Uncategorized

The Cost of Being a Midwife

Posted by amidwifenation on
pexels-photo-164527.jpeg
Photo by Pixabay on Pexels.com

I remember getting one lecture on the costs it takes to MAINTAIN your midwifery certification in midwifery school. The lecture was at the end of the final semester before integration. There were other topics reviewed that grabbed by attention much more so than the cost to maintain my certification. (At this point in midwifery school, you can see the finish line and it’s been a really long race.) My mind was focused on how to take your boards, how long it takes to get credentialed, and how much times passes from the last babe you catch as a student midwife to the first babe you catch as an actual midwife.

This is my best effort at capturing all the fees, certifications and requirements that go into maintaining your midwifery skillset. This skill set looks different for everyone. There are a lot of pieces.

In general, it’s expensive.

And the cost varies greatly for each individual because of the many steps, the different degrees or school options and the time it takes to complete the training. Some people go from start to finish in 4-6 years in their 20s. Some people work slowly from one stepping stone to the next just doing what they can during each phase of their life. The nurse-midwife that taught me how to suture was 70 years old. (No one is too old for midwifery. If you have the heart and it’s your calling, we need you.)

I’ve divided the possible costs up by before, during and after school, as well as the maintenance costs expected as a practicing provider.

If this is helpful to you, please share it with someone!

Before midwifery school…

  • Nursing degree (for certified nurse-midwives) or other degree (for certified midwives or licensed midwives/certified professional midwives): Cost varies.
    • If you are considering nurse-midwife, remember that all registered nurses take the same license exam (i.e. choose a school with less tuition).
  • Applying to schools (application fees, revamping your resume, studying/taking GRE, completing any pre-requisites, asking people if they can be a recommendation): Cost varies.
    • I looked up the graduate school I went to…for 2023, their application fee to just apply to the midwifery program is $250.
    • This is a lot of personal time too.
  • Time to complete interviews, complete a visit site visit, quit your job/move to a new city.
    • This is mostly a personal time cost unless you are paying to move.

During midwifery school…

  • Tuition: $50,000-$300,000
    • Tuition depends on what school you are going to and what training or degree you obtaining; program length is an important factor (the longer you are in school, the more tuition you will probably pay) here as well as if you are completing an apprentice type training.
      • For full transparency, I attended the University of Colorado in 2012, full time, for 2 years and paid $57,000 for my Masters in Nurse Midwifery. I paid $25,000 in cash for my degree and the United States Air Force paid for the rest. In return for their help financially, I served a commitment of 2.5 years. Next most common question I get is did you work? Yes, I worked full time until my last semester before Integration. I worked night shift and did not have any children. If you are looking for stories on how people attended/paid/completed their own trainings, head to the STATE RESOURCES page and look for interviews from the Journey to Midwifery podcast in the states that you are interested in attending school or working in.
  • Books: $1,000-1,500
    • May vary based on if book is used and/or digital
      • Speaking of BOOKS, if you’re wondering why the heck college is so freaking expensive, I highly recommend this book: The Price You Pay for College: An Entirely New Road Map for the Biggest Financial Decision Your Family Will Ever Make by Ron Lieber. I recently read this book and earmarked it to read again in 10 years when my daughter is applying for colleges – that’s a pretty big compliment for a book.)
  • School fees: expect $250-500/semester
    • There is a fee for everything. This may be even higher with inflation right now.
  • Your time.
    • The recommendation still rings true: for every semester hour you take, expect to study 3 hours a week. For 12 credit hours, that’s 36 hours of studying, reading or preparation per week.
  • Thank you gifts for your preceptors (a card is just fine but if you want to go above and beyond, look here)

After midwifery school/before boards…

  • The application fee to take your boards:
    • CM/CNM (certified midwife/certified nurse-midwife): $500.
    • LM/CPM (licensed midwife/certified professional midwife): Varies… I’ve included the chart below from NARM with the specifics:
Source

  • Your initial midwife license: $80-$100 to $500.
    • Initial application for CNMs, CMs, or LMs/CPMs all vary. This is hard to predict because it’s overseen by the individual states. The most expensive license I could find was $500 (California), but there could be another state that is more expensive.
    • If you are applying for licenses in multiple states, you’ll obviously have more licensing fees. Keep this in mind if your family plans to move a lot. If you’re a military family, a new law passed in January 2023 may cover you and you may not have to transfer licenses from state to state. Read it here.
    • Some states charge additional fees if you are applying for prescriptive authority for the first time.
    • Some states prefer that you apply for a RN and CNM license at the same time.
    • Look to either state nursing or medical boards for more information. Don’t hestisate to compare states either to see how different they can be from one another.
  • Initial DEA (drug enforcement administration) license fee: $888.
  • Applying for jobs and prepping for interviews: more personal time.

*Student Tip #1: Because of all these costs, this is why I recommend working at least prn or part time while you are in school if that works for you. Midwifery training is long and draining, working isn’t for everyone. But a regular paycheck helps offset some of the fees inherent in the license and certification phases.

*Student tip #2: If you’re overwhelmed, I see you. I’ve been there. I made a guide to help you be a successful student midwife. Check it out here.

Take me to the SHOP

As a practicing midwife…

  • Midwife license fees (for CNMs, this is your RN license and your CNM license): $100-$300 every 2-3 years, varies by state
  • Certification for CNM/CMs:
    • AMCB annual maintenance fee: $70
    • AMCB recertification: Due every 5 years. Must complete 3 education modules/complete a test on module content and 20 continuing education hours to renew certification. Read more here. (*See tips below.)
      • Although annoying, this is important. The modules for certification award 20 continuing education hours each (yes, that’s 60 hours). BUT, you can’t use any of those hours for your recertification. Sigh.
      • Or, you could opt to retake your certification exam. The choice is yours every 5 years.
  • Certification for LM/CPMs:
    • Re-certification is every 3 years: $210.
      • Recertification requires:
        • 5 contact hours related to peer review
        • A course on cultural awareness in the past 3 years
        • And either: 30 hours of continuing education OR you can retake the NARM exam.
    • Read more here.
  • Continuing education: Varies.
    • Plan on completing 20 to 60 required hours to renew your licenses or recertifications.
    • A lot of states are including a specific number of opioid focused hours as a requirement to renew licenses and/or certifications.
    • There are a lot of free continuing education hours out there; I also maintain a list in the monthly newsletter. Be sure you’re signed up.
  • Life support courses: Varies. (may be free/employer paid but these cost you your time)
    • Plan for 8 hours every 1-2 years to complete online training and in-person trainings
      • Most midwives need Basic Life Support (BLS) and Neonatal Resuscitation Program (NRP)
  • Precepting: Your time and mental resolve.
  • DEA (drug enforcement administration) license fee: $888 (every 3 years as of 2020)
  • Trainings: Varies.
    • All sorts of things fall into this category. You may need Nexplanon training or colposcopy training. Your office may want you to attend a training on hormone replacement therapy.
    • Tip: If you go to a new training for the first time, the training will likely give you a bunch of continuing education credits; generally, you only get to use these one time for license or recertification.
  • Professional organizations (*most organizations offer a student discount)
  • Other certifications (many midwives are dual certified in other areas: doula, lactation consultant, licensed counselors, other advanced practice nurse degrees): These will all cost extra depending on what you choose to maintain.
    • Because of this cumulative factor, I let my NRP instructor, AWHONN EFM instructor and RNC-OB certifications expires this year. Don’t be afraid to let something expire if you’re not using it or it doesn’t fit with your phase of life.

*Practicing midwife tip #1: If you have library access, download the AMCB module articles for re-certification for free.

*Practicing midwife tip #2: If you don’t have library access, or you’re too lazy (that’s me, hello…I have 4 children), get with a couple other midwives and have everyone buy a different module. Complete yours, then do a swapsies. Bonus, you can get your journal club done too with your colleagues.

As a practicing midwife, my licenses, certifications and memberships average $700-800 a year. Some years, everything needs renewing and it is more expensive. Sometimes I choose to go to a conference and thats cost can vary greatly. To me, most of the cost of the training is front loaded, but you have to do the work to maintain your licenses, certification and continuing education as a practicing provider.

Some last bits to scrape off the plate…you know those are the best bits anyways.

  • In some cases, your employer will pay for some of these costs. You can negotiate these costs into your contracts – but if you don’t ask, it may not be offered.
  • Don’t apply to midwifery schools you aren’t serious about attending. The expenses are simply too high just to see if you’re going to get in. Pick your top 2-3 and go all in.
  • If you are going to take out loans for school, consider midwife jobs that will help you pay them back so you can get out of debt as quickly as possible. Find out more about those programs and other scholarships on the MAKE MORE MIDWIVES page.

And if you need them, some helpful resources:

Looking for more information about midwifery?

A last note. Despite these high costs, there are moments in midwifery practice that make every dollar absolutely worth it. Newborn cries. Rubbing a mama’s back in labor. Telling her she can do it, because you know she can, and you know she’s going to have a baby on the next contraction.

It’s a long, hard and very worthwhile road.

My hope is to help make more midwives with this kind of content. Keep me honest and transparent – if I got something wrong. send me an email: amidwifenation@gmail.com.

If you know someone who is interested in midwifery, be sure to share this post with them!

1 year ago on the blog…Update Your Discharge Teaching (Part 1)

2 years ago on the blog…5 Handy Provider Handouts

3 years ago on the blog…Women Ask Wednesday: Amazing, FREE educational resources for pregnancy, labor, postpartum and breastfeeding!

Leave a Reply