Look after people through pregnancy, birth and the year after, and provide their everyday reproductive health care too.
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Pay, the path, pros and cons and the facts on one printable page. Good for a wall or a guidance counsellor.
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What you earn and what it costs to get there.
Median
$134,040
Starting out
$93,620
Top tenth
$188,320
The national median is $134,040 a year, and the bottom tenth start near $93,620. The federal wage survey counts this job under the title Nurse Midwives, so these are figures for the nursing route. Home birth midwives who are self-employed are not represented well by this survey and typically earn far less.
About $95,000 to $110,000
First job as a certified nurse-midwife
You reach this after a bachelor's degree, a nursing license and a graduate degree, so it is a high number arrived at slowly. Hospital systems in expensive cities pay more, rural clinics and birth centers usually pay less.
Extra for nights, weekends and being on call
Babies do not arrive during office hours
Most midwifery jobs pay a premium for overnight call, and many pay per birth attended on top of salary. That is a lot of why the top tenth sit near $188,320.
Tuition, fees, exams and kit. Not rent, food or travel
The cheap route is a two year associate nursing degree at a community college, working as a nurse while a bachelor's top up is part paid or reimbursed by the hospital, then a graduate midwifery program at the lower end of $40,000. The high end is a four year nursing degree at up to $18,000 a year followed by a graduate midwifery program near $90,000, plus the national licensure examination for nurses, a state nursing licence and the national midwifery certification exam. Many hospitals pay part of the graduate tuition, and non-profit hospitals and public clinics count for the Public Service Loan Forgiveness program, which matters a great deal at these loan sizes.
Fill in the Free Application for Federal Student Aid every year. Many midwives work as nurses while studying, and hospital employers often pay part of the graduate tuition. Non-profit hospitals and public clinics usually count for the Public Service Loan Forgiveness program, which matters when graduate loans are this size.
Hospital benefits
Health coverage, retirement matching and paid leave are standard for employed midwives.
Loan repayment programs
Federal and state programs repay education loans for clinicians who work in areas short of maternity care.
Paid continuing education
You have to keep your certification current, and employers normally fund the courses and the time.
Strong demand
Maternity units have closed across large parts of rural America, so people who can staff them have options.
The exact path from high school to qualified.
In the United States the main route runs through nursing first. Expect six to eight years from high school.
High school
Grades 11 and 12
Biology, chemistry and any health science course. Volunteer or work somewhere that puts you near patients.
Bachelor of Science in Nursing
4 years
Four years, with clinical placements from year two. Nursing programs are competitive, so grades count.
Pass the NCLEX (National Council Licensure Examination) and get licensed
A few months
This makes you a registered nurse, which is the entry ticket for the next step.
Work as a nurse
1 to 2 years
Most graduate programs want real experience, and labor and delivery experience is the obvious choice.
Graduate midwifery program
2 to 3 years
A master's or doctorate accredited by the Accreditation Commission for Midwifery Education. Classroom work plus hundreds of supervised clinical hours.
Certify and get your state license
A few months
Pass the national examination from the American Midwifery Certification Board, then apply for advanced practice licensure in your state.
Biology and anatomy
Everything in the degree builds on this.
Chemistry
Needed for pharmacology, which is a large part of graduate training.
Statistics
Reading the evidence behind a guideline is part of the job.
Psychology
A lot of midwifery is talking people through fear, grief and hard decisions.
Certified nurse-midwives are licensed as advanced practice nurses by each state board of nursing, and every state licenses them. What varies is how independently you can work. Some states let a midwife run a practice and prescribe on their own authority; others require a written agreement with a physician. There is also a second, non-nursing route: the Certified Midwife, credentialed by the same national board from an accredited graduate program, and the Certified Professional Midwife, who works mostly at home births and is licensed in many states but not all of them. Check your state before you commit to a route.
Things you don't need, but that help.
Doctor of Nursing Practice
The doctoral degree in clinical nursing. Needed for some faculty and leadership jobs, and increasingly the standard entry degree.
Neonatal resuscitation training
Required by most employers and renewed every couple of years.
Lactation consultant credential
Adds a whole service line and is valued in birth centers and clinics.
Ultrasound training
Limited obstetric scanning is a skill some practices pay extra for.
Work as a birth doula first
Short training, low cost, and the fastest honest look at whether you want this life.
Nursing assistant job in high school or college
Pays a little, teaches a lot, and strengthens a nursing school application.
Spanish
Useful almost everywhere in maternity care in the United States.
Comfort with night work
Not optional. Roughly half of births happen outside business hours.
Large parts of the country have no hospital that delivers babies any more, and people drive an hour or more to give birth. Federal and state programs will repay a serious chunk of your student loans to work in those places. The work is harder and more isolated, you carry more on your own, and it is the fastest way to feel like the job matters.
Day to day, pros and cons, where you'd work.
Clinic days look like any other clinic: prenatal visits, contraception, screening, results, and a lot of listening. Call days are different. A birth takes as long as it takes, so you may be with one person for 14 hours or you may attend three in a night. You watch, you wait, you intervene when you have to, and you know when to call for a doctor or a surgeon. Then you write it all up and go to clinic anyway.
The good
The hard parts
Things people don't tell you.
The American Midwifery Certification Board grants both the Certified Nurse-Midwife and the Certified Midwife. The second route does not require a nursing license, but it still needs an accredited graduate midwifery degree.
Nurse-midwives are primary care and reproductive health providers. They do contraception, screening, menopause care and general well visits for people across their whole lives, not only during pregnancy.
Only graduates of programs accredited by the Accreditation Commission for Midwifery Education can sit the national certification exam. Check the accreditation before you pay anyone tuition.
Frontier Nursing University grew out of a service that sent nurse-midwives on horseback into rural Kentucky. It still trains midwives specifically for rural and underserved communities.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.