Despite an increasing demand in Arkansas for the uniquely personalized services that certified nurse midwives provide, the Arkansas State Board of Nursing reported that no new licenses were issued for CNMs in 2014, and only four were issued the year before.
As of 2015, there were only about 27 certified nurse midwives working throughout the state. With more women seeking primary gynecological, intrapartum and postpartum nurse-midwifery care, and with so few CNMs currently practicing in the state, Arkansas’s nurse-wives are finding no shortage of opportunities, whether seeking conventional employment or looking to establish private practice women’s clinics and birth centers.
In 2018, less than 7% of births in Arkansas were attended by midwives, according to the U.S. Department of Health & Human Services, Centers for Disease Control and Prevention and the National Center for Health Statistics.
Midwife-attended deliveries in birthing centers and in the home have a much longer tradition in Arkansas than hospital births. Though nurse-midwifery has evolved to become a well-established advanced practice nursing specialization, there has been a growing interest among women who wish to return to the tradition of gentle intrapartum care and the less invasive delivery processes associated with midwifery. This has led to more women opting to work with certified nurse midwives outside of hospitals so as to enjoy a greater level of individualized care and personal input during pregnancy and labor.
Steps to Becoming a Nurse-Midwife in Arkansas
To become a certified nurse midwife (CNM) in Arkansas, RNs must meet the requirements for Advanced Practice Registered Nurse (APRN) licensure through the Arkansas State Board of Nursing by earning a master’s degree at minimum and gaining national certification through the American Midwifery Certification Board (AMCB).
Registered nurses would be required to follow the steps shown here to become a certified nurse-midwife in Arkansas:
Step 1. Earn a Qualifying Education in Nurse Midwifery
In order to become a nurse-midwife, registered nurses must complete a graduate program in nurse midwifery approved by the Accreditation Commission for Midwifery Education (ACME).
Accredited online nurse-midwifery programs are available through some of the nation’s top schools and offer working RNs the flexibility necessary to earn a graduate degree while maintaining their current job. Those interested in a full-time campus-based experience may consider ACME-accredited programs at schools located nearby in Texas and Tennessee.
Graduate programs in midwifery may also offer dual specializations in a related field such as women’s health. Completing a dual-focus graduate program in nurse-midwifery/women’s health would fulfill the Arkansas State Board of Nursing’s education requirements for recognition as both a certified nurse midwife (CNM) and a nurse practitioner in women’s health (WHNP).
Admissions Requirements
Graduate admission requirements are unique to each school, however many share common elements like:
- BSN and/or completion of nursing prerequisite courses
- Letters of recommendation
- Minimum undergraduate GPA
- Essay on professional goals or a personal video message
- Current RN license
Most prospective graduate students hold a BSN, however, the American Commission on Midwifery Education (ACME) does accredit RN-to-MSN programs designed for ADN-educated nurses looking to earn both a BSN and master’s degree in one comprehensive dual-degree program.
Completing a Nurse Midwife/Women’s Health Graduate Program
The content of a Nurse-Midwifery/Women’s Health Nurse Practitioner (NM/WHNP) program can have between 40-60 semester credits of classes that cover topics like:
- Female care before, during, and after pregnancy
- Advanced topics in women’s reproductive health
- Advanced pharmacology topics for childbearing women
- Legal and ethical issues in women’s health
- Advanced women’s physiology and pathophysiology
- Biostatistics and other research methods for advanced-practice nurses
- Labor, birth, and newborn care
- Integrated midwifery care of women
- Maternity nutrition
NM/WHNP graduate programs will also include a clinical education segment that is usually 1,000 hours in duration. During this portion of the program, students will apply their theoretical classroom knowledge to real-life situations under close supervision.
Online students are assigned a faculty advisor early on in the process who will help to locate and develop clinical opportunities in local facilities. In some cases students may need to commute or relocate to complete the clinical portion of their program. Examples of places where clinical education might take place in Arkansas include:
- Northwest Medical Center in Bentonville
- Washington Regional in Fayetteville
- Baptist Health Medical Center in Little Rock and North Little Rock
- Saline Memorial in Benton
- Medical Center of South Arkansas in El Dorado
- Forrest City Medical Center
- CHI Saint Vincent Infirmary in Little Rock
Upon earning their graduate degree, RNs would them be qualified to sit for the national certifying exams.
Step 2. Achieve National Certification in Nurse Midwifery
Nurses who have earned an accredited dual-focus master’s degree in Nurse-Midwifery/Women’s Health Nurse Practitioner (NM/WHNP) will be qualified to register for either one or both national certifying exam(s) through these sponsoring organizations:
- American Midwifery Certification Board (AMCB) – sponsor of the nationally-recognized Certificate in Nurse Midwifery
- National Certification Corporation (NCC) – sponsor of the nationally-recognized Women’s Health Nurse Practitioner (WHNP-BC) credential
Both exams are administered through the third-party testing company Applied Measurement Professional (APM), which has exam centers located in Fayetteville and Little Rock. After registering for their exams with the AMCB and/or NCC, exam candidates can sign up for a testing date for one or both exams through APM’s website.
Certified Nurse Midwife Exam
Aspiring nurse midwives can begin preparing for this exam by reviewing the AMCB’s Candidate Handbook. The four-hour test is administered on a computer and comprised of 175 multiple-choice questions. The topics covered on the exam are:
- Antepartum – 19-26 percent
- Intrapartum – 17-26 percent
- Postpartum – 15-18 percent
- Gynecology – 15-18 percent
- Women’s health and primary care – 8-16 percent
- Newborn – 7-16 percent
Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
Upon successful completion the AMCB will issue candidates a Certificate in Nurse Midwifery.
Women’s Health Care Nurse Practitioner (WHNP) Exam
Candidates can prepare for this exam by studying the NCC’s WHNP Candidate Guide. The three-hour exam is administered on a computer and is comprised of 150 scored multiple-choice test questions. Up to 25 unscored additional pretest questions may also be present. The topics covered on the exam are:
- Gynecology – 35-40 percent
- Obstetrics – 25-30 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Pharmacology – 5-10 percent
Candidates can apply for the WHNP Exam online through the NCC’s website. Upon successful completion the NCC will issue candidates the WHNP-BC credential.
Step 3. Apply for APRN Status with the Arkansas State Board of Nursing
The Arkansas State Board of Nursing offers two routes to APRN status in NM/WHNP:
- Via examination – this is for first-time midwives and/or women’s health NPs who have completed, or will soon complete, their national certification examinations
- Via endorsement – this is for nurse midwives and/or women’s health NPs who already have their APRN status recognized by a board of nursing in a different state
Candidates can indicate their application route, as well as if they are applying for APRN status as a nurse midwife, women’s health nurse practitioner, or both, through the Arkansas State Board of Nursing’s online application portal.
Applicants can check the status of their application on the board’s status check website. Once this shows the APRN status is active, licensees may begin practicing in their new field.
Option for Temporary Permit
While completing the application, applicants can opt for a temporary permit that is valid for six months if they have fulfilled all requirements other than completing the national certification exam(s). Furthermore they must be registered for their national certification exam(s), and if the exam(s) are not passed then the temporary license becomes invalid.
Step 4. Explore New Career Opportunities and Maintain Credentials
APRN status must be renewed every two years through the Arkansas State Board of Nursing, while national certification must be maintained through the respective certification agencies as described below.
APRN Status Renewal with the Arkansas State Board of Nursing
APRN status as a nurse midwife and/or women’s health nurse practitioner expires at the same time as the nurse’s traditional RN license (every two years on the last day of a nurse’s birth month). To renew their APRN status, nurses must submit the following to the Arkansas State Board of Nursing:
- APRN renewal form
- Proof of current RN license
- Proof of current certification with the appropriate national certifying organization – AMCB and/or NCC
Certificate in Nurse Midwifery Renewal with the American Midwifery Certification Board (AMCB)
This national certification is on a five-year renewal cycle, which is completed through the AMCB’s Certificate Maintenance Program. This involves one of the following methods:
- Re-examination
- Completion of three certificate maintenance modules and 20 hours of continuing education
Women’s Health Care Nurse Practitioner (WHNP-BC) Renewal with the National Certification Corporation (NCC)
This national certification is on a three-year maintenance cycle. To complete this, women’s health NPs will first take a Continuing Competency Assessment through the NCC. The score on this assessment determines the amount of required continuing education hours, which ranges between 10 and 50 hours.
Career Opportunities in Nurse Midwifery and Women’s Health
Many newly licensed APRNs advance within their current place of employment or at the location where they completed their clinical education. Others may find it appealing to start their own practice or team up with other colleagues to open a local women’s clinic or birthing center. Examples of practice models in Arkansas, ranging from large hospitals to smaller practices, include:
- Conway Women’s Health Clinic
- Arkansas Women’s Center in Little Rock
- The Women’s Clinic in Little Rock
- Center for Women’s Health in Fort Smith
- Saint Edwards Women’s Center in Fort Smith
- Creekside Center for Women in Springdale
- Regional Women’s Center in Jonesboro
- Johnelle Hunt Women’s Center at Washington Regional in Fayetteville
- Labor and Delivery Department at Saline Memorial Hospital in Benton
- Baptist Memorial Health Care’s Women’s Center in Jonesboro
- Obstetrics Unit at the Willow Creek Women’s Hospital in Johnson
- CHI Saint Vincent Labor and Delivery unit in Hot Springs
- Neonatal Intensive Care Unit at the University of Arkansas Medical Center in Little Rock
- Baptist Health’s Mother-Baby Unit in Little Rock
- Conway Regional Labor and Delivery Hospital
The following job listings are taken from actual vacancy announcements posted throughout Arkansas. These were sampled from a statewide survey completed in 2015, and are provided here as illustrative examples only:
- RN Women’s Services Director in Magnolia
- Labor and Delivery Nurse with a local healthcare provider in Arkadelphia
- RN II with Arkansas Children’s Hospital in Little Rock
- Labor and Delivery Nurse with a local healthcare provider in Stuttgart
- Pediatric Nurse at the Center for Pediatric and Adolescent Medicine in Fort Smith
Salaries for Certified Nurse-Midwives in Arkansas
According to the United States Bureau of Labor and Statistics, the number of certified nurse-midwives working throughout the country is projected to grow by 45% through 2029, a trend that is also expected to be seen in Arkansas. The annual average salary for nurse midwives in 2019 was $108,810. Entry-level nurses earn around $69K, but experienced nurse midwives can earn $127,110 in the 75th percentile and $158,990 in the 90th percentile of all certified nurse-midwives.
As more women turn to certified nurse-midwives for the less-invasive whole-person centered antepartum, intrapartum and postpartum care they have become so well known for, hospitals and integrated health systems throughout Arkansas are offering generous starting salaries and benefits packages as a way to attract CNMs.
An Overview of the Nurse Midwife Profession in Arkansas
Two prominent professional associations, American College of Nurse-Midwives and the Citizens for Midwifery, published the following information about nurse midwives of Arkansas:
- In 2014, there were 34 licensed certified nurse midwives employed in Arkansas
- 44% of certified nurse midwives in Arkansas were members of the American College of Nurse-Midwives.
- Less than 1% of births in Arkansas were attended by certified nurse midwives or certified midwives in 2012.
- In 2010, 67.13% of births in Arkansas were covered by Medicaid, the largest single payer of certified nurse midwife services in the country.
- Most certified nurse-midwives in Arkansas practice in the northwest and central regions of the state.
- 1,503 births in Arkansas have been assisted by licensed midwives from 2005 to 2015.
- Nurse midwives typically work in health care centers such as the Mercy Hospital in Fort Smith or the University of Arkansas Medical Center in Little Rock.
(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2019. Figures represent state data, not school-specific information. Job growth data provided by Projections Central, a resource funded by the U.S. Department of Labor’s Employment and Training Administration. Conditions in your area may vary. Information accessed March 2021.)