How to become a nurse midwife

1. 1Become a registered nurse

   Time: 2-4 yearsCost: Varies by schoolSources 4, 2

   Every ACME-accredited program requires a bachelor's degree for entry, though some offer a bridge to the BSN for RNs with an associate degree. Earn your nursing degree and pass the NCLEX-RN to get your state RN license. Labor and delivery, postpartum or women's health nursing gives you useful experience, though not every program requires it. If you already have a bachelor's in another field, some programs combine accelerated nursing education with the midwifery degree.

2. 2Choose an ACME-accredited midwifery program

   Time: 6-12 months to applyCost: Application fees varySources 4, 10

   Only graduates of programs accredited or pre-accredited by ACME can sit for the AMCB exam. ACME's current list has about 50 accredited or pre-accredited programs, offering a master's, a DNP or a post-graduate certificate. Compare delivery format, whether the school places you at clinical sites or expects you to find your own, and how many semesters it takes.

3. 3Complete the graduate program and clinical training

   Time: About 20 months to 3 yearsCost: Varies; median federal debt $45,241Sources 6, 7

   Coursework covers advanced health assessment, pharmacology, pathophysiology, prenatal and gynecologic care, and labor management. Clinical hours under practicing midwives are the core: Rutgers requires at least 964 clinical hours, and Vanderbilt reports more than 840 hours across three rotations. Vanderbilt's full-time MSN takes 5 semesters; Rutgers' hybrid plan runs 8 semesters over 3 years. Expect night and weekend shifts during intrapartum rotations.

4. 4Pass the AMCB certification exam

   Time: 1-3 months after graduatingCost: $425Sources 3, 12

   The American Midwifery Certification Board administers the national exam through PSI test centers once your program director sends AMCB a letter confirming you completed the program. A CNM candidate must also show an active U.S. RN license. A retake costs $350, and candidates get at most four attempts, all within 24 months of finishing the program. Passing earns the Certified Nurse-Midwife (CNM) credential.

5. 5Get your state license and prescribing authority

   Time: Several weeksCost: State fees varySources 1, 11

   Apply to your state's licensing board, usually the board of nursing (a few states use a midwifery or medical board or the health department), for licensure as a CNM or advanced practice registered nurse. States differ on whether a collaborative agreement with a physician is required and on prescriptive authority, which may need a separate application and a DEA registration for controlled substances. Hospitals then credential you before you can admit patients and attend births.

6. 6Maintain certification every five years

   Time: OngoingCost: Annual AMCB feeSources 8

   AMCB certification runs on a five-year cycle. To recertify, midwives complete continuing education modules in three areas (antepartum and primary care in pregnancy; intrapartum, postpartum and newborn care; and gynecology and well-woman care) and average 10 approved contact hours a year, and they pay an annual fee. A midwife whose certification lapses must retake the exam.

Programs, tuition and graduates’ earnings

U.S. Department of Education, College Scorecard (most recent cohorts, released 2026-10-15). Scorecard groups programs by 4-digit field, so a row can include related programs. Tuition is the median published undergraduate tuition and fees of the colleges offering the program (shown only for undergraduate credentials); debt is the median of programs’ median federal loan debt at completion; earnings are the national median for the field and credential four years after completion.

Requirements differ by state. Check your state’s rules in the CareerOneStop License Finder (U.S. Department of Labor) before you enroll.

Calm under pressure

A shoulder dystocia or postpartum hemorrhage gives you seconds to act while keeping the family steady.

Clinical judgment

Midwives decide when a labor is normal and when to call in an obstetrician, and getting that line right protects mother and baby.

Listening and patient education

Much of midwifery care is counseling on choices about birth, pain relief, feeding and contraception.

Stamina

Long labors, overnight shifts and 24-hour call are common in hospital and birth center roles.

Hands-on skill

Delivering babies, repairing lacerations and placing IUDs all take practiced, steady hands.

O*NET 31.0 rates these skills as most important for the occupation: active listening, speaking, critical thinking, reading comprehension, active learning.

Training cost

$625–$45.9K

Before financial aid

Time

7-8 years

Typical path

Median pay

$134,040

All US jobs: $50,980

Payback once qualified

Under 1 year

Pay above the all-jobs median vs. cost

We do not have an official national tuition figure for midwifery programs, which differ widely between public and private schools. Low: the unavoidable exam fees only, the NCLEX-RN at $200 (before Feb. 1, 2027) plus the AMCB exam at $425. High: those fees plus $45,241, the College Scorecard median federal loan debt for nursing master's graduates, as a guide to what students borrow for the graduate degree. Not included: the BSN, state license fees, books, travel to clinical sites and income lost while in school.

Rough guide only: ignores taxes, aid, interest and earnings given up during training. How we calculate it.

• Obstetrician-gynecologist$292,910 median

  Requires medical school and a four-year OB-GYN residency; a few midwives make this switch to perform surgery and manage high-risk pregnancies.

• Nurse practitioner$132,300 median

  A post-graduate certificate in a women's health or family NP track lets a CNM widen their primary care scope.

• Midwifery program faculty or director

  Experienced CNMs often precept students, and a DNP or PhD opens faculty and program director roles.

• Birth center or practice owner

  In states that allow independent practice, CNMs can open a birth center or private practice, which also involves accreditation and business licensing.