Certified nurse midwives (CNMs) work in a wide range of settings, but hospitals are by far the most common. About 87% of midwife-attended births in the U.S. take place in hospitals, and roughly one in five CNMs lists a hospital or medical center as their primary employer. Beyond labor and delivery units, you’ll find nurse midwives in physician practices, birth centers, community clinics, universities, military bases, and private practices offering home birth services.
Hospitals and Medical Centers
Hospitals are the dominant workplace. In a workforce survey of CNMs in Texas, 21.3% reported a hospital or medical center as their primary employment site, making it the single most common setting. Nationally, the picture is even clearer when you look at birth data: 87% of all midwife-attended births in 2020 happened inside hospitals. In these settings, CNMs typically manage labor, perform vaginal deliveries, handle triage, round on postpartum patients, and care for newborns in the first hours of life.
Many hospitals use a collaborative model where nurse midwives and obstetricians share responsibilities. In one well-documented example at a community hospital, CNMs staff 24-hour in-hospital shifts, admitting patients in active labor, managing inductions, and performing postpartum rounds. Obstetricians remain on call from home and step in for cesarean deliveries, high-risk cases, and gynecologic emergencies. The two groups coordinate through twice-daily team rounds and biweekly multidisciplinary meetings that also include family medicine residents, neonatal providers, anesthesiologists, and social workers.
This kind of arrangement lets nurse midwives manage low- and moderate-risk pregnancies from the antepartum period through delivery and recovery, while ensuring that surgical backup is always available. For patients, it often means their primary point of contact throughout labor is a midwife rather than a physician.
Physician Practices and OB-GYN Groups
The second most common employer for CNMs is a physician practice, accounting for 17.7% of primary employment in the Texas workforce study. In these settings, nurse midwives typically see patients for prenatal visits, annual gynecologic exams, contraceptive counseling, and postpartum follow-up. They operate under the same roof as obstetricians, which makes referrals for high-risk pregnancies or surgical consultations straightforward. Many patients in these practices see a midwife for most of their routine care and only interact with a physician if a complication arises.
Birth Centers
Freestanding birth centers offer a lower-intervention environment designed around physiologic birth. Only about 2% of all U.S. births happen outside of hospitals, and birth centers account for a portion of that small share. CNMs who work in birth centers focus on patients with low-risk pregnancies, providing prenatal care, labor support, delivery, and early postpartum monitoring all in one location. These centers typically have transfer agreements with nearby hospitals in case complications develop during labor.
Home Birth Practices
Some CNMs attend births in patients’ homes, though this represents a small slice of their overall workforce. Certified nurse midwives and certified midwives primarily attend births in hospitals, while certified professional midwives (a different credential) are the providers most commonly associated with home births. CNMs who do offer home birth services often run small private practices and carry portable equipment for monitoring the baby’s heart rate, managing the delivery, and handling common postpartum needs. They also maintain a relationship with a collaborating physician or hospital for transfers.
Community Health Centers and Rural Areas
Federally qualified health centers (FQHCs) serve medically underserved populations, and midwifery care is one strategy these clinics use to address gaps in maternal health access. In rural areas, though, midwifery coverage remains thin. A national analysis of rural hospitals found that more than half of those with active childbirth services reported having no locally available midwifery care. Among rural hospitals that had stopped offering childbirth services, 75% had no local midwife either.
The gap hits some communities harder than others. Rural hospitals without midwifery care were more than twice as likely to serve majority Black, Indigenous, and people of color populations (24%) compared to rural hospitals that did have midwives (10%). This disparity highlights both the need for more CNMs in underserved areas and the reality that where a nurse midwife can practice is often shaped by state regulations, reimbursement policies, and local physician willingness to collaborate.
Universities and Research Institutions
About 13.5% of CNMs in the Texas workforce survey listed an educational institution as their primary employer. These are nurse midwives who teach in graduate nursing and midwifery programs, supervise students in clinical rotations, and conduct research. Yale School of Nursing, for example, recruits PhD-prepared midwifery faculty to teach across its nurse practitioner, midwifery, and doctoral programs while maintaining active research portfolios. Faculty midwives at institutions like Yale collaborate with schools of public health, medical schools, cancer centers, and VA systems on studies spanning everything from health promotion to chronic disease management.
Beyond tenure-track positions, some CNMs work in continuing education, develop clinical simulation programs, or serve as clinical preceptors while maintaining a part-time patient care practice.
Military and Government Settings
The U.S. Army employs certified nurse midwives as officers in the Army Nurse Corps under the military occupational specialty 66W. Army CNMs provide the full scope of women’s health care, including pregnancy, childbirth, postpartum recovery, newborn care, family planning, and gynecologic services in both inpatient and outpatient military facilities. Positions are available in active duty, Army Reserve, and Army National Guard. Applicants need a master’s degree in nursing, an active nursing license, and eligibility for a secret security clearance. The Navy and Air Force have similar roles, and some CNMs also work in Veterans Affairs hospitals and Indian Health Service facilities.
Midwifery Group Practices and Other Settings
About 8.5% of CNMs work in midwifery group practices, where the entire clinical team is made up of midwives rather than a mix of midwives and physicians. These practices may contract with hospitals, run birth centers, or offer home birth services. Another 10.6% of CNMs fall into an “other” category that includes roles in public health departments, insurance companies, health policy organizations, international aid agencies, and telehealth platforms.
Job Growth and Workforce Size
The Bureau of Labor Statistics counted approximately 8,600 nurse midwives employed in the U.S. in 2024, with projected growth to 9,500 by 2034, an 11% increase. The broader category that includes nurse anesthetists and nurse practitioners is expected to grow 35% over the same period, far outpacing most occupations. About 32,700 openings across all three advanced practice nursing roles are projected each year over the coming decade, driven by retirements, workforce expansion, and growing demand for midwifery-led care as a strategy to improve maternal outcomes.
Currently, midwives attend about 12% of births in the U.S., a figure that health policy organizations have pointed to as low compared to other high-income countries. Expanding where and how nurse midwives practice, particularly in rural and underserved communities, is a central part of ongoing efforts to address the country’s maternal health crisis.