CNM Career Guide

Certified Nurse Midwives (CNMs) are advanced practice registered nurses who specialize in women’s reproductive health and childbirth. This rewarding career combines the clinical expertise of nursing with the holistic, patient-centered approach of midwifery. If you’re considering becoming a CNM, understanding the career landscape helps you make an informed decision.

CNM Career Overview

Factor	Details
Credential	CNM (Certified Nurse-Midwife)
Education	Master’s or Doctoral degree
Certification	AMCB (American Midwifery Certification Board)
Average Salary	$115,000-$125,000
Job Growth	40%+ through 2032
Work Settings	Hospitals, birth centers, private practice

What CNMs Do

Certified Nurse Midwives provide comprehensive care across the women’s health spectrum:

Prenatal Care

• Initial pregnancy confirmation and counseling
• Routine prenatal visits and monitoring
• Prenatal testing coordination
• Nutrition and lifestyle counseling
• High-risk screening and referrals
• Birth planning and education

Labor and Delivery

• Manage normal labor and birth
• Continuous labor support
• Non-pharmacologic pain management
• Pharmacologic pain management (epidural orders in most states)
• Perform deliveries (vaginal births)
• Episiotomy and laceration repair
• Newborn assessment and initial care

Postpartum Care

• Postpartum checkups
• Breastfeeding support
• Contraceptive counseling
• Mental health screening
• Recovery monitoring

Gynecologic Care

• Annual well-woman exams
• Pap smears and cervical cancer screening
• STI screening and treatment
• Contraceptive management (all methods)
• Menopause management
• Gynecologic problem visits

Newborn Care

• Newborn examinations
• Initial newborn care (first 28 days)
• Well-baby visits (varies by setting)
• Circumcisions (in some practices)

CNM Salary Data

National Salary Overview

Experience Level	Salary Range
Entry-level (0-2 years)	$95,000-$105,000
Mid-career (3-7 years)	$110,000-$125,000
Experienced (8+ years)	$125,000-$145,000
Practice owners	$150,000-$200,000+

Salary by Practice Setting

Setting	Average Salary	Notes
Hospital	$115,000-$130,000	Most common setting, benefits included
Birth Center	$100,000-$120,000	May include profit sharing
Private Practice	$120,000-$150,000	Higher with partnership
Academic Medical Center	$110,000-$125,000	Often includes teaching
FQHC/Community Health	$105,000-$120,000	Loan repayment eligible
Home Birth Practice	$90,000-$140,000	Highly variable

Highest-Paying States

State	Average CNM Salary
California	$145,000
New York	$135,000
Massachusetts	$130,000
New Jersey	$128,000
Washington	$125,000
Minnesota	$122,000

Lowest-Paying States

State	Average CNM Salary
Alabama	$90,000
Mississippi	$92,000
West Virginia	$94,000
Arkansas	$95,000
Iowa	$96,000

Factors Affecting Salary

1. Geographic location — Urban vs. rural, cost of living
2. Years of experience — Significant increases in first 10 years
3. Practice setting — Hospitals often pay more than birth centers
4. Call requirements — Higher pay for more call responsibility
5. Certifications — Additional certifications may increase pay
6. Full practice authority — Independent practice potential in FPA states

Job Outlook and Demand

Growth Projections

The Bureau of Labor Statistics projects CNM employment to grow 40%+ through 2032, significantly faster than the average for all occupations.

Driving Factors

Increasing Demand

• Patient preference for midwifery model of care
• Lower cesarean section rates with midwifery care
• Cost-effective maternity care
• Growing acceptance of birth center and home birth options
• Physician shortage in obstetrics

Expanding Scope

• Full practice authority expanding to more states
• Birth center growth and development
• Telehealth prenatal care options
• Integration into large health systems

Current Job Market

• Open positions: 3,000+ nationally at any time
• Time to fill: Many positions open 3-6+ months
• Geographic need: Highest demand in rural and underserved areas
• Competition: Lower than other NP specialties due to smaller pipeline

Practice Settings

Hospital-Based Practice

Description: CNMs work within hospital L&D units, often as part of OB/GYN groups or hospitalist programs.

Typical Role:

• Manage laboring patients
• Attend births
• Provide triage coverage
• Collaborate with OB/GYN physicians for high-risk cases

Pros:

• Regular salary and benefits
• Access to emergency resources
• Collaborative environment
• Predictable scheduling (often shift-based)

Cons:

• Less autonomy than independent practice
• Hospital policies may limit midwifery practices
• May have higher intervention rates
• Call requirements

Birth Center Practice

Description: Freestanding birth centers offer out-of-hospital births in a homelike setting.

Typical Role:

• Provide all prenatal care
• Manage labor and birth at birth center
• Limited interventions available
• Transfer to hospital when needed

Pros:

• Midwifery model of care
• Lower intervention rates
• Patient-centered environment
• Often higher autonomy

Cons:

• Must transfer high-risk patients
• Lower volume than hospitals
• Business sustainability challenges
• May have lower salaries

Private Practice

Description: CNMs in private practice (solo or group) provide prenatal care and birth services.

Typical Role:

• Own or partner in practice
• Manage business operations
• Provide full-scope midwifery care
• May have hospital privileges or birth center affiliation

Pros:

• Maximum autonomy
• Build your own practice philosophy
• Potential for higher income
• Schedule flexibility

Cons:

• Business management responsibilities
• Unpredictable income initially
• Call coverage challenges
• Overhead costs

Home Birth Practice

Description: CNMs attend planned home births for low-risk patients.

Typical Role:

• Prenatal care (often at office or patient homes)
• Home birth attendance
• Postpartum home visits
• Transfer coordination when needed

Pros:

• Highly rewarding for midwifery-minded CNMs
• Maximum patient autonomy
• Growing patient demand

Cons:

• Legal restrictions in some states
• Malpractice insurance challenges
• Lower volume
• 24/7 on-call demands

Academic/Teaching

Description: CNMs in academic settings teach in midwifery programs and may have clinical practice.

Typical Role:

• Didactic and clinical teaching
• Clinical precepting
• Research and scholarship
• May maintain clinical practice

Pros:

• Regular schedule
• Shape future midwives
• Academic benefits
• Less call responsibility

Cons:

• Often lower clinical salary
• Publish or perish pressure
• May have less clinical time

Career Advancement

Clinical Advancement

1. Lead midwife/Chief of midwifery — Oversee midwifery services
2. Specialty focus — High-risk prenatal, lactation, gynecology
3. Birth center director — Lead freestanding birth center
4. Quality improvement — Focus on outcomes and metrics

Administrative Leadership

1. Department director — Oversee OB/women’s health services
2. CNO pathway — Chief Nursing Officer roles
3. Health system leadership — VP of women’s services
4. Policy and advocacy — Influence midwifery regulations

Academic Path

1. Clinical faculty — Part-time teaching while practicing
2. Full-time faculty — Tenure-track academic positions
3. Program director — Lead midwifery education programs
4. Research — Midwifery and women’s health research

Entrepreneurship

1. Practice ownership — Start your own midwifery practice
2. Birth center development — Open a freestanding birth center
3. Consulting — Quality, policy, legal consulting
4. Education business — Childbirth education, doula training

Work-Life Considerations

Typical Schedule

Setting	Schedule Type
Hospital	12-hour shifts + call
Birth center	Variable + on-call
Private practice	Office hours + call
Home birth	On-call heavy
Academic	Regular hours, less call

Call Responsibilities

Most CNM positions involve being on-call for births:

• Shared call: Rotate with other midwives/providers
• Solo call: Responsible for all your patients’ births
• Hospitalist model: 24-hour shifts covering all patients

Burnout Prevention

Midwifery can be demanding. Successful CNMs:

• Set boundaries around on-call time
• Choose practices with adequate coverage
• Maintain self-care practices
• Connect with midwifery community
• Consider part-time or job-sharing arrangements

Getting Started as a CNM

Education Pathway

1. Become an RN — BSN preferred
2. Gain experience — L&D, women’s health recommended
3. Complete CNM program — ACME-accredited master’s or DNP
4. Pass certification — AMCB exam
5. Obtain state license — Requirements vary by state

Timeline

Step	Duration
BSN	4 years
RN experience	1-2 years (recommended)
CNM program	2-3 years
Total	7-9 years

Learn More

• How to Become a Nurse Midwife — Complete pathway guide
• CNM State Requirements — Licensing by state
• CNM FAQs — Common questions answered

Is CNM Right for You?

You Might Love Being a CNM If You:

• Are passionate about supporting physiologic birth
• Value building relationships with patients over time
• Want to provide comprehensive women’s healthcare
• Prefer a collaborative, patient-centered approach
• Can handle unpredictable schedules
• Want to make a significant impact on maternal health

Consider Other Paths If You:

• Prefer predictable schedules with no call
• Don’t want to attend births
• Prefer high-acuity, intervention-heavy settings
• Aren’t comfortable with home or birth center settings
• Want maximum salary potential (CRNA pays more)

Summary

A career as a Certified Nurse Midwife offers meaningful work, excellent job security, competitive compensation, and diverse practice options. With demand growing faster than supply, CNMs are well-positioned for career success. Whether you envision yourself attending hospital births, running a birth center, or providing home birth care, the CNM credential opens doors to rewarding practice opportunities.

Ready to start your midwifery journey? Learn how to become a CNM.