A certified nurse midwife (CNM) is an advanced practice registered nurse who specializes in pregnancy, childbirth, and reproductive health, but also provides primary care across all stages of life. CNMs hold at minimum a master’s degree in nursing and must pass a national certification exam. They work in hospitals, birth centers, private practices, and home settings, and in many states they practice independently without physician oversight.
What CNMs Actually Do
Most people associate midwives with delivering babies, and that is a core part of the role. CNMs manage care throughout pregnancy, guide labor and delivery, and provide postpartum support for both the birthing parent and newborn. But the scope of practice extends well beyond birth.
CNMs provide family planning services, prescribe birth control, perform gynecological exams, order and interpret diagnostic tests, prescribe medications, and give vaccinations. They also offer primary care for wellness checkups and health screenings across all stages of life, inclusive of all gender identities and sexual orientations. In surgical settings, CNMs may assist physicians during procedures. The range of services varies somewhat by state, with some states granting full independent practice and prescriptive authority while others require a collaborative agreement with a physician.
Education and Certification Path
Becoming a CNM starts with earning a Bachelor of Science in Nursing and passing the NCLEX-RN licensing exam to work as a registered nurse. From there, candidates complete a graduate program: either a Master of Science in Nursing or a Doctor of Nursing Practice degree, with a specialization in midwifery through an accredited program.
After finishing their graduate education, candidates sit for the national certification exam administered by the American Midwifery Certification Board (AMCB). The exam is 175 multiple-choice questions with a four-hour time limit. Roughly a fifth of the exam covers prenatal care, another fifth covers labor and delivery, and the remaining questions span postpartum care, newborn care, gynecology, and primary care topics. Candidates get up to four attempts within 24 months of completing their program.
Certification doesn’t last forever. The credential expires after five years, and CNMs must complete an ongoing maintenance program with continuing education to renew. If certification lapses, the CNM has to retake the exam and submit proof of continuing education hours for each year since their last certification.
How CNMs Differ From Other Midwives
The term “midwife” covers several different credentials, and the differences matter. A CNM builds midwifery training on top of a nursing degree. A certified midwife (CM) completes effectively the same midwifery education and takes the same AMCB certification exam, but without the nursing background. CMs are only legally recognized in about a dozen states plus the District of Columbia, so their numbers are much smaller.
A certified professional midwife (CPM) follows a different path entirely. The CPM credential, issued by the North American Registry of Midwives, is designed for direct-entry midwives who practice in out-of-hospital settings like homes and birth centers. CPMs are trained specifically for low-risk, community-based births rather than the full range of clinical settings and primary care services that CNMs cover.
CNMs historically practiced under physician supervision, which kept most of them in hospital settings. That requirement has been dropped in many states, and a growing number of CNMs now deliver babies in birth centers and homes while maintaining the same clinical scope they’d have in a hospital.
Patient Outcomes With Midwife-Led Care
A large body of research supports the safety and effectiveness of midwife-led care for low-risk pregnancies. A systematic review and meta-analysis covering more than 1.4 million pregnancies found that midwife-led models were linked to lower cesarean delivery rates and fewer interventions like epidurals, forceps, and medical inductions, without compromising newborn safety. Other reviews have found lower rates of preterm birth, stillbirth, and low birth weight among midwife-led patients.
Women in midwife-led care also report substantially higher satisfaction with their birth experience compared to standard obstetrician-led care. Studies in high-complexity hospital settings have confirmed that these outcomes hold even outside small, low-volume practices. Neonatal outcomes are comparable or, in some studies, slightly better, with reduced NICU admissions. The consistent finding across multiple large analyses is that for uncomplicated pregnancies, midwife-led care produces equal or better outcomes with fewer medical interventions.
CNMs are trained to recognize when a pregnancy moves beyond their scope. Part of their role involves co-managing or transferring care to obstetricians or other specialists when complications arise.
Insurance Coverage and Cost
CNM services are covered by most private insurance plans, Medicare, and are mandatorily covered by Medicaid. This makes them one of the most accessible categories of midwife for patients concerned about cost. Nationally, CNM-attended births are most commonly paid for by private insurance or Medicaid. Reimbursement typically works on a fee-for-service basis, similar to how other healthcare providers bill.
The Bureau of Labor Statistics counted roughly 7,000 employed nurse midwives in the U.S. as of May 2023, though this figure excludes self-employed practitioners. The actual number of certified CNMs is higher, as many work in independent or group practices not captured by employer-based surveys. Despite relatively small numbers compared to obstetricians, CNMs attend a meaningful share of births nationally, particularly in hospital settings and among Medicaid-covered populations.
Where CNMs Practice
Hospitals remain the most common work setting for CNMs, but the landscape is shifting. Birth centers, which offer a more home-like environment with clinical resources on hand, are a growing practice site. Some CNMs run their own practices or work within physician group practices, women’s health clinics, or community health centers. A smaller number attend home births.
Because CNMs provide primary care and gynecological services alongside maternity care, many patients see a CNM as their regular provider for annual exams, contraception, and health screenings even if they’re not pregnant or planning to be. This continuity of care is one of the defining features of the midwifery model: the same provider may see a patient through routine wellness visits, pregnancy, birth, and postpartum recovery.