Tennessee recognizes two types of practicing midwives: Certified Nurse-Midwives (CNMs) and Certified Professional Midwives (CPMs). Each follows a distinct educational and licensing path, and the one you choose will shape your scope of practice, your work setting, and your earning potential. Here’s what each route requires.
Two Paths to Midwifery in Tennessee
A CNM is a registered nurse who completes graduate-level education in midwifery and earns national certification. CNMs work in hospitals, birth centers, and clinics. They can diagnose conditions, order tests, and prescribe medications. In Tennessee, they’re regulated by the Board of Nursing as advanced practice registered nurses.
A CPM takes a different route, one centered on out-of-hospital birth. CPMs earn certification through the North American Registry of Midwives (NARM) and are regulated by Tennessee’s Council of Certified Professional Midwifery, a six-member body that includes three practicing CPMs, a CNM, a physician, and a consumer representative. CPMs typically attend births in homes and freestanding birth centers rather than hospitals.
Becoming a Certified Nurse-Midwife
The CNM path is longer but offers the broadest scope of practice. You’ll move through four stages: earning your RN, completing a graduate midwifery program, passing a national board exam, and obtaining your Tennessee license.
Step 1: Become a Registered Nurse
You need an active RN license before you can enter a nurse-midwifery program. Most applicants hold a Bachelor of Science in Nursing (BSN), which typically takes four years. If you already have a nursing degree from an associate program, many midwifery schools offer bridge pathways, but a BSN is the standard entry point for graduate study.
Step 2: Complete a Graduate Midwifery Program
Tennessee’s in-state option is the University of Tennessee Health Science Center in Memphis, which offers a Nurse Midwifery concentration within its Doctor of Nursing Practice (DNP) program. The program accepts RNs with a BSN through its Post-BSN to DNP pathway, and CNMs who already hold a master’s degree can use the Post-MSN track. Coursework covers prenatal, intrapartum, and postpartum care along with primary care across the lifespan, plus extensive clinical rotations.
You’re not limited to in-state programs. Several accredited midwifery programs around the country accept students who plan to practice in Tennessee, including online-hybrid options that pair distance coursework with clinical placements closer to home. The key requirement is that the program be accredited by the Accreditation Commission for Midwifery Education (ACME), which is necessary for you to sit for the national board exam.
Step 3: Pass the National Certification Exam
After graduating, you’ll take the certification exam administered by the American Midwifery Certification Board (AMCB). Passing this exam earns you the CNM credential, which Tennessee requires for licensure.
Step 4: Apply for Tennessee Licensure
With your CNM credential and active RN license in hand, you apply to the Tennessee Board of Nursing for a certificate of fitness as an advanced practice registered nurse. This certificate authorizes you to perform medical diagnoses, develop care plans, prescribe medications, and order tests. To prescribe, you must file a notice with the Board that includes your formulary (the categories of drugs you’ll prescribe) and the name of a collaborating physician. Tennessee requires CNMs who prescribe to maintain this physician collaboration.
Becoming a Certified Professional Midwife
The CPM route does not require nursing school. It’s built around midwifery-specific education and hands-on apprenticeship, with a focus on physiologic birth in out-of-hospital settings.
Step 1: Complete a NARM-Approved Education Pathway
To sit for the NARM exam, you can attend a program accredited by the Midwifery Education Accreditation Council (MEAC) or complete NARM’s Portfolio Evaluation Process (PEP), which combines coursework with a structured apprenticeship under a qualified preceptor. Either way, you’ll need to demonstrate competency in prenatal care, labor management, newborn assessment, postpartum care, and emergency skills. The clinical component requires you to attend a set number of births as a primary midwife under supervision.
Step 2: Earn NARM Certification
After completing your education, you take the NARM Written Examination and fulfill all clinical documentation requirements. Passing earns you the Certified Professional Midwife credential.
Step 3: Apply to Tennessee’s Midwifery Council
Tennessee requires anyone who wants to practice as a CPM to apply for state certification through the Council of Certified Professional Midwifery. You’ll submit an application on the Council’s forms, pay the required fees, and have NARM send verification of your current certification directly to the Council’s administrative office. The Council reviews applications and can approve, deny, or request additional information.
Once certified, you must maintain your NARM credential and renew your Tennessee certification according to the Council’s schedule. The state also has rules covering inactive status and reactivation if you take time away from practice.
Scope of Practice Differences
CNMs in Tennessee function as advanced practice registered nurses. They provide full-spectrum reproductive and primary care: annual exams, contraception, prenatal care, labor and delivery management, postpartum care, and newborn care. With a certificate of fitness and a collaborating physician on file, they can prescribe legend drugs, order imaging and lab work, and manage complications. Many CNMs also provide gynecological care and basic primary care for people of all ages.
CPMs focus specifically on pregnancy, birth, and the immediate postpartum period in out-of-hospital settings. They do not prescribe medications or perform surgical procedures. Their training emphasizes recognizing when a pregnancy or birth moves outside normal parameters and requires transfer to a higher level of care. Tennessee’s regulations outline professional ethics standards, advertising rules, and disciplinary grounds for CPMs, reflecting the state’s framework for protecting clients in home and birth center settings.
Salary and Job Outlook
Compensation varies significantly between the two credentials. CNMs in Tennessee earn an average of about $120,700 per year, with the range running from roughly $83,000 to $147,000 depending on experience, location, and practice setting. That figure is projected to climb to around $137,000 by 2031, a 14% increase over five years. CNM salaries tend to be higher in urban hospitals and lower in rural clinics, though rural areas often have stronger demand for providers.
CPM income is harder to pin down with a single number because most CPMs work in private practice or small birth centers, and earnings depend heavily on client volume and local market. CPMs generally earn less than CNMs, partly because their scope is narrower and partly because out-of-hospital birth care is less consistently covered by insurance, though Medicaid reimbursement for CPMs has been expanding in several states.
Choosing the Right Path
If you want to work in hospitals, prescribe medications, and provide primary care beyond pregnancy, the CNM route is the clear fit. It requires more schooling (a minimum of six to seven years from the start of your nursing degree through your DNP), but it opens the widest range of practice settings and typically offers higher pay and more job stability.
If your goal is to support families through home births or to run a freestanding birth center, the CPM path aligns more directly with that vision. It can be completed in roughly three to four years depending on your educational pathway and clinical opportunities, and it doesn’t require you to become a nurse first. The trade-off is a narrower scope of practice and more variable income.
Both paths require ongoing certification renewal, continuing education, and compliance with Tennessee’s regulatory standards. Whichever route you choose, your first practical step is the same: contact either the Tennessee Board of Nursing (for the CNM path) or the Council of Certified Professional Midwifery (for the CPM path) to confirm current application requirements and fees before you begin your education.