Nurse midwives
Also called Nurse midwife, Certified nurse midwife, CNM, Midwife, Certified midwife
In brief
In May 2025, BLS counted 7,920 US nurse midwives, with median pay of $134,040 a year. Of the BLS counts since 2012, the highest was 8,280, in May 2024, close to the May 2025 count. The earliest figure here is an estimate of 124 from 1955, not measured the same way as today's count. The last full technology era for nurse midwives: AI electronic fetal monitoring and remote prenatal surveillance, 2018 to 2023. PeriWatch Vigilance deployments reduced missed category II-III FHR pattern events and cognitive load on multi-patient labor assignments.
What the sources say
Official outlook
BLS projects employment to grow 11.5% from 2025 to 2035.
AI exposure studies
- 29.3% of this job's tasks are exposed to large language models. Not a forecast of job losses. Eloundou and others, 2023
Data as of BLS OEWS May 2025; BLS Employment Projections 2025-35. BLS publishes these counts as yearly survey snapshots and cautions against reading them as a precise trend. In May 2021 BLS changed how it estimates these counts (a model-based method using three years of survey data) and moved fully to the 2018 occupation codes, so part of a change across 2021 can come from the method rather than the work.
Last updated .
Cite this page
Future History. (2026, October 11). Nurse midwives: jobs and pay since 1955 [Data set; data as of BLS OEWS May 2025; BLS Employment Projections 2025-35]. https://futurehistory.earth/timeline/29-1161
Future History. "Nurse midwives: jobs and pay since 1955." Data as of BLS OEWS May 2025; BLS Employment Projections 2025-35. Last modified October 11, 2026. https://futurehistory.earth/timeline/29-1161.
@misc{futurehistory_29_1161, author = {{Future History}}, title = {Nurse midwives: jobs and pay since 1955}, year = {2026}, month = oct, howpublished = {\url{https://futurehistory.earth/timeline/29-1161}}, note = {Last updated 2026-10-11. Data as of BLS OEWS May 2025; BLS Employment Projections 2025-35}, }
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≈ $130,603 in 2024 prices (derived by us, CPI-adjusted)
New York City enacts one of the earliest formal licensing requirements for midwives in the American colonies. The ordinance positioned midwives as "keepers of social and civil order," reflecting the profound community role midwives played in colonial society where they were among the few women to hold any formally recognized civic function. This is the earliest documented formal regulation of midwifery in North America.
The Flexner Report, commissioned by the Carnegie Foundation, recommends that childbirth be conducted only in hospitals under physician supervision and calls for the abolition of midwifery. The report is later recognized by historians as having embedded racist, sexist, and class-based assumptions into American medical education. Its recommendations accelerated the campaign by organized medicine to eliminate the lay midwife and restrict birth attendance to licensed physicians, a campaign that would succeed in dramatically reducing midwife-attended births from approximately 50% of all US births in 1900 to 15% by 1930.
Congress passes the Sheppard-Towner Maternity and Infancy Protection Act, funding state maternal and infant health programs and, in some states, midwifery training and licensing. The act was a victory for women's health advocates but had an ironic effect on traditional midwifery: states used the new licensing frameworks to impose educational and literacy requirements that predominantly Black and Indigenous granny midwives could not meet, effectively eliminating thousands of traditional practitioners. A federal survey identified 42,627 predominantly Black midwives practicing in the US in the early 1920s; this population declined sharply over the following two decades.
Mary Carson Breckinridge founds the Frontier Nursing Service in Leslie County, Kentucky, on May 28, 1925. She and two British-trained nurse-midwives she recruited in London, Edna Rockstroh and Freda Caffin, deliver the first baby in September 1925. FNS staff nurses traveled by horseback to reach laboring women in cabins with no road access. By the time of Breckinridge's death in 1965, FNS had registered over 64,000 patients and delivered 17,053 babies with only 11 maternal deaths, reducing Leslie County's maternal mortality rate from the highest in the nation to below the national average.
The Maternity Center Association opens the first school of nurse-midwifery in New York City, accepting its first students in the United States without requiring training in Britain. The Lobenstine Midwifery Clinic attached to the school demonstrates that nurse-midwives can reduce maternal mortality in an urban poor population. This is the origin of the city-based academic nurse-midwifery program model that would expand to dozens of universities through the 1970s and 1980s.
The American College of Nurse-Midwifery is formally incorporated on November 7, 1955, in New Mexico, with 124 founding members. Hattie Hemschemeyer, director of the Maternity Center Association School of Nurse-Midwifery, is elected the first president. The founding of the college consolidates the profession's identity: it will set educational standards, promote research, seek practice legislation, and advocate for CNM-attended birth as a legitimate mainstream care option, not just a service for populations no physician would serve.
ACNM offers the first national certification examination for nurse-midwives. Before 1971, a nurse who completed a ACNM-accredited program was considered a qualified nurse-midwife but there was no standardized national credential. The certification exam creates a credential physicians can verify, malpractice insurers can rate, and state legislatures can reference in scope-of-practice statutes. It is the professional inflection point that makes CNMs credentialing-eligible for hospital privileges and Medicaid provider enrollment.
The Maternity Center Association opens the first freestanding urban birth center in Manhattan, in a modified townhouse, as a response to the growing "do-it-yourself" home birth movement. The center is staffed by CNMs and offers a middle path: out-of-hospital birth in a medically supervised environment with nurse-midwives rather than obstetricians. The model spreads rapidly: the National Association of Childbearing Centers (later American Association of Birth Centers) is founded in 1983 to represent the growing number of freestanding birth centers, and CNMs become the primary clinical staff in this new care setting.
An ACNM Division of Research mini-survey finds 1,735 CNMs responding, with 70.6% in active clinical practice. The survey captures the growth of CNM employment into physician-owned OB practices and hospital-based labor and delivery units during the 1980s. By this point the profession had fully transitioned from its roots as a service for underserved populations into a career path for nurses seeking APRN scope. Growth through the 1990s would be driven partly by managed care organizations, which found that CNMs cost substantially less than OB/GYNs while providing equivalent outcomes for low-risk prenatal care.
The COVID-19 pandemic accelerates telehealth expansion in prenatal care. CNMs in community health and independent practice settings adopt remote prenatal monitoring platforms (Babyscripts, other BP-cuff telehealth systems) to maintain patient contact during lockdowns and reduce in-person visit density. Telehealth prenatal visits, previously a rarity, become normalized for low-risk patients and expand CNM panel capacity. The pandemic simultaneously demonstrates the fragility of the US maternity care system: a disproportionate share of CNMs work in community health centers and FQHC settings that were financially stressed during the pandemic, and CNM workforce attrition during 2020-2022 exceeded projections.
The American Midwifery Certification Board counts 12,997 certified nurse-midwives and certified midwives in the United States in 2020. OEWS, the employment series plotted here, counted 7,120 nurse midwife jobs in May 2020: it counts wage-and-salary jobs only, and not every certified midwife works as one.
Will AI replace nurse midwives? What the research says
Each figure is stated by the named source; we publish no forecasts of our own. Where sources disagree, we show the disagreement rather than an average.
Each figure is stated by the named source; we publish no forecasts of our own. Where sources disagree, the spread is the honest signal.
What's changing day to day for nurse midwives
Three parts of your work where AI is already doing real lifting, and what stays yours.
AI is sitting alongside you hereDocument prenatal, intrapartum, and postpartum encounters using ambient AI scribing (Dragon Copilot / Nuance DAX Copilot), reviewing AI-drafted SOAP notes from recorded clinical conversations, verifying accuracy of captured subjective complaints, CNM examination findings, and plan elements before filing to the EHR, and maintaining licensed accountability for every signed documentation entry.
Document prenatal, intrapartum, and postpartum encounters using ambient AI scribing (Dragon Copilot / Nuance DAX Copilot), reviewing AI-drafted SOAP notes from recorded clinical conversations, verifying accuracy of captured subjective complaints, CNM examination findings, and plan elements before filing to the EHR, and maintaining licensed accountability for every signed documentation entry.[10],[11]
Ambient scribing tools reduce documentation time by 60–70% per encounter: a prenatal visit note that previously required several minutes of post-visit charting now drafts in seconds. Your value shifts to expert review: develop a fast audit habit (read the AI note top-to-bottom against your actual clinical assessment before signing), and build the documentation literacy to catch subtle AI errors in fetal heart rate terminology, gestational age calculations, and prenatal labs.
AI is sitting alongside you hereMonitor the laboring patient's fetal heart rate strip using PeriWatch Vigilance AI alerts, reviewing color-coded acuity notifications on the Hub Board for indeterminate or abnormal FHR patterns, interpreting automated 5-tier FHR classification against direct patient assessment, escalating category III findings to the supervising OB or MFM, and documenting the CNM's independent clinical response rationale when managing or overriding an AI-flagged alert.
Monitor the laboring patient's fetal heart rate strip using PeriWatch Vigilance AI alerts, reviewing color-coded acuity notifications on the Hub Board for indeterminate or abnormal FHR patterns, interpreting automated 5-tier FHR classification against direct patient assessment, escalating category III findings to the supervising OB or MFM, and documenting the CNM's independent clinical response rationale when managing or overriding an AI-flagged alert.[3],[12]
PeriWatch Vigilance is the only FDA-cleared continuous EFM AI in the U.S.: it reduces the cognitive load of manual strip scanning across multi-patient labor assignments and catches pattern deterioration earlier than intermittent human review alone. Your edge is knowing which patterns require immediate CNM action vs. watchful waiting: develop fluency with the tool's 5-tier classification rubric and build the habit of cross-checking AI acuity flags with your bedside fundal assessment before escalating.
AI is sitting alongside you hereManage remote prenatal surveillance for low-risk and high-risk patients enrolled in Babyscripts myJourney, reviewing remotely submitted blood pressure readings and symptom flags in the EHR dashboard, responding to configurable alert protocols when vitals exceed risk thresholds, conducting asynchronous telehealth touchpoints between office visits, and escalating out-of-range readings to in-office or triage assessment.
Manage remote prenatal surveillance for low-risk and high-risk patients enrolled in Babyscripts myJourney, reviewing remotely submitted blood pressure readings and symptom flags in the EHR dashboard, responding to configurable alert protocols when vitals exceed risk thresholds, conducting asynchronous telehealth touchpoints between office visits, and escalating out-of-range readings to in-office or triage assessment.[13],[14]
Remote prenatal monitoring platforms like Babyscripts myJourney cut in-person visits per pregnancy for low-risk patients: your panel capacity increases, but so does the volume of remote data you interpret. Develop efficient alert-triage workflows: distinguish which BP readings require same-day evaluation from those warranting a scheduled visit; use the asynchronous touchpoint as a relationship-maintenance tool, not just a data-collection exercise.
Where nurse midwives go next
Natural next steps for someone with your foundation: not exits, evolutions.
- Medical and Health Services Managers
- US median pay
- $123,860 (May 2025)
- BLS outlook 2025-35
- +24.2%
- Nurse Practitioners
- US median pay
- $132,300 (May 2025)
- BLS outlook 2025-35
- +41%
- Obstetricians and Gynecologists
- US median pay
- $292,910 (May 2025)
- BLS outlook 2025-35
- +1.7%
What each move takes
Medical and Health Services Managers
Experienced CNMs who develop birth center director, perinatal program coordinator, or midwifery department chief experience naturally build toward Medical and Health Services Manager roles. As health systems adopt AI tools for perinatal monitoring (PeriWatch Vigilance, Mirvie Encompass, remote prenatal platforms), they need clinical leaders who understand both the midwifery philosophy and the technology governance requirements. CNMs in program director roles earn significantly above staff CNM median; perinatal program directors and birth center administrators are in growing demand as health systems expand midwifery-led care models to address the projected 22,000-provider shortage by 2050. BLS projects Medical and Health Services Managers at +29% growth 2024-2034.
- · Healthcare management credentials: MSN with nursing administration/healthcare leadership track or MBA (Healthcare Management)
- · ACNM Certified Midwifery Manager credential or ANCC Nurse Executive Certification (NE-BC)
- · Budget management: perinatal program operating budget, staffing ratios, productivity benchmarking for L&D units
- · AI technology governance: evaluating EFM AI tools, remote monitoring platforms, vendor contracts, patient safety reporting
- · Quality improvement: maternal safety bundles (ACOG SMFM), hemorrhage protocols, Joint Commission perinatal care certification
How has the work of nurse midwives changed since 1925?
The tools that defined the work, one line per era. Select an era to see how it reshaped the work.
Horseback bag and manual skills (FNS model: Pinard horn, manual palpation, herbal and early pharmaceutical kit)
The Frontier Nursing Service nurse-midwives of the late 1920s and 1930s carried a standardized bag of supplies on horseback into rural Kentucky hollows. Their diagnostic tools were the Pinard stethoscope (a wooden horn for auscultating fetal heart tones, invented 1819), external manual palpation (Leopold maneuvers, formalized 1894), and the blood pressure cuff (sphygmomanometer, in widespread clinical use by the 1910s). Birth required hands, knowledge of normal labor progression, and the judgment to know when a physician needed to be summoned. The bag also held ergometrine (ergot derivative for postpartum hemorrhage, widely available by the 1930s) and basic antiseptics. What distinguished FNS nurses from earlier lay midwives was not the tools but the formal training: a structured curriculum, supervised clinical hours, and the habit of record-keeping that made outcomes measurable and improvable.
Effect on the workFNS demonstrated a maternal mortality outcome better than most urban hospitals of the era, establishing the evidence base that trained nurse-midwives operating within a consultative system with physicians could safely manage low-risk birth.
Hospital-based obstetrics and pharmacological labor management (oxytocin induction, epidural analgesia, early EFM)
By 1960, 97% of US births occurred in hospitals. Nurse-midwifery had to negotiate an entirely different environment than the home-birth setting of the FNS model: a facility with physicians on call, an operating suite for cesareans, and an expanding pharmacological toolkit. Oxytocin (Pitocin) had been synthesized by Vincent du Vigneaud in 1953 (Nobel Prize, 1955) and was in widespread clinical use for labor induction and augmentation by the early 1960s. Epidural analgesia expanded through the 1960s, changing the experience and timeline of labor. The first continuous electronic fetal monitor suitable for clinical use was sold commercially in 1968; by 1979 at least half of all laboring women were monitored electronically. For the nurse-midwife, this era represented both an opportunity (the hospital setting created new CNM positions to handle the volume of births) and a constraint: labor was increasingly managed by pharmacological protocol rather than the physiological, hands-off watchfulness that was the philosophical core of midwifery.
Effect on the workThe hospitalization of birth nearly eliminated community-based nurse-midwifery for two decades. CNM practice in this era concentrated in public health settings, Native American reservation health clinics, and a small number of progressive teaching hospitals. Employment of CNMs remained in the hundreds through the late 1960s.
ACNM certification, Doppler fetoscope, and the birth center model (professionalization era)
ACNM established its first national certification examination in 1971, creating a formal credential that distinguished certified nurse-midwives from other birth attendants and gave CNMs a credential physicians and hospitals could recognize. The handheld Doppler fetoscope (popularized in clinical use from the late 1960s) replaced the Pinard horn, giving CNMs an accurate, portable fetal heart rate check without the EFM strip. Freestanding birth centers emerged as a third-path setting between home and hospital: the Maternity Center Association opened the first urban birth center in Manhattan in 1975 to serve women who wanted out-of-hospital birth in a medically supervised environment. The 1983 founding of the American Association of Birth Centers codified the model. By 1984 there were thousands of CNMs and the profession was growing rapidly, driven in part by federal Medicaid mandates requiring reimbursement for CNM services and by the expansion of the birth center setting.
Effect on the workACNM certification and birth center growth roughly tripled CNM employment between 1971 and 1984, from hundreds of active practitioners to thousands of ACNM members. Federal Medicaid coverage of CNM services, first required by law in the 1980s, was the single largest structural driver of employment growth in this era.
Electronic health records, continuous EFM strip review, and managed care credentialing (hospital integration era)
Through the 1990s and 2000s, nurse-midwives integrated into mainstream hospital obstetric units at scale. By 2000 the ACNM had over 7,000 members, and CNMs were routinely employed by physician-owned OB practices, hospital-based labor and delivery units, and community health centers. Electronic health records began replacing paper charts in hospitals during the late 1990s and 2000s, adding documentation burden to every clinical encounter. Continuous EFM had become universal in hospital birth by the 1990s: 85% of laboring women were electronically monitored by 1994. The CNM role in this era became heavily intertwined with strip interpretation and EFM-driven labor management protocol. Managed care required CNMs to obtain hospital privileges and malpractice coverage, and state-by-state variation in CNM scope of practice (prescriptive authority, independent practice authority, physician supervision requirements) shaped where CNMs could practice and how.
Effect on the workACNM membership growth plateaued in the early 2000s despite continued healthcare demand, constrained by insufficient CNM educational program capacity, high student clinical training costs, and state-level practice restrictions that depressed demand in some markets.
AI electronic fetal monitoring (PeriWatch Vigilance) and remote prenatal surveillance (Babyscripts myJourney)
PeriGen's PeriWatch Vigilance, available from 2018 and expanded in scope by FDA clearance of Patterns 3.0 in February 2025, became the first and only FDA-cleared AI system in the US for continuous automated fetal heart rate pattern interpretation. For nurse-midwives in hospital labor and delivery units, it replaced manual periodic strip review intervals with a 24/7 color-coded acuity alert on a Hub Board spanning multiple patients. Babyscripts myJourney and similar remote prenatal monitoring platforms, growing through the COVID-era telehealth expansion of 2020-2022, allowed CNMs to reduce in-person prenatal visits per pregnancy for low-risk patients by keeping continuous BP surveillance via a cellular-connected cuff synced to the EHR. These tools represented augmentation of the CNM's surveillance reach, not displacement: every alert still required CNM interpretation, response, and documentation.
Effect on the workPeriWatch Vigilance deployments reduced missed category II-III FHR pattern events and cognitive load on multi-patient labor assignments. Telehealth prenatal platforms expanded CNM panel capacity in underserved and rural practices, contributing to the ACNM's projection of needed workforce growth.
Ambient AI documentation and RNA biomarker risk stratification (Dragon Copilot, Mirvie Encompass)
Microsoft Dragon Copilot (rebranded from Nuance DAX Copilot in March 2025), deployed at hundreds of US health systems, converts clinical conversations into specialty-specific SOAP notes in seconds, reducing documentation time by 60-70% per encounter. For CNMs handling several prenatal visits per day in a community health setting, the recovery of many minutes of charting time per session is material. The ACNM's 2025 policy statement on appropriate use of technology frames both these developments explicitly: technology augments the midwife's clinical judgment; it does not replace it.
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Browse all rolesNurse Midwives employment and pay by year
View all 20 years of cited US data, each linked to its source
| Year | US employment | Annual pay (median unless marked) | Source | Report |
|---|---|---|---|---|
| 1955 | 124 | n/a | Est., How ACNM and AMCB Shaped… Researched context | Report |
| 1975 | 860 | n/a | Est., ACNM historical summary via… Researched context | Report |
| 1977 | 1,000 | $14,000 | Est., PMC1619506 Researched context | Report |
| 1984 | 2,534 | n/a | Est., ACNM historical summary via… Researched context | Report |
| 2000 | 7,000 | $67,000 | Est., ACNM historical summary via… (employment) Researched contextEst., BLS OOH (pay) Researched context | Report |
| 2010 | n/a | $87,000 | Est., BLS OOH Researched context | Report |
| 2012 | 5,710 | $89,600 | BLS OEWS May 2012 Official statistic | Report |
| 2013 | 5,460 | $92,290 | BLS OEWS May 2013 Official statistic | Report |
| 2014 | 5,110 | $96,970 | BLS OEWS May 2014 Official statistic | Report |
| 2015 | 7,430 | $92,510 | BLS OEWS May 2015 Official statistic | Report |
| 2016 | 6,270 | $99,770 | BLS OEWS May 2016 Official statistic | Report |
| 2017 | 6,530 | $100,590 | BLS OEWS May 2017 Official statistic | Report |
| 2018 | 6,250 | $103,770 | BLS OEWS May 2018 Official statistic | Report |
| 2019 | 6,930 | $105,030 | BLS OEWS May 2019 Official statistic | Report |
| 2020 | 7,120 | $111,130 | BLS OEWS May 2020 Official statistic | Report |
| 2021 | 7,750 | $112,830 | BLS OEWS May 2021 Official statistic | Report |
| 2022 | 7,950 | $120,880 | BLS OEWS May 2022 Official statistic | Report |
| 2023 | 6,960 | $129,650 | BLS OEWS May 2023 Official statistic | Report |
| 2024 | 8,280 | $128,790 | BLS OEWS May 2024 Official statistic | Report |
| 2025 | 7,920 | $134,040 | BLS OEWS May 2025 Official statistic | Report |