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Education to Become a Certified Nurse Midwife

Certified nurse midwives are highly trained and even perform many of the same duties as a physician.

midwife and assistant examine pregnant patient in exam room

Certified nurse midwives (CNMs) are a type of advanced practice registered nurse (APRN) with specialty training in midwifery. The minimum education required to practice in this role is a Master of Science in Nursing (MSN).

While the philosophy of midwifery is holistic at its core, CNMs who want to pursue alternative or holistic care can earn certification as a holistic nurse in addition to nurse midwife certification.

Education Overview

The comprehensive knowledge and clinical experience CNMs need before they practice prepares them to care for women during pregnancy, labor, and delivery. Certified nurse midwives are also trained to provide primary and gynecological care to women from adolescence through adulthood.

As advanced practice registered nurses (APRNs), CNMs perform many of the same tasks as physicians, including diagnosing and treating patients and prescribing medication.
While other APRNs, including nurse anesthetists, clinical nurse specialists, and nurse practitioners, are moving toward the requirement of a doctorate to practice, midwifery has maintained a master's degree as the minimum educational requirement for now. However, it's worth tracking in case the requirement changes.

Education Options

There are several educational pathways to earning an MSN in Midwifery. The traditional route starts with becoming an RN after completing an undergraduate program—either a two-year Associate Degree in Nursing (ADN) or four-year Bachelor of Science in Nursing (BSN).

Here's how your education will differ on each path to a master's degree.

Prerequisites

ADN-to-MSN

Active RN licensure, ADN plus completion of a BSN before enrollment in MSN (unless you choose an ADN-to-MSN bridge program)

BSN-to-MSN

Active RN licensure and completion of BSN

Typical Curriculum

ADN-to-MSN

Nursing theory and clinical requirements for RN licensure in ADN
General education courses required for completion of a BSN
Graduate-level nursing and specialized midwifery courses to earn an MSN

BSN-to-MSN

General education, nursing theory, and clinical requirements for RN licensure and a BSN
Graduate-level nursing and specialized midwifery courses to earn an MSN

Time to Complete

ADN-to-MSN

6 years

This includes 2 years for an ADN, 2 more years for a BSN, and 2 years for an MSN.

BSN-to-MSN

6 years

This includes 4 years for a BSN and 2 years for an MSN

Required Licensing

ADN-to-MSN

RN upon completion of ADN

BSN-to-MSN

RN upon completion of BSN

Target Student

ADN-to-MSN

Students who want to start working as a nurse as soon as possible, with the option to earn advanced degrees in stages as they're ready.

BSN-to-MSN

Traditional student able to commit to four years of full-time study then proceed to post-graduate studies as soon as they qualify.

"A student needs to choose the program that aligns with their own philosophy of care, but also supports what they can spend financially on school and what platform works best for them, their learning style, and their location," says Amber Wilson, CNM, DNP, host of the "Journey to Midwifery" podcast.

Earning a Master's

An MSN in Midwifery typically includes a combination of coursework and clinical work.

In addition to an active RN license, MSN programs typically require the completion of specific coursework before enrollment. These courses can include:

Anatomy
Chemistry
Microbiology
Statistics

Nutrition
Pathology
Abnormal psychology

The core curriculum is typically the initial phase of the master's program and can include advanced classes in:

Physiology/pathophysiology
Health assessment
Pharmacology
Principles in nursing management

Healthcare policy
Scientific inquiry for evidence-based practice
Ethics

Specialized curriculum in midwifery comes before—or in conjunction with—clinical work. These courses can include:

Health care of childbearing women
Primary care of women
Comprehensive prenatal care
Antepartum care

Postpartum care
Fetal evaluation
Professional issues in midwifery
Complementary/alternative therapies in women's health

Clinical Work

Your clinical hours may involve an irregular schedule that includes nights and weekends, similar to a schedule that a CNM would work in midwifery practice.

During your clinical work, you'll participate in all aspects of hands-on care, including labor and delivery, natural and surgical births, and providing primary care for women.

MSN clinical requirements will depend on the number of midwife clinical hours required by the state in which you will practice. MSN programs typically average between 600 and 1,000 clinical hours, with more than 50% under the supervision of a CNM.

During your clinical work, you'll participate in all aspects of hands-on care, including labor and delivery, natural and surgical births, and providing primary care for women.

Clinical training is crucial to your success as a certified nurse midwife, says Sarita Bennett, DO, CPM, president of the Midwives Alliance of North America (MANA). "You don't learn midwifery by reading about it in a book," she says. "No matter how many books you read or how many tests you ace, if you don't know what to do in the real life of midwifery, then you're not much good to us."

Holistic Midwifery Programs

While holistic care is central to the practice of midwifery in general, CNMs can become certified in holistic nursing from the American Holistic Nurses Credentialing Corporation (AHNCC). Holistic nursing involves a specific way of thinking about people and nursing.

"Holism and midwifery form a natural partnership," says, Kathleen Bell RN, MSN, CNM, AHN-BC, MS1-BC, special advisor to the board of directors of the Oregon Holistic Nurses Association. "A holistic midwife integrates modern science with the truths of healing traditions in practice. As healers, holistic nurses and midwives are capable of catalyzing integration within themselves and within clients."

Certification as a holistic nurse requires:

An active RN license
2,000 hours or one year of full-time holistic nursing practice
Completion of a nationally accredited graduate nursing program
Completion of 48 hours in continuing nursing education in holistic theory, research, practice, or related topics

While it's possible to attend a holistic CNM program endorsed by the AHNCC, many nurses pursue their holistic studies after completing a traditional CNM program, a pathway that Bell recommends.

No matter your path, your holistic education may include learning about some of the following complementary and alternative therapies:

Aromatherapy
Massage
Hypnosis, hydrotherapy, and balneotherapy
Chinese and Eastern healing practices

Wellness coaching
Strategies and techniques for self-compassion and self-care
Assisting patients in stress management techniques
Integration of natural or homeopathic products

Time to Complete a Master's

The amount of time it takes to complete an MSN in midwifery can vary by individual and program. The average time for full-time students is two years, although clinical hours can vary by program.

Students must complete clinical rotations to allow them to gain a range of experience in prenatal, labor, delivery, and postpartum care. "Part of the reason that you see some variation is the amount of time that it might take someone to meet their clinical requirements," Bennett says.

Here's the amount of time you can expect to spend at each degree level:

Degree	Typical Time to Completion
Associate Degree in Nursing (ADN)	2 years
Bachelor's Degree in Nursing (BSN)	4 years or 18 months to 2 years with ADN
Master's Degree in Nursing (MSN) in Midwifery	2 years
Post-graduate certificate in midwifery with an MSN in another area	1 year
Doctor of Nursing Practice (DNP) in Midwifery	2 years or more
Doctor of Philosophy (PhD) in Nursing	3 years or more

Fast-Track Programs

While many nurses follow the traditional pathway to earning a graduate education in midwifery, you may be able to accelerate your education and save time and money with a bridge program.

Bridge programs allow you to earn an advanced degree by expanding upon your practical nursing knowledge and experience without duplicating material you already know. Admission criteria, time to completion, and clinical requirements can vary by program and school.

RN-to-MSN Bridge Program

If you're working as a licensed RN and know that your goal is to work as a CNM, you can bypass the need to earn a separate BSN with an RN-to-MSN bridge program. This type of program can take about three years to complete.

BSN-to-DNP Bridge Program

If a DNP is your ultimate goal, you can combine the curriculum of an MSN and DNP with a BSN-to-DNP bridge program. These programs can take three to four years full time or four to six years part time to complete.

While not as common, some schools offer a RN-to-DNP program. These programs can take three to six years full time or six or more years part time.

Direct-entry or Accelerated MSN or DNP Program

You can also reduce your time in school if you pursue a nurse-midwifery education without a BSN by enrolling in a direct-entry, or accelerated, program.

This type of program is intended for students with a bachelor's degree in a non-nursing area of study. In these programs, your initial coursework includes the requirements necessary to earn RN licensure in your state.

A direct-entry MSN program can range from 18 months to about three years of full-time study. A direct-entry DNP program can take four to six years of full-time study. Part-time options typically aren't offered because of the intensity of the curriculum.

Online Programs

Online MSN midwifery programs allow you to complete your theory-based coursework at home, often at your convenience. This can make it easier to take classes if you're also juggling a job or family responsibilities while you study.

However, you can't complete an MSN in Midwifery exclusively online. Most online MSN programs are offered as hybrid models, which will require you to complete your clinical requirements in person at an approved healthcare facility in your area.

Program and School Accreditation

When choosing a nurse midwifery program, it's important to look for accreditation of the program and school. Attending an accredited school allows you to transfer credits to other accredited institutions. This can be important if you plan to transfer or apply your graduate credits toward a doctorate in the future.

Attending an accredited institution also is necessary to be eligible for federal financial aid and student loans. You can verify an institution's accreditation on a database maintained by the U.S. Department of Education.

All types of MSN programs, including midwifery programs, are accredited by the Commission on Collegiate Nursing Education (CCNE) and/or the Accreditation Commission for Education in Nursing (ACEN).

Look for the following specialty accreditations to qualify for specific midwifery certifications and state licensure:

Accreditation Commission for Midwifery Education (ACME): ACME accredits master's, post-graduate certificate, and doctoral midwifery programs. Completion of an ACME-accredited program is necessary to qualify to take the national certification exam administered by the American Midwifery Certification Board (AMCB).
American Holistic Nurses Credentialing Corporation (AHNCC): AHNCC "endorses" holistic nursing programs at the baccalaureate, master's, and doctoral levels, though attending an endorsed program is not necessary to apply for certification as a holistic nurse.

Nurse Midwife Certification

The American Midwifery Certification Board (AMCB) is the national organization that awards certification to CNMs. To earn certification, a nurse midwife must pass a computer-based exam that includes 175 multiple-choice questions and earn a score of 75.

To qualify for the AMCB exam, you must:

Complete an accredited graduate program and provide confirmation from the program director
Provide confirmation from the program director that you have the skills of a "safe, beginning practitioner"
Register for the exam and pay the $500 fee
Provide proof that you're actively licensed as an RN on the date of the exam

You must take the exam within 24 months of completing your graduate degree. You can take it up to four times during this period.

In addition to passing the certification exam, you must apply for licensure as a CNM in the state in which you plan to practice.

Education for Other Midwife Roles

While the majority of midwives in the U.S. are CNMs, there are other midwife roles that do not require you to be an RN to practice. Education requirements and training vary significantly, and midwives with these credentials don't have the level of responsibility or autonomy that CNMs have. In addition, their salaries are typically lower than CNM salaries.

Certified Midwife (CM) : CMs complete an undergraduate degree in any field and a graduate midwifery program. Certification is from the AMCB, the same credentialing organization that certifies CNMs.
CMs provide a full range of primary health care services for women and work in the same environments as CNMs, including hospitals and birth centers. However, only Delaware, Hawaii, Maine, New Jersey, New York, and Rhode Island recognize CMs, so opportunities are geographically limited. CMs have prescriptive authority in New York, Rhode Island, and Maine.
Certified Professional Midwife (CPM) : CPMs meet the standards of the North American Registry of Midwives (NARM), an accrediting body for CPMs. These midwives must complete a program accredited by the Midwife Education Accreditation Council (MEAC) or complete NARM's Portfolio Evaluation Process (PEP).
CPMs offer care and support to women and their families through pregnancy, birth, and postpartum. Their authority to conduct physical examinations varies by state law. The majority of CPMs support births in birth centers and homes.
Registered/Licensed Midwives: The designation of registered and licensed midwives varies by state. Registered/licensed midwives typically support home births and, in some cases, births in birthing centers based on their credentials.
Lay Midwives: Lay midwives, also called traditional midwives, may or may not be authorized to practice midwifery in their state. They are usually self-educated and trained as apprentices. With no consistency in education or training, lay midwives typically work outside the healthcare system and only assist in home births.