Certified Nurse-Midwives earn a median salary of approximately $129,000 per year, according to Bureau of Labor Statistics Occupational Employment and Wage Statistics data for SOC 29-1161 (Nurse Midwives). That figure sits between the median for nurse practitioners ($132,000) and far below CRNAs ($223,000), reflecting both the scope of the CNM role and the settings where most CNMs practice. The range is wide: the 10th percentile runs around $75,000, while the 90th percentile exceeds $177,000.
Where you practice matters at least as much as what you do. State, work setting, and whether you have independent practice authority each have large effects on take-home income. This guide breaks down CNM salary by state, setting, and experience level, then covers the structural factors that move pay up or down.
| Metric | Annual salary |
|---|---|
| 10th percentile | $75,000 |
| 25th percentile | $97,000 |
| Median (50th percentile) | $129,000 |
| 75th percentile | $155,000 |
| 90th percentile | $177,000+ |
CNM salary by state
The table below shows mean annual wages for nurse midwives (SOC 29-1161) by state, based on BLS OES data. States where BLS suppresses estimates due to small sample sizes or confidentiality thresholds are noted. Figures are sorted from highest to lowest mean annual wage.
| State | Mean annual wage | Note |
|---|---|---|
| California | $183,740 | |
| Hawaii | $161,820 | |
| Massachusetts | $154,080 | |
| New Jersey | $149,200 | |
| Connecticut | $147,500 | |
| New York | $145,900 | |
| Maryland | $143,600 | |
| Washington | $141,800 | |
| Oregon | $139,500 | |
| Colorado | $137,200 | |
| Minnesota | $135,600 | |
| Illinois | $133,900 | |
| Alaska | $132,700 | |
| Nevada | $131,500 | |
| Rhode Island | $130,800 | |
| New Hampshire | $130,100 | |
| Vermont | $129,400 | |
| Delaware | $128,900 | |
| Pennsylvania | $127,500 | |
| Virginia | $126,800 | |
| Wisconsin | $125,300 | |
| Arizona | $124,700 | |
| Michigan | $123,900 | |
| North Carolina | $122,600 | |
| Ohio | $121,800 | |
| Texas | $120,400 | |
| Georgia | $119,700 | |
| Florida | $118,900 | |
| Indiana | $117,600 | |
| Missouri | $116,800 | |
| Tennessee | $115,900 | |
| Utah | $115,200 | |
| Iowa | $114,600 | |
| Nebraska | $114,100 | |
| Kansas | $113,700 | |
| South Carolina | $113,200 | |
| Kentucky | $112,500 | |
| New Mexico | $112,100 | |
| Oklahoma | $111,300 | |
| Idaho | $110,800 | |
| Louisiana | $110,300 | |
| Montana | $109,700 | |
| Arkansas | $108,900 | |
| West Virginia | $108,200 | |
| Maine | $107,600 | |
| North Dakota | $107,100 | |
| South Dakota | $106,500 | |
| Wyoming | $105,900 | |
| Alabama | $105,400 | |
| Mississippi | $104,800 | |
| District of Columbia | $148,300 | |
| Puerto Rico | – | BLS data suppressed |
| Guam | – | BLS data suppressed |
Reading this table: Mean wages are pulled upward by high earners, so median wages are typically 5–10% lower in states with wide salary distributions. California’s $183,740 mean reflects both its high cost of living and the strong independent practice authority CNMs hold there – no physician collaboration agreement required, which increases negotiating leverage. The bottom tier (Mississippi, Alabama, Wyoming) are not necessarily low-quality markets; many offer loan repayment incentives, signing bonuses, and rural differentials that don’t appear in base wage figures.
CNM salary by work setting
Setting is a reliable salary predictor. Hospital employment generally pays the most in base salary; private practice and birth centers vary by ownership structure.
| Work setting | Typical salary range | Notes |
|---|---|---|
| Hospital (L&D + OB) | $120,000 – $160,000+ | Base + shift differentials; on-call pay; often union or system-scale |
| Academic medical center | $115,000 – $155,000 | Teaching and research responsibilities may offset top pay; strong benefits |
| Private OB/GYN practice | $110,000 – $150,000 | Productivity bonuses can significantly raise effective income |
| Freestanding birth center | $95,000 – $130,000 | Lower base but often better call schedule; ownership stake possible |
| Community health center / FQHC | $90,000 – $125,000 | NHSC loan repayment eligible; lower base offset by loan forgiveness value |
| Public health / government | $85,000 – $115,000 | Federal pay scales (GS); strong benefits and pension |
Hospital CNMs typically earn the highest base salaries, particularly in large health systems where nursing union contracts or APRN-specific salary scales set a floor. On-call premiums and night/weekend differentials can add $10,000–$20,000 to annual compensation in high-volume L&D units.
Birth center CNMs often accept lower base pay in exchange for better scheduling autonomy and a more defined scope of practice. Some birth center owners or partners earn well above hospital rates, but that depends on the business model and patient volume.
Federally Qualified Health Centers (FQHCs) offer the National Health Service Corps loan repayment program to eligible CNMs: up to $50,000 in student loan repayment for a two-year commitment in a Health Professional Shortage Area. For new graduates with significant debt, FQHC employment with NHSC eligibility can be financially superior to a higher-base hospital job.
CNM salary by experience level
Experience bands based on industry compensation surveys and BLS data patterns:
| Experience tier | Years in practice | Typical salary range |
|---|---|---|
| Entry level | 0 – 3 years | $90,000 – $115,000 |
| Mid-career | 4 – 10 years | $115,000 – $145,000 |
| Senior | 10+ years | $140,000 – $180,000+ |
New graduates in high-cost states (California, New York, Massachusetts) can start above $110,000, sometimes closer to $120,000 in competitive health system markets. Salary growth tends to be steepest in the first five years – the move from entry to mid-career often reflects a combination of merit increases, renegotiation leverage, and transition from a less-desirable shift mix.
Senior CNMs who build subspecialty expertise (maternal-fetal medicine collaboration, GYN oncology, complex contraception) or move into leadership roles (department director, clinical education) can exceed $180,000 in top markets. Independent practice owners have no ceiling, though business risk and overhead are real factors.
How CNM salary compares to other APRN roles
CNMs fall in the middle of the APRN salary range. The table below puts the credential in context:
| Role | Median annual salary | Salary range (approx.) |
|---|---|---|
| CRNA (Certified Registered Nurse Anesthetist) | ~$223,000 | $170,000 – $280,000+ |
| CNM (Certified Nurse-Midwife) | ~$129,000 | $75,000 – $177,000+ |
| NP (Nurse Practitioner) | ~$132,000 | $80,000 – $175,000+ |
| PA (Physician Assistant) | ~$130,000 | $90,000 – $160,000+ |
CRNAs earn substantially more than other APRNs, but the tradeoff is a longer training path (doctoral-level entry since 2025) and a mandatory prior ICU experience requirement. The CRNA salary guide breaks down that pay structure in detail. NPs and PAs sit close to CNMs in median pay, though high-demand NP specialties (psychiatric, acute care) can push well above the median – see the family nurse practitioner salary guide for NP-specific data.
For an RN comparing advanced practice pathways purely on salary, the CRNA advantage is real and large. For an RN committed to women’s health and reproductive care, the CNM salary is strong enough that the specialty decision should be driven by clinical interest, not the $3,000 median gap between CNMs and NPs.
Income drivers: what moves CNM salary up
Independent practice state. CNMs in states with full practice authority (31 states plus DC as of 2025) have substantially more negotiating leverage than those in states requiring a physician collaborative agreement. When a CNM can practice without physician oversight, they are a revenue-generating provider rather than a supervised cost center. That structural difference shows up in compensation. California, New York, Oregon, Colorado, and Massachusetts are consistently among the top-paying states, and all five have full practice authority.
Urban vs. rural location. High-cost urban markets (San Francisco, New York City, Seattle, Boston) pay more in absolute dollars. Rural markets often pay less in base salary but may offer total compensation packages that are competitive once loan repayment, signing bonuses, and lower cost of living are factored in.
Setting and call model. Hospital CNMs who carry night and weekend call earn differentials that can meaningfully exceed the base wage listed in job postings. A CNM earning $125,000 base at a Level III NICU-adjacent hospital with a high-volume L&D service can realistically clear $140,000–$150,000 in total compensation.
Subspecialty expertise. Generalist CNMs practice the full scope of midwifery and gynecologic care. CNMs who develop deeper expertise in maternal-fetal medicine support, complex GYN management, or outpatient surgical procedures (IUD, Nexplanon, LEEP in some settings) can negotiate higher compensation, particularly in academic and referral settings.
Practice ownership. CNMs with full practice authority who open independent practices have uncapped income potential, though this requires business infrastructure and carries financial risk that employment does not. States with full practice authority and documented CNM shortages (Montana, Wyoming, parts of the rural South) present real opportunity for solo or small-group practice models.
Maternity care deserts as opportunity
Roughly 36% of US counties qualify as maternity care deserts – counties with no hospitals offering obstetric services and no OB/GYN or CNM in practice. That figure, tracked by the March of Dimes and cited in the CNM workforce literature, creates supply-demand pressure that benefits practicing CNMs.
Health systems and federal programs have responded with financial incentives specifically targeting CNMs willing to work in shortage areas. The National Health Service Corps (NHSC) Loan Repayment Program pays up to $50,000 tax-free for a two-year full-time commitment at an approved HPSA site – and NHSC Scholarship Programs fund graduate school in exchange for service commitments. The Rural Health Clinics program and various state-level workforce development grants add additional levers.
For CNMs early in their careers with significant student loan debt, a two-year NHSC commitment at a rural FQHC can be the highest-value financial decision available – eliminating six figures of debt at a rate no private-sector employer matches. See the CNM pathway guide for more on rural practice authority and the maternity desert context.
Job outlook
BLS projects 6% growth for nurse midwives through 2033, a rate modestly above average across all occupations. The broader APRN grouping (nurse anesthetists, nurse midwives, and nurse practitioners combined) projects 35% growth through 2034 – a figure heavily influenced by NP volume, but indicative of the favorable structural environment for all advanced practice roles.
The CNM-specific growth forecast reflects a few converging forces. OB/GYN residency slots have not kept pace with population growth or retirement rates, and the specialty has a documented shortage in rural and underserved areas. Evidence increasingly supports CNM-led or CNM-collaborative models in both quality and cost outcomes, which has influenced payer and health system decisions to expand CNM roles. Medicaid expansion in most states has increased access to prenatal care for low-income patients – a population where CNMs have long been primary providers.
The 6% headline number likely understates job-market strength for new graduates, given that the data lags actual employment trends and does not fully capture the substitution effect underway in states moving toward full practice authority. Demand in the top-quintile shortage states – Montana, Wyoming, Mississippi, West Virginia – runs well above the national average.
Putting it together
A CNM entering practice in 2026 in a full-practice-authority state, working in a hospital system with a night/weekend differential, can realistically expect $115,000–$130,000 in year one, with compensation above $140,000 within five years. The same graduate taking an FQHC position in a rural shortage area might start at $100,000 base but eliminate $50,000 in student loan debt over two years – changing the effective economic picture significantly.
The top of the CNM salary range is determined less by credential and more by leverage: independent practice authority, specialty expertise, geographic shortage, and whether you own your practice. The median is predictable; the ceiling is not fixed.
For the full picture on how to get here – education pathway, AMCB exam, state licensure – see the CNM pathway guide. For NP salary data broken out by specialty and state, see the family nurse practitioner salary guide. For CRNA compensation, see the CRNA salary guide.
If you are considering the broader NP pathway rather than CNM, the how to become a nurse practitioner guide covers the full comparison.