Virginia enjoys a spot as one of the top 20 states in the U.S. for the practice of nurse-midwifery according to the ACNM, with 258 state-licensed CNMs in practice presiding over one out of every 20 births that take place in the state.
In 2018, approximately 11-13.69% of births in Virginia 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.
Before discussing requirements for Nurse-Midwives, it is important to understand how Virginia distinguishes between a certified nurse-midwife and a direct entry midwife (DEM). Certified nurse-midwives hold a master’s or higher degree, national certification through the American Midwifery Certification Board (AMCB), and are licensed as nurse practitioners in their specialty through the Virginia Board of Nursing. DEMs, on the other hand, have less formal education and training, generally have no nursing experience or credentials, and cannot practice as a midwife in any capacity without a certified medical professional present to oversee their work.
Classified as nurse practitioners, certified nurse-midwives in Virginia are exempt from supervisory requirements levied on other midwives. Their advanced education and training s sets them apart as experts in facilitating the birthing process, as well as providing general patient care and obstetric and gynecologic care over the course of the lifespan.
Steps to Become a Certified Nurse-Midwife in Virginia
These steps offer a clear path for Virginia RNs interested in becoming certified nurse-midwives, from education and national certification in nurse-midwifery to nurse practitioner specialty licensing as a certified nurse-midwife through the Virginia Board of Nursing:
Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery
To meet the requirements for national certification through the American Midwifery Certification Board (AMCB) and nurse practitioner licensure as a nurse-midwife through the Virginia Board of Nursing, registered nurses with licenses in good standing must complete a master’s or higher degree through a program recognized by the Accreditation Commission for Midwifery Education (ACME). While there are a number of flexible online master’s degree programs available to accommodate working RNs, there is only one school physically located in Virginia with a qualifying ACM-accredited program.
Admission Requirements
Typical entry requirements for graduate programs in nurse-midwifery are similar to those of most graduate level nursing programs across the country. These often 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 0 GPA
Program Structure and Components
All ACME-accredited programs meet the ACNM requirements for taking the CNM certification exam. These include:
- 40-60 credits of didactic curriculum
- Specialized Midwifery courses requiring a minimum of 600 clinical hours and as much as 720
- The hours vary due to the unpredictable nature of birth
- Completion of an Evidence Based Practice Project
Midwifery programs cover a variety of topics that encompass the general knowledge that an advanced practice nurse requires:
- Pharmacology and Therapeutics
- Anatomy and Physiology
- Health Promotion and Assessment
- Data Analysis
- Theory and Research
Coursework specific to the major would typically include:
- 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
While the classroom will encompass most of the theoretical discussion needed to prepare someone for a career in nurse-midwifery, clinical experience is needed to make the transition into full practice. An advisor will assist students of online programs with finding an appropriate clinical environment. Participating facilities in Virginia include:
- The Virginia Hospital Center
- Sentara Norfolk General Hospital
- Carilion Roanoke Memorial Hospital
- Winchester Medical Center
- Augusta Health
Clinical observations will put students in direct contact with pregnant women and provide students with a first hand look at women’s needs during the birthing process, to include:
- Comprehensive antepartal care
- Prenatal care
- Applied obstetrics
- Ambulatory care
Step 2. Successfully Complete the Exam for National Certification in Nurse-Midwifery
Holding a master’s degree in midwifery qualifies candidates to sit for the AMCB National Certification Examination. The AMCB’s qualifications are subject to change at any time and an up to date copy can be found here. As of November 20, 2014, a candidate must uphold all of the following requirements to be eligible to take the exam:
- Maintain licensure as a Registered Nurse in one of the 50 states, a U.S. territory, or the District of Columbia
- Proof consists of a copy of licensure that is valid on the date of the examination
- Satisfactory completion of a graduate degree program that has met the institutional requirements prescribed by ACME
- Verification by the director of a nurse-midwifery program confirming that institutional requirements are met
- Attestation by the director of the nurse-midwifery program that the candidate is performing at the level of a safe, beginning practitioner
Applicants to the exam must apply within 24 months of completing their program. The application is available here. It can be completed online, but applicants may request a hardcopy of the form to be submitted alongside their required credentials. Those required credentials include:
- Proof of licensure
- $500 licensing fee
- $121 processing fee
- This fee is forfeited if an applicant’s exam needs to be rescheduled or if an applicant is late to their examination and will need to be reassessed in either event.
- Your application (if a hard copy is submitted)
All of these materials should be mailed to:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
Applicants will schedule their examination online through Applied Measurement Professionals, Inc. In Virginia, there are testing centers available in:
- Alexandria
- Fredericksburg
- Norfolk
- Richmond
- Roanoke
Addresses and specific directions to these testing centers are available here.
Studying for and Passing the Exam
Candidates can use the Candidate Handbook as a study guide leading up to the exam. It features an overview of the exam as well as an overview of the topics that will be covered. These include:
- Antepartum:19-26 percent
- Intrapartum: 17-26 percent
- Postpartum: 15-18 percent
- Newborn: 7-16 percent
- Well Women/Gyn: 15-18 percent
- Women’s Health/ Primary care: 8-16 percent
Step 3. Apply for Nurse Practitioner Licensure in Virginia as a Certified Nurse-Midwife
Upon successfully completing the exam and becoming certified, CNMs will then be eligible to seek licensure as a nurse practitioner in Virginia specialized in nurse-midwifery. Nurse practitioner licensure candidates specialized in nurse-midwifery are required to present the following when applying for licensure online:
- Proof of licensure as a registered nurse in Virginia or proof of multistate licensure
- A graduate degree in nursing
- Submit evidence of current specialty certification (CNM certification)
- Submit a registration fee of $130
As nurse practitioners, CNMs can also pursue Authorization to Prescribe in order to gain prescriptive authority. The application for Authorization to Prescribe is available through the online licensure application portal linked to above.
Once the Virginia Board of Nursing grants nurse practitioner licensure, CNMs may begin practicing nurse-midwifery in the state.
Step 4. Begin a Career as a Certified Nurse-Midwife in Virginia and Keep Credentials Current
Nurse practitioner licensure in Virginia grants a nurse-midwife full clinical privilege. As a result, many hospitals employ nurse-midwives within their obstetric units.
Virginia is home to one certified birth center recognized by the Commission for the Accreditation of Birth Centers (CABC). New Life Birth Center is located in Rocky Mount, and is the only birth center in the state that has so far met the standards of the CABC. As of now, the state of Virginia has no policies in place to regulate the use of the title “Birth Center”, and any other facility claiming certification at this time is not operating under any kind of nationally accredited certification.
Hospitals, medical centers and clinics that employ CNMs in Virginia include:
- Carilion Clinic, Blacksburg
- Mary Washington Healthcare, Stafford
- Planned Parenthood South Atlantic, Blacksburg
- Cejka Search, Springfield
- The Virginia Hospital Center
- Sentara Norfolk General Hospital
- Carilion Roanoke Memorial Hospital
- Winchester Medical Center
- Augusta Health
Keeping Nurse Practitioner Licensure Current through the Virginia Board of Nursing
Licensees will be required to renew their license every two years during the month of their birth, along with:
- $80 renewal fee
- Proof of continued CNM certification through AMCB
No other continuing education credits or classes are currently required by the state of Virginia as long as that licensure is maintained. However, if the license lapses, one of the following will be required:
- Completion of a minimum of three credit hours of post-licensure academic education relevant to nursing practice
- A board-approved refresher course in nursing
- Completion of nursing related, evidence-based research study
- Completion of publication as the author or co-author
- Teaching or developing in a nursing related course resulting in no less than three semester hours of college credit
- Teaching or developing nursing related continuing education courses for up to 30 contact hours
- 15 contact hours of workshops, seminars, or conferences alongside 640 hours of active practice as a nurse
- 30 contact hours of workshops, seminars, conferences, or courses relevant to the practice of nursing
Keeping the CNM Credential Current through the American Midwifery Certification Board (AMCB)
All those that hold the CNM credential through the American Midwifery Certification Board (AMCB) are required to enroll in the AMCB’s five-year Certificate Maintenance Program. During each five-year renewal cycle, CNMs must complete one of the following:
- Re-take and pass the Certified Nurse-Midwife Examination
- Completing 20 hours of continuing education and three certificate maintenance modules
Salaries for Certified Nurse-Midwives in Virginia
In May of 2014, the median midwife salary in Virginia was $90,216, according to labor market data published by the Virginia Employment Commission. The average starting salary for a nurse-midwife in Virginia was 35% less at $58,610, while the average salary for an experienced nurse-midwife in the state was 6.2% more at $96,196.
Occupational employment statistics published by the Virginia Employment Commission reveal that the expected occupational growth rate for certified nurse-midwives in Virginia between 2012 and 2022 is 24%. Nationally, the expected 10-year occupational growth rate among certified nurse-midwives is 31%, according to the U.S. Department of Labor. However, in Virginia, the average 10-year occupational growth rate for all occupations is just 13%, which means that employment opportunities for certified nurse-midwives in Virginia are growing at nearly twice the rate of most other occupations in the state.
Nurse Midwife Salaries in Virginia by Location
In May of 2014, the U.S. Department of Labor published salary findings for certified nurse-midwives in Virginia that were similar to those of the Virginia Employment Commission. The U.S. Department of Labor reported an average salary among midwives in Virginia of $81,980.
The U.S. Department of Labor’s median salary figure was 7.3% more at $88,400. Here is an overview of the salary data published by the U.S. Department of Labor in 2014:
Statewide
- Average: $94,920
- Entry-Level: $56,530
- Experienced: $125,070
Richmond
- Average: $109,550
- Entry-Level: $89,070
- Experienced: $130,220
Virginia Beach-Norfolk-Newport-News
- Average: $95,640
- Entry-Level: $64,820
- Experienced: $121,120
Washington-Arlington-Alexandria
- Average: $103,700
- Entry-Level: $64,870
- Experienced: $130,120
(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.)