As described in a 2013 article in the Pittsburgh Post-Gazette, women throughout Pennsylvania are increasingly choosing to work with nurse-midwives for a more personalized level of care during pregnancy and over the long-term. The American College of Nurse-Midwives (ACNM) recognizes numerous benefits associated with nurse-midwifery, including fewer instances of low birth weight and fewer costly, unnecessary and invasive procedures like episiotomies and C-sections.
As of 2019, Pennsylvania’s 400 certified nurse-midwives earned an average annual salary of $98,680, according to the U.S. Bureau of Labor Statistics. In 2018, more than 13.7% of births in Pennsylvania 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.
Pennsylvania is representative of a growing trend that is seeing more woman making the choice to bring their babies into the world under the care of a nurse-midwife. Though most CNMs work in hospital obstetric departments, other nurse-midwifery practice models include freestanding birth centers, women’s health clinics and even home birthing services.
Since 1978, Lifecycle WomenCare in Bryn Mawr has been providing health services to women that include labor and delivery, gynecological care, contraception, breastfeeding services, menopausal care, and educational classes on topics that relate to women’s health. At this facility seven certified nurse midwives work alongside a team that includes women’s health nurse practitioners, registered nurses, and additional qualified staff.
Steps to Becoming a Certified Nurse-Midwife in Pennsylvania
The Pennsylvania State Board of Nursing is responsible for licensing nurse midwives. To earn a nurse midwife license, candidates must hold an active Pennsylvania RN license and complete the following steps:
Step 1. Complete a Graduate Program in Nurse-Midwifery
The first step toward earning the certified nurse-midwife (CNM) credential through the American Midwifery Certification Board (AMCB) and qualifying for state licensure as a nurse-midwife through the Pennsylvania State Board of Nursing is to earn a master’s or higher degree in nurse midwifery from a program that has been approved by the Accreditation Commission for Midwifery Education (ACME).
There are two such approved schools with campus locations in Philadelphia. There are also a number other ACME-accredited schools offering Pennsylvania residents the opportunity to enroll in online graduate degree programs in nurse-midwifery. Online programs provide the additional advantage of allowing nurses to keep their current job while also completing their studies on their own time and at their own pace.
Graduate programs in nurse-midwifery also often offer students the option for a dual specialization in women’s health. Graduating from one of these Nurse Midwife/Women’s Health Nurse Practitioner (NM/WHNP) programs fulfills the education requirements for national certification and state licensure in both specialty areas.
Graduate Admission Standards
Common admission requirements for nurse-midwife graduate programs include:
- Letters of recommendation
- Current RN license
- Personal essay, video essay, or statement of purpose
- BSN or completion of nursing prerequisite courses
- GRE General Test
- Minimum GPA
Although most applicants to nurse-midwife graduate programs hold a BSN, ACME also accredits RN-to-MSN bridge programs in midwifery for those that hold associate’s degrees in nursing. These RN-to-MSN bridge programs result in both a bachelor’s and master’s degree in nursing, all in one accelerated program that can usually be completed in about three years.
Structure of the Graduate Program
A nurse midwifery graduate program can be broken into two parts, which may be completed concurrently:
- Didactic education – approximately 40-60 semester credits
- Clinical education – as many 1,000 hours for dual-focus programs
Didactic Education
The didactic education segment covers vital topics and theory that nurse-midwives will use on a daily basis to provide effective antepartum, intrapartum and postpartum care:
- Conducting advanced health assessments
- Advanced physiology
- Psychology for pregnancy
- Female reproductive health
- Labor, birth, and newborn care procedures
- Complicated pregnancies and deliveries
- Advanced integrated midwifery
- Mother and infant bio-statistics
- Multicultural midwifery
- Legal issues and ethics in maternal healthcare
- Advanced pharmacology – at least 45 hours of coursework is required for prescriptive authority
Clinical Education
Students put their didactic knowledge into action during the clinical portion of their education. Online students work closely with faculty advisors from their college of nursing to identify clinical sites at local facilities throughout Pennsylvania. Nursing schools that offer online programs continue to work to develop more clinical partnerships with hospitals and other healthcare providers throughout the nation to ensure commutes and relocations are kept to a minimum.
Examples of potential clinical sites located in Pennsylvania include:
- Einstein Medical Center with locations in Philadelphia, Elkins Park, and East Norriton
- Saint Luke’s University Health Network in Bethlehem and Allentown
- University of Pennsylvania Medical Center in Erie
- Hahnemann University Hospital in Philadelphia
- Jefferson University Hospitals in Philadelphia
- Pennsylvania Hospital in Philadelphia
- Lehigh Valley Hospital in Allentown
- Moses Taylor Hospital in Scranton
- Reading Hospital
Step 2. Pass the National Nurse-Midwife Certification Exam
With a master’s degree in nurse-midwifery or women’s health/nurse-midwifery, RNs can apply to take the national exams required to become certified nurse midwives or dually certified as nurse midwives/women’s health nurse practitioners through the respective organizations:
- American Midwifery Certification Board (AMCB), sponsor of the Certificate in Nurse Midwifery (CNM)
- National Certification Corporation (NCC), sponsor of the Women’s Health Care Nurse Practitioner (WHNP-BC) credential
Certification candidates can register for national exams directly through the appropriate sponsoring agency. Exam candidates may then register with Applied Measurement Professional (APM) for a testing date, time, and location. APM proctors both the Certified Nurse-Midwife Exam and the Women’s Health Care Nurse Practitioner Board Certification Exam at H&R Block Centers in the cities of:
- Harrisburg
- Philadelphia (two locations)
- Pittsburgh
- Wyoming
Certified Nurse Midwife Exam
Prospective nurse midwives can start preparing for this exam by reviewing the AMCB’s Candidate Handbook. The exam is comprised of 175 questions with four hours allowed for completion. The topics evaluated 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
Successful examiners will receive a Certificate in Nurse Midwifery (CNM) from the AMCB. 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
Women’s Health Care Nurse Practitioner (WHNP) Exam
Candidates can prepare for this exam by studying the NCC’s WHNP Candidate Guide. The exam comprises 150 scored test questions, and may contain up to 25 unscored pretest questions. Three hours are allowed for completion, and subjects covered 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
Upon passing the exam nurses will earn the NCC’s WHNP-BC credential. Candidates can register for this exam online through the NCC’s website.
Step 3. Apply for a Nurse-Midwife License with the Pennsylvania State Board of Nursing
Once the education and national certification requirements have been met, nurse-midwife licensure applicants may submit a Nurse-Midwife License Application with Pennsylvania’s State Board of Nursing.
Those that have earned the Women’s Health Care Nurse Practitioner-Board Certification credential may additionally choose to apply for women’s health NP recognition with Pennsylvania’s State Board of Nursing by submitting the Certified Registered Nurse Practitioner License in Women’s Health Application.
Applications may be submitted to:
State Board of Medicine
PO Box 2649
Harrisburg, PA 17105-2649
Applicants for either one or both licenses can also apply online through the Pennsylvania Board of Nursing Online Application Portal.
Nurse midwives and women’s health NPs must also maintain medical professional liability insurance.
Collaborative Agreement
Pennsylvania’s certified nurse-midwives must establish a collaborative agreement with a physician or physician group, and register this agreement with the Board of Nursing. The physician or physician group must also specialize in midwifery and have hospital privileges. A collaborative agreement form is included in the nurse-midwife license application.
Nurse practitioners are not required to enter into a collaborative agreement.
Prescriptive Authority
Nurse midwives and women’s health NPs have the option to apply for prescriptive authority. To earn this, candidates must complete the following:
- Complete at least 45 hours of classes in advanced pharmacology
- Complete the appropriate application(s) with the State Board of Nursing:
- Register with the Drug Enforcement Agency (DEA)
Nurse midwives and women’s health NPs must enter into a prescriptive collaborative practice agreement with a supervising physician who practices in their area of expertise (midwifery or women’s health). This agreement is contained within each professional’s respective application packet.
Step 4. Explore Career Opportunities and Maintain Credentials
Applicants can determine when their license has been approved by checking the Pennsylvania Department of State’s online license verification portal.
Upon becoming licensed, nurse-midwives may be interested in pursuing advanced career opportunities at their current place of employment or where they completed their clinical education.
Examples of significant employers and clinic models in the field of nurse-midwifery from throughout Pennsylvania include:
- Hahnemann University Hospital’s NICU or Center for Genetics and Fetal Medicine in Philadelphia
- Lifecycle WomanCare in Bryn Mawr
- Pennsylvania Hospital’s Labor and Delivery Unit
- The Birth Place at Sacred Heart Hospital in Allentown
- Reading Health System’s Beginning’s Maternity Center
- The Midwife Center for Birth and Women’s Health in Pittsburgh
- Moses Taylor Hospital’s Neonatal Intensive Care Unit in Scranton
- Lehigh Valley Hospital’s Center for Mother Baby Care in Allentown
- Valley Birthplace Birth Center and Woman Care in Huntingdon Valley
- Einstein Medical Center’s Neonatal Intensive Care Unit in Philadelphia
- University of Pennsylvania Medical Center’s Hamot Women’s Hospital in Erie
- Saint Luke’s New Beginnings Family Birth Centers in Allentown and Bethlehem
- Jefferson University Hospitals’ Department of Obstetrics and Gynecology in Philadelphia
The following job listings were taken from a December 2015 survey of job vacancy announcements in Pennsylvania. (These are provided here as illustrative examples only and should not be interpreted as a job offer or assurance of employment.):
- Certified Nurse Midwife with WellSpan Health in Gettyburg
- Certified Nurse Midwife with the Allegheny Clinic in Pittsburg
- Women’s Health NP with WellSpan Health Services in Lancaster
- Nurse Midwife with the Reading Health System in West Reading
- Women’s Health NP at the Saint Mary Medical Center in Langhorne
- Certified Nurse Midwife with Conemaugh Health System in Johnstown
- Certified Nurse Midwife with the Pocono Health System in East Stroudsburg
Maintaining Licensure with the State Board of Nursing
Pennsylvania’s State Board of Nursing has different license maintenance requirements for different medical professionals:
- Nurse Midwives – licenses expire on December 31 of even-numbered years; must maintain national certification with the AMCB
- Women’s Health NPs – licenses expire every two years on October 31; 30 hours of board-approved continuing education required for renewal (the NCC is a board-approved provider of continuing education)
Renewing Prescriptive Authority with the State Board of Nursing
Nurse midwives and women’s health NPs who choose to renew their prescriptive authority must do so before their license expires. To complete the renewal process, candidates must earn 16 hours of continuing education in advanced pharmacology.
Renewing National Certification with the American Midwifery Certification Board (AMCB)
To maintain their certification, CNMs will need to enroll in the AMCB’s five-year Certificate Maintenance Program. During each five-year renewal cycle, CNMs must complete one of the following:
- Certified Nurse-Midwife re-examination
- Completing 20 hours of continuing education and three certificate maintenance modules
Renewing National Certification with the National Certification Corporation (NCC)
Those that hold the WHNP-BC credential can renew their certification by completing the NCC’s three-year maintenance program. This involves taking the Continuing Competency Assessment and, based on the results, completing between 10-50 hours of continuing education.
Pennsylvania’s State Board of Nursing accepts continuing education sponsored by the NCC for state license renewal purposes as well.
Salaries for Certified Nurse-Midwives in Pennsylvania
In 2019, the U.S. Bureau of Labor Statistics reported that the average salary for midwives in the state was $98,680. The average salary for those new to the field was $25K less at $73,070, while the most experienced nurse-midwives earned about $30K more than the overall average at $127,920.
Positive Growth Trends in Nurse-Midwifery
In 2012, the Centers for Disease Control and Prevention published the findings of a nearly 20-year long study examining home birthing trends. The study found that Pennsylvania had the 5th highest rate of at-home births in the nation, with 1.61% of all deliveries in the state taking place in the home. Pennsylvania was also one of four states with the highest percentage of births in a birthing center, with 0.7% of all births in the state occurring in such settings. Home birthing rates in Pennsylvania also increased by 2.5% in the three short years between 2003 and 2006. With statistics such as these showing a positive trend toward less invasive midwife attended homebirths, career opportunities for nurse-midwives in hospital obstetric departments, birthing centers and in independent private practices are expected to remain strong.
The Bureau of Labor Statistics estimates that the demand for nurse-midwives will increase by 45% nationally during the 10-year period between 2019 and 2029. According to the American College of Nurse-Midwives, between 2005 and 2014, there has been an overall increase of 91% in the number of nurse-midwives obtaining CNM (Certified Nurse-Midwife) certification. According to the U.S. Department of Labor, the projected growth for nurse-midwives in Pennsylvania from 2018 to 2028 is 9.1%.
Nurse-Midwife Salaries in Pennsylvania by County
The highest paying area for nurse-midwives in Pennsylvania at the entry-level and average salaries is Reading. For nurse-midwives in the 90th percentile for highly experienced nurse-midwives, Lancaster is the highest-paying region, according to 2019 BLS data.
Lancaster:
- Entry-Level: $69,730
- Average: $99,270
- Experienced: $132,640
Philadelphia-Camden-Wilmington:
- Entry-Level: $69,020
- Average: $97,620
- Experienced: $130,530
Pittsburgh:
- Entry-Level: $81,700
- Average: $91,370
- Experienced: $102,600
Reading:
- Entry-Level: $84,790
- Average: $106,140
- Experienced: $128,560
(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.)