Certified Nurse-Midwives earn a median salary of $134,040 per year ($64.44/hr), according to Bureau of Labor Statistics Occupational Employment and Wage Statistics data for SOC 29-1161 (Nurse Midwives), May 2025. That figure sits slightly above the median for nurse practitioners ($132,300) and far below CRNAs ($236,590), reflecting both the scope of the CNM role and the settings where most CNMs practice. The range is wide: the 10th percentile runs $93,620, while the 90th percentile reaches $188,320.
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 | $93,620 |
| 25th percentile | $116,510 |
| Median (50th percentile) | $134,040 |
| 75th percentile | $157,400 |
| 90th percentile | $188,320 |
CNM salary by state
Nurse midwifery is a small occupation – about 8,600 employed nationally on the 2024 BLS employment base – and that has a direct consequence for salary data. BLS suppresses state estimates wherever the sample falls below its confidentiality threshold, so a complete 50-state table of CNM wages does not exist in the official data. Mississippi, Wyoming, and a number of other states publish no CNM wage estimate at all. Any site presenting a full 50-state CNM table is estimating, not reporting.
The table below lists median annual wages for nurse midwives (SOC 29-1161) in the states where BLS does publish an estimate, May 2025 vintage, sorted highest to lowest.
| State | Median annual wage | vs. national median |
|---|---|---|
| California | $203,840 | +52% |
| Massachusetts | $159,800 | +19% |
| Washington | $158,970 | +19% |
| New Jersey | $153,970 | +15% |
| Oregon | $146,900 | +10% |
| New York | $144,510 | +8% |
| Arizona | $140,960 | +5% |
| Maryland | $140,120 | +5% |
| Colorado | $137,610 | +3% |
| Virginia | $135,710 | +1% |
| Minnesota | $134,810 | +1% |
| National median | $134,040 | – |
| Connecticut | $130,790 | -2% |
| Ohio | $127,730 | -5% |
| Florida | $127,460 | -5% |
| North Carolina | $126,040 | -6% |
| Michigan | $125,140 | -7% |
| Texas | $123,380 | -8% |
| Illinois | $120,840 | -10% |
| Pennsylvania | $119,990 | -10% |
| Georgia | $105,510 | -21% |
Reading this table: These are medians, not means – half of CNMs in each state earn above the listed figure and half below. California is a structural outlier rather than simply the most expensive state: its $203,840 median is $44,040 clear of second-place Massachusetts, a gap larger than the entire spread between Massachusetts and Illinois. Cost of living explains part of that, but so does practice environment. California grants CNMs independent practice authority without a physician supervision requirement, which turns the midwife into a directly billable provider rather than a supervised cost center.
Geography inside a state matters as much as the state line. Boston CNMs post a $174,870 median against the Massachusetts statewide $159,800, and the New York-Newark metro median of $159,730 runs $15,220 above New York State as a whole. Rural nonmetropolitan areas run correspondingly below – western North Carolina’s $97,830 median sits $28,210 under the state figure.
States absent from this table are not low-paying by implication; they are unmeasured. Many of them (Mississippi, Wyoming, Montana, the Dakotas) combine documented maternity care shortages with loan repayment incentives and rural differentials that never appear in a base wage table.
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. BLS publishes CNM wages by industry rather than by these job-title settings, so the ranges below are indicative bands drawn from posted CNM job listings and positioned against the May 2025 national percentile distribution. Treat them as orientation, not as measured data.
| Work setting | Indicative salary range | Notes |
|---|---|---|
| Hospital (L&D + OB) | $130,000 – $170,000+ | Base + shift differentials; on-call pay; often union or system-scale |
| Academic medical center | $125,000 – $165,000 | Teaching and research responsibilities may offset top pay; strong benefits |
| Private OB/GYN practice | $120,000 – $160,000 | Productivity bonuses can raise effective income considerably |
| Freestanding birth center | $105,000 – $140,000 | Lower base but often better call schedule; ownership stake possible |
| Community health center / FQHC | $100,000 – $135,000 | NHSC loan repayment eligible at the primary care tier (up to $75,000 / 2 years); lower base offset by loan forgiveness value |
| Public health / government | $95,000 – $125,000 | 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. HRSA classifies certified nurse-midwives as primary care clinicians, which puts them in the higher NHSC award tier: up to $75,000 for a two-year full-time commitment at an approved site in a Health Professional Shortage Area, or up to $37,500 half-time. Many guides quote the $50,000 figure, which is the non-primary-care tier and understates what a CNM can claim by a third. 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
BLS does not publish CNM wages by years of experience. The bands below map experience tiers onto the published May 2025 national percentile distribution, which is the closest defensible approximation – early-career CNMs cluster in the lower percentiles and senior CNMs in the upper ones.
| Experience tier | Years in practice | Approximate percentile band | Annual salary |
|---|---|---|---|
| Entry level | 0 – 3 years | 10th – 25th | $93,620 – $116,510 |
| Mid-career | 4 – 10 years | 25th – 50th | $116,510 – $134,040 |
| Senior | 10+ years | 50th – 75th | $134,040 – $157,400 |
| Top of market | Subspecialty or leadership | 90th+ | $188,320+ |
New graduates in high-median states start well above these national bands. A first-year CNM in California is competing in a market whose 10th percentile is $140,970 – above the national 75th percentile. Salary growth tends to be steepest in the first five years, reflecting merit increases, renegotiation leverage, and the transition out of 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 clear the 90th percentile of $188,320. 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 | 10th – 90th percentile |
|---|---|---|
| CRNA (Certified Registered Nurse Anesthetist) | $236,590 | $155,250 – $339,500 |
| PA (Physician Assistant) | $135,880 | $99,380 – $190,280 |
| CNM (Certified Nurse-Midwife) | $134,040 | $93,620 – $188,320 |
| NP (Nurse Practitioner) | $132,300 | $101,340 – $174,420 |
CRNAs earn substantially more than other APRNs, and the gap widened in the May 2025 data: at $236,590 the CRNA median is $102,550 above the CNM median, and the CRNA 10th percentile ($155,250) sits within $2,150 of the CNM 75th percentile ($157,400). A CRNA at the bottom decile of the profession earns roughly what a CNM in the top quartile earns. 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, PAs, and CNMs now cluster tightly. The May 2025 figures put PAs at $135,880, CNMs at $134,040, and NPs at $132,300 – a spread of $3,580 across all three credentials. High-demand NP specialties (psychiatric, acute care) push well above the NP 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 weighing CNM against NP, the $1,740 median difference is small enough to be noise. Let clinical interest in women’s health and reproductive care drive that decision.
Income drivers: what moves CNM salary up
Independent practice state. CNMs in states granting autonomous practice have more negotiating leverage than those in states requiring a physician collaborative or supervisory agreement. ACNM advocates for full practice authority nationally but does not publish a fixed state count, and the landscape shifts with each legislative session – roughly half the states currently allow CNMs to practice and prescribe without a collaborative agreement, with several more permitting autonomy for a subset of midwifery services only. Check your state board of nursing for the current rule rather than relying on any published tally.
The compensation effect is visible in the state table. California removed its physician supervision requirement for CNMs under SB 1237 in 2020, and California now posts the highest CNM median in the country by a wide margin. Washington, Oregon, New Jersey, and Massachusetts also permit autonomous CNM practice and all four sit in the top five for median pay. When a CNM bills as an independent provider rather than working under supervision, the revenue math changes and compensation follows.
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 $134,000 base at a Level III NICU-adjacent hospital with a high-volume L&D service can reasonably clear $150,000–$160,000 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
About 35% of US counties qualify as maternity care deserts – 1,104 counties with no birthing facility and no obstetric clinician in practice. Roughly 2.3 million women of reproductive age live in them. That figure, tracked by the March of Dimes, 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 CNMs up to $75,000 tax-free for a two-year full-time commitment at an approved HPSA site, with a further $5,000 available for demonstrated Spanish-language proficiency. Awards are exempt from federal income and employment tax under IRC section 108(f)(4), and they are capped at your outstanding qualifying loan balance, so the headline figure is a ceiling rather than a payment. NHSC Scholarship Programs separately 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 11.1% growth for nurse midwives from 2024 to 2034, a rate well above the 3.1% average across all occupations. The broader APRN grouping (nurse anesthetists, nurse midwives, and nurse practitioners combined) projects 35% growth over the same period – a figure heavily influenced by NP volume, but indicative of the favorable structural environment for all advanced practice roles. Both figures come from the same 2024–34 projection cycle, which matters when comparing them: guides that pair a midwife-specific number from an older cycle against the current combined-group number are comparing across vintages.
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 11.1% headline number likely understates job-market strength for new graduates, given that the data lags employment trends and does not fully capture the substitution effect underway in states moving toward autonomous practice. Demand in the top-quintile shortage states – Montana, Wyoming, Mississippi, West Virginia – runs well above the national average. Those four are also among the states where BLS publishes no CNM wage estimate, a reminder that thin data and thin supply tend to travel together.
Putting it together
A CNM entering practice in 2026 in an autonomous-practice state, working in a hospital system with a night/weekend differential, can reasonably expect to start near the national 25th percentile of $116,510 and reach the median of $134,040 within about five years. The same graduate taking an FQHC position in a rural shortage area might start closer to the 10th percentile of $93,620 in base pay but retire up to $75,000 of student loan debt over two years – roughly $37,500 a year of tax-free debt relief on top of base, which changes the effective economic picture substantially.
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.
References
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Nurse Midwives (SOC 29-1161),” May 2025. National median annual wage $134,040 ($64.44/hr); 10th percentile $93,620; 25th percentile $116,510; 75th percentile $157,400; 90th percentile $188,320. Accessed via O*NET OnLine local wages, 29-1161.00.
- U.S. Bureau of Labor Statistics / O*NET OnLine, state and metropolitan wage estimates for SOC 29-1161, May 2025. Basis for the state median table. BLS suppresses state estimates below its confidentiality threshold; states omitted from the table have no published CNM wage estimate.
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics,” May 2025, for the comparison occupations: Nurse Anesthetists (29-1151) median $236,590; Nurse Practitioners (29-1171) median $132,300; Physician Assistants (29-1071) median $135,880; Registered Nurses (29-1141) median $97,550.
- U.S. Bureau of Labor Statistics, “Employment Projections, 2024–2034,” and “Occupational Outlook Handbook: Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners.” Projected 11.1% employment growth for nurse midwives (SOC 29-1161) and 35% growth for the combined nurse anesthetist / nurse midwife / nurse practitioner group, both over 2024–34.
- American College of Nurse-Midwives (ACNM), “Full Practice Authority” issue brief and state advocacy resources.
- California SB 1237 (2020), “Nurse-midwives: scope of practice.” Removed the physician supervision requirement for California CNMs.
- Health Resources and Services Administration (HRSA), “Fiscal Year 2026 NHSC Loan Repayment Program Application and Program Guidance,” nhsc.hrsa.gov. Certified nurse-midwives are classified as primary care clinicians: up to $75,000 full-time / $37,500 half-time for a two-year commitment at an approved Health Professional Shortage Area site, plus a $5,000 Spanish-language proficiency enhancement. The $50,000 tier applies to non-primary-care disciplines. Awards are excluded from gross income under IRC section 108(f)(4).
- March of Dimes, “Nowhere to Go: Maternity Care Deserts Across the US,” 2024 Report (released September 2024). 35% of US counties (1,104 counties) classified as maternity care deserts; 2.3 million women of reproductive age affected.
- American Association of Colleges of Nursing (AACN), “Advanced Practice Registered Nursing: Education and Workforce Data,” 2024.