The Colorado affiliate of the American College of Nurse-Midwives reports that nurse-midwives attend a full 10 percent of all births that take place statewide. In 2018, more than 13.7% of births in Colorado 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.
While most nurse-midwives work in hospitals – which are also where most births take place – each year Coloradans are expanding the trend of nurse-midwife assisted births at other locations. This growing interest in a more gentle birthing process outside of the hospital setting has helped birthing centers thrive, with Baby & Co opening a chain of five outpatient birthing centers in the state, as featured in a 2015 CNN report, “The Rise of the Birthing Center.”
The greater Denver metropolitan area has one of the highest concentrations and overall number of nurse midwives of all cities in the nation. Even so, the U.S. Department of Labor’s Employment and Training Administration projects that the number of nurse-midwives in the state will increase by 31% over the 10-year period leading up to 2028, just to keep pace with the growing demand for CNM attended births and more personalized well-woman and gynecological care.
Steps to Becoming a Nurse-Midwife in Colorado
Nurse-midwifery is considered an Advanced Practice Nursing (APN) designation. This means that RNs interested in becoming certified nurse-midwives must meet APN licensing requirements through the Colorado Department of Regulatory Agencies’ (DORA) Board of Nursing.
From national certification to state licensing, the following steps offer detailed instructions on how to become a certified nurse-midwife in Colorado:
Step 1. Earn a Qualifying Graduate Degree in Nurse Midwifery
To work as a certified nurse midwife in Colorado, candidates need to complete a graduate-level education in nurse midwifery that is approved by the Accreditation Commission for Midwifery Education (ACME).
There is one such campus-based program in Aurora, and many others available to Colorado residents online. RNs often choose online graduate programs in nurse midwifery because they allow for greater flexibility.
An increasing number of accredited graduate programs are offering graduate programs that provide a dual focus in nurse midwifery and the related subject of women’s health. These Nurse Midwife/Women’s Health NP (NM/WHNP) dual specialization programs prepare RNs to specialize in two APN (Advanced Practice Nursing) areas of focus:
- Certified Nurse-Midwife
- Women’s Health Nurse Practitioner
Admission Standards
The admission standards are similar for campus-based and online programs, with common requirements including:
- Current RN license
- BSN or completion of nursing prerequisite courses
- Minimum GPA
- GRE General Test
- Personal essay, video essay, or statement of purpose
- Letters of recommendation
Most candidates for nurse-midwife graduate programs hold a BSN, however ACME also accredits RN-to-MSN bridge programs in midwifery/women’s health for RNs who hold associate’s degrees in nursing.
Graduate Program Structure
Online and campus-based graduate programs have a similar structure, with between 40-60 semester credits of didactic coursework and around 1,000 hours of clinical education.
During the didactic segment of the program, prospective nurse midwives study important topics in their field:
- Legal issues and ethics in maternal healthcare
- Advanced pathophysiology
- Disease prevention and health promotion
- Psychology for pregnancy
- Advanced clinical assessments
- Labor, birth, and newborn care procedures
- Complicated pregnancies and deliveries
- Advanced pharmacology and therapeutics
- Mother and infant biostatistics
- Research methods for advanced-practice nurses
- Advanced pharmacology for childbearing women
The clinical education segment is important for translating didactic academic knowledge into practice. Students who are pursing an online education work with faculty advisors from an early stage to identify potential local clinical programs. Nationally recognized graduate schools make a concerted effort to develop partnerships with clinical sites throughout the nation, including in Colorado.
Examples of potential clinical sites located throughout the state can include:
- Denver Health Hospital
- Poudre Valley Hospital
- Memorial Hospital North in Colorado Springs
- Parkview Medical Center in Pueblo
- TriStar Centennial Medical Center
- Boulder Medical Center
- University of Colorado Anschutz Medical Campus in Denver
- Clinical Education Center
- Center for Midwifery
- University Nurse Midwives
With a master’s degree in nurse-midwifery or women’s health/nurse-midwifery (NM/WHNP), graduates can apply to take the national exams required to become certified nurse midwives or dually certified as nurse midwives/women’s health nurse practitioners.
Step 2. Pass the Required National Certification Examination in Nurse-Midwifery
In addition to graduating from an accredited master’s program, to gain APN status from the Colorado Board of Nursing, candidates will need to gain national certification from the appropriate organization(s). While the Certified Nurse Midwife credential is the standard for all nurse-midwives, graduates of dual-focus programs in nurse-midwifery/women’s health nurse practitioner may also choose to pursue the WHNP-BC credential.
- American Midwifery Certification Board (AMCB) – sponsor of the Certificate in Nurse Midwifery (CNM)
- National Certification Corporation – sponsor of the Women’s Health Care Nurse Practitioner (WHNP-BC) credential
National certification in a given field is granted once candidates have passed the sponsoring agency’s national examination. Upon registering for examinations with the appropriate agency, candidates can sign up for a testing date and location with the company Applied Measurement Professional (APM). APM offers both exams at its testing sites, located in H&R Block Centers in the cities of:
- Aurora
- Grand Junction
Certified Nurse Midwife Exam
To register with American Midwifery Certification Board (AMCB), candidates can fill out an application and send it to:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
Prospective nurse midwives can start preparing for this exam by reviewing the Candidate Handbook. Comprising 175 multiple-choice questions, candidates have four hours to complete the exam, which covers the topics of:
- 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
Once the exam is passed RNs will receive a Certificate in Nurse Midwifery (CNM) from the AMCB.
Women’s Health Care Nurse Practitioner (WHNP) Exam
Candidates can register for this exam online through the National Certification Corporation’s (NCC). Prospective APNs can prepare for this exam by studying the WHNP Candidate Guide. Comprising 150 score multiple-choice questions and up to 25 unscored pretest questions, candidates have three hours to complete this exam. Subjects evaluated on the test 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
Once the exam is passed RNs will earn the NCC’s WHNP-BC credential.
Step 3. Apply for APN Licensure with the Colorado Board of Nursing
At this point prospective RNs will be ready to apply for APN status with the Colorado Department of Regulatory Agencies’ (DORA) Board of Nursing.
RNs can make their application online through the Division of Professions and Occupations Online Services Portal. Before applying candidates may want to browse the relevant checklists:
Twenty-four hours after submitting an application, candidates must create a Healthcare Professional Profile (HPP) with the DORA.
Collaboration with Other Medical Professionals
Collaborating with other medical professionals, especially physicians, is an important part of working as an APN. While a collaborative agreement is not a formal part of the application process for APN status, APNs are expected to establish a safe mechanism for consulting and collaborating with physicians. The same holds true for APN referral to physicians when appropriate, as well as referrals to other healthcare providers.
Prescriptive Authority
APNs also have the option of applying for the authority to write prescriptions. To be eligible for this APNs must meet these conditions:
- Hold an active and unencumbered RN license from Colorado or a compact state
- Complete at least 1,800 hours of mentoring with a physician or other APN who has prescriptive authority – these medical professionals must specialize in the same APN area as the applicant
- Obtain liability insurance of at least $500,000
- Complete graduate-level courses in patient assessment, pathophysiology, and pharmacology if these were not previously completed as part of an NM/WHNP program
To apply, candidates can fill out an APN Application for Provisional Prescriptive Authority, submitting this to:
Division of Professions and Occupations
State Board of Nursing – Advanced Practice Nursing
1560 Broadway, Suite 1350
Denver, CO 80202
Before being allowed to prescribe medication in Colorado, APNs will also need to register with the Drug Enforcement Agency (DEA) to obtain a DEA number.
Out-of-State Applicants
RNs who hold APN status in another state can apply for APN status in Colorado if they meet one of these conditions:
- Their state is part of the national APRN Compact
- They have practiced as an APN nurse in their home state for two of the last five preceding years
Step 4. Maintain APN Licensure and National Certification
Prospective APNs can check the status of their application on DORA’s online license lookup. Once the APN status becomes active, candidates can print their license and begin their new careers.
Renewing Advanced Practice Nursing (APN) Status with the Board of Nursing
An RN’s APN status expires every two years at the same time as the traditional RN license, which must also be renewed. Candidates can renew their APN registration online by signing into their DORA account. APNs need to maintain continuing competency in their field to be eligible to renew their status, and this can be done in one of two ways:
- Maintenance of national certification through the appropriate organization (AMCB and/or NCC)
- Petitioning of the Board of Nursing to determine an alternative method for demonstrating continuing competency
Renewing Prescriptive Authority with the Department of Nursing
Within five years of having provisional prescriptive authority, APNs must complete the following to convert this designation to full prescription authority:
- Another mentorship that is at least 1,800 hours
- Create a plan that describes safe prescribing methods
- Maintain liability insurance
Renewing the Certificate in Nurse Midwifery (CNM) with the American Midwifery Certification Board (AMCB)
The CNM is on a five-year renewal cycle, which can be completed by enrolling in the AMCB’s Certificate Maintenance Program. Renewing will require completing one of the following:
- Re-examination
- Completion of three certificate maintenance modules and 20 hours of continuing education
Renewing the Women’s Health Care Nurse Practitioner (WHNP-BC) with the National Certification Corporation (NCC)
The WHNP-BC credential is on a three-year maintenance cycle. The process of obtaining continuing education starts with a Continuing Competency Assessment. The results of this assessment will determine how many hours of continuing education – between 10-50 hours per cycle – are required.
Employers and Practice Models
As APN status becomes active, these trained medical professionals will often decide to pursue more advanced positions at their current place of employment or at the location of their clinical studies. Other nurse midwives and women’s health NPs may choose to work independently or join together with other colleagues to open local women’s clinics or birth centers.
The following list represents significant nurse midwife employers in Colorado as well as potential business models for local practices:
- The Birth Center of Boulder
- Beautiful Beginnings Birth Services in Fort Collins
- Mountain Midwifery Birth Center in Englewood
- Bloomin’ Babies Birth Center in Grand Junction
- Monfort Family Birth Center at the North Colorado Medical Center in Greeley
- Labor and Delivery Unit with Denver Health
- Poudre Valley Hospital Birthing Center
- Memorial Hospital North’s Birth Center in Colorado Springs
- Birth Center at the Parkview Medical Center in Pueblo
- Tristar Centennial Women’s Hospital
- Boulder Community Health’s Family Birth Center
Certified nurse midwives and women’s health NPs can browse the following list of actual job vacancies that were surveyed from across the state in December, 2015. These are provided here for illustrative examples only to give candidates a sense of what this career field has to offer:
- Midwifery Fellow at the UC Anschutz Medical Campus in Denver
- Certified Nurse Midwife at Saint Joseph Hospital in Denver
- Women’s Services Nurse Practitioner at the Castle Rock Adventist Medical Campus
- Certified Nurse Midwife with the Metro Community Provider Network (MCPN) in Denver
- Certified Nurse Midwife for an Instructor position at the UC College of Nursing in Denver
- Women’s Health Nurse Practitioner with an OB/GYN office in Greenwood Village
- Certified Nurse Midwife at the Denver Center for Birth and Wellness
Salaries for Certified Nurse-Midwives in Colorado
The U.S. Bureau of Labor Statistics provides a detailed analysis of the salaries of the 90 nurse midwives employed in the Denver-Aurora-Lakefield area as of 2019. The average annual salary for nurse midwives in the state was $109,900. Experienced nurse midwives in the 90th percentile in Colorado earned an average of $150,750, while nurse midwives in the 25th percentile earned annual salaries that averaged $93,540.
Colorado’s CNMs Enjoy Opportunities for Employment and Advancement
U.S. Department of Labor’s Employment and Training Administration expects job growth for nurse midwives to be extremely high during the projection period between 2018 and 2028. The department expects that the number of jobs for nurse midwives in Colorado to increase by 31% during the 10-year projection period.
Additionally, 12.47% of all births in Colorado were attended by a certified nurse midwife in 2013, according to Georgetown University’s School of Nursing and Health Studies.
Physician Shortages in Colorado Lead to a Growing Demand for Certified Nurse-Midwives
The 2015 report entitled Colorado’s Future Healthcare Workforce and the Role of Advanced Practice Registered Nurses produced by the Colorado Center for Nursing Excellence provides a detailed analysis of the importance certified nurse-midwives and other Advanced Practice Registered Nurses (APRN) to the residents of the state.
While urban counties in Colorado generally have a high number of doctors and other healthcare providers, rural areas typically lack an adequate number of primary care providers. Certified nurse-midwives and other types of APRNs are increasingly being relied upon to provide critical healthcare support in rural parts of Colorado, and in its community health clinics that cater to underserved populations.
Certified nurse-midwives are especially critical to providing healthcare to the residents of Colorado, because fully half of the state’s counties do not have any OB-GYN physicians according to the 2014 fact sheet on Colorado published by the American Congress of Obstetricians and Gynecologists.
The Colorado Center for Nursing predicted that the demand for healthcare workers between 2015 and 2024 would be especially high in these counties:
- Adams County
- Arapahoe County
- Boulder County
- Broomfield County
- Denver County
- Douglas County
- Jefferson County
- Mesa County
- Pueblo County
- Weld County
(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.)