BSN coursework, before advancing to graduate-level midwifery education. These programs typically take 3-4 years of full-time study to complete.