What You Need to Do to Become a Licensed Midwife in Texas

Texas recognizes two types of midwives: Certified Nurse Midwives (CNMs), who are registered nurses with additional midwifery training, and Licensed Midwives (LMs), who follow a separate pathway that does not require nursing credentials first. The route you take depends on whether you already have a nursing license and which type of midwifery practice you want to pursue. Both require formal education, clinical experience, and passing a state or national exam, but the timelines and prerequisites differ significantly.

This guide covers the requirements for both pathways, the bodies that oversee them, and the actual steps to move from where you are now to holding a license you can use to practice in Texas.

Key Takeaways

  • Certified Nurse Midwives must first become a registered nurse, then complete a graduate midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME), then pass the American Midwifery Certification Board (AMCB) exam.
  • Licensed Midwives in Texas complete a direct-entry midwifery program, accumulate 1,500 hours of supervised clinical experience, and pass the North American Registry of Midwives (NARM) exam, then register with the Texas Department of State Health Services.
  • The Texas Board of Nursing oversees CNMs; the Texas Department of State Health Services oversees LMs — these are separate regulatory bodies with different requirements.
  • Both pathways typically take three to five years from start to licensure, depending on whether you already hold a nursing degree.

The Certified Nurse Midwife (CNM) Pathway

If you want to become a CNM, you must first hold a current Registered Nurse (RN) license in Texas or another state. This means completing a nursing degree (either an Associate's or Bachelor's degree in nursing) and passing the NCLEX-RN exam. Once you hold an active RN license, you can then pursue a graduate midwifery program.

The graduate program itself must be accredited by the Accreditation Commission for Midwifery Education (ACME). These programs are offered at universities and nursing schools across the country; Texas schools offering ACME-accredited programs include the University of Texas at Austin School of Nursing and Texas Tech University Health Sciences Center. The program typically takes two to three years of full-time study and includes classroom work, clinical rotations, and supervised births. You will deliver a minimum number of babies under supervision — usually between 50 and 100 — before you graduate.

After you complete the program, you become may be able to access to sit for the American Midwifery Certification Board (AMCB) exam. This is a national exam, not a Texas-specific one. You pass it, and then you register with the Texas Board of Nursing as a CNM. The Board of Nursing issues your license to practice in Texas. The entire process from RN license to CNM license typically takes three to five years, depending on whether you already hold an RN license when you start.

The Licensed Midwife (LM) Pathway

Texas also licenses Licensed Midwives who do not hold nursing degrees. This is a direct-entry pathway: you do not need to become a nurse first. Instead, you complete a midwifery education program, accumulate clinical hours, and pass a national exam. The regulatory body is the Texas Department of State Health Services, not the nursing board.

To pursue this route, you must enroll in a midwifery education program. These programs vary in length and format — some are full-time classroom-based programs lasting 18 to 24 months, while others are part-time or apprenticeship-based and may take longer. The program must cover the core competencies set by the North American Registry of Midwives (NARM), the organization that oversees the national exam. Texas does not mandate that programs be ACME-accredited (that is a CNM requirement), but many programs voluntarily seek that accreditation or accreditation from other bodies like the Midwifery Education Accreditation Council (MEAC).

Alongside your education, you must accumulate 1,500 hours of supervised clinical experience. These hours include attending births, conducting prenatal and postpartum care, and performing other midwifery tasks under the supervision of a licensed midwife, physician, or nurse midwife. Many programs integrate this clinical work into their curriculum, so you build hours as you study. Once you have completed your education and logged your 1,500 hours, you become may be able to access to sit for the Certified Professional Midwife (CPM) exam administered by NARM.

After passing the CPM exam, you register with the Texas Department of State Health Services as a Licensed Midwife. The entire process typically takes three to five years, depending on the program format and how quickly you accumulate your clinical hours.

Education Program Requirements and Where to Find Them

For CNMs, your graduate program must be ACME-accredited. You can search for programs on the ACME website, which lists all accredited midwifery programs in the United States. In Texas, the University of Texas at Austin and Texas Tech University Health Sciences Center both offer ACME-accredited programs. You will need a bachelor's degree (in any field) and an active RN license to be admitted to these programs.

For Licensed Midwives, your program does not have to be ACME-accredited, but it should prepare you for the NARM CPM exam. Programs may be offered by midwifery schools, community colleges, or through apprenticeship arrangements. The Midwifery Education Accreditation Council (MEAC) accredits some direct-entry programs; the NARM website lists programs and resources for aspiring midwives. You should verify that any program you choose will allow you to accumulate the required 1,500 clinical hours and will prepare you for the CPM exam.

Both pathways require you to complete coursework in topics like anatomy and physiology, pharmacology, pathophysiology, and midwifery management of pregnancy, labor, and the postpartum period. The difference is that CNM programs are graduate-level and assume you already have nursing knowledge, while LM programs teach midwifery from the ground up.

Clinical Experience and Supervised Practice Hours

Clinical experience is where you learn to actually deliver babies and manage the full scope of midwifery care. For CNMs, your graduate program includes clinical rotations, and you must attend a minimum number of births before graduation — the exact number varies by program but is typically 50 to 100. These births are supervised by experienced midwives, physicians, or nurse midwives.

For Licensed Midwives, you must log 1,500 hours of supervised clinical experience. These hours must be documented and verified by your preceptor — the licensed midwife, physician, or nurse midwife who supervises you. Hours typically include time spent in prenatal visits, labor and delivery, postpartum care, and newborn assessment. You cannot count classroom time or study time toward these hours; they must be hands-on clinical work. Many LM programs help you find a preceptor or arrange placements, but you are responsible for ensuring your hours are properly documented.

The supervision requirement is strict: you cannot practice independently until you are licensed. All your clinical work must be under the direct oversight of someone already licensed to practice midwifery or medicine. This is enforced by both the education program and the state regulatory body.

Passing the National Exam and Registering with Texas

After you complete your education and clinical hours, you sit for a national exam. For CNMs, this is the American Midwifery Certification Board (AMCB) exam. For Licensed Midwives, this is the North American Registry of Midwives (NARM) Certified Professional Midwife (CPM) exam. Both are multiple-choice exams administered on computer at testing centers across the country. You register for the exam through the respective organization's website, pay the exam fee (which varies), and schedule your test date.

The AMCB exam covers midwifery knowledge and clinical judgment for CNMs. The NARM CPM exam covers the same general topics but is designed for direct-entry midwives without nursing backgrounds. Both exams typically take three to four hours. You receive your score when ready or within a few days, depending on the testing organization.

Once you pass the exam, you are certified nationally. But you are not yet licensed to practice in Texas. The final step is to register with the appropriate Texas regulatory body. For CNMs, you register with the Texas Board of Nursing. For Licensed Midwives, you register with the Texas Department of State Health Services. You will submit proof of your national certification, your education credentials, and any other documents the agency requires. The agency reviews your process and issues your Texas license.

The registration process typically takes two to four weeks, though it can be longer if the agency requests additional information. Once your license is issued, you can practice midwifery in Texas.

Costs and Timeline Overview

The cost of becoming a midwife in Texas varies widely depending on the program you choose. Nursing school (required for CNMs) typically costs between $20,000 and $100,000 or more, depending on whether you attend a public or private institution and whether you pursue an Associate's or Bachelor's degree. Graduate CNM programs typically cost $15,000 to $50,000 for the full program. Direct-entry LM programs typically cost $10,000 to $30,000. Exam fees are separate: the AMCB exam costs around $500 to $600, and the NARM CPM exam costs around $700 to $800. Registration fees with Texas agencies are typically under $500.

The timeline depends on your starting point. If you already hold an RN license, you can complete a CNM program in two to three years. If you do not have an RN license, add another two to four years for nursing school. For the LM pathway, the timeline is typically three to five years from start to licensure, depending on the program format and how quickly you accumulate your clinical hours. Some people complete the LM pathway faster if they find a preceptor who can supervise them full-time; others take longer if they work while studying.

Frequently Asked Questions

Do I need to be a nurse to become a midwife in Texas?

No. You can become a Licensed Midwife (LM) without a nursing degree by completing a direct-entry midwifery program and passing the NARM CPM exam. However, if you want to become a Certified Nurse Midwife (CNM), you must first be a registered nurse. The two licenses are separate; both allow you to practice midwifery in Texas, but they have different educational pathways and regulatory bodies.

Can I practice midwifery in Texas while I am still in school?

No, not independently. You can attend births and perform midwifery tasks as part of your education program, but only under direct supervision. You cannot bill for services, make independent clinical decisions, or practice without a licensed preceptor present. Once you pass your exam and register with the state, you can practice independently.

What is the difference between a CNM and an LM in Texas?

Both are licensed to practice midwifery, but CNMs are registered nurses with additional midwifery training, while LMs follow a direct-entry pathway without nursing credentials. CNMs are regulated by the Texas Board of Nursing; LMs are regulated by the Texas Department of State Health Services. Both can attend births, manage pregnancy and postpartum care, and order certain tests, but their scope of practice and insurance coverage may differ. Some employers or insurance plans prefer one credential over the other.

How long does it take to get a midwife license in Texas?

If you already have an RN license, a CNM license typically takes two to three years. If you do not have an RN license, add another two to four years for nursing school, making the total four to seven years. For a Licensed Midwife, the timeline is typically three to five years from start to licensure. The exact time depends on the program you choose, whether you study full-time or part-time, and how quickly you accumulate your clinical hours.

Do I have to pass a Texas-specific exam, or is the national exam enough?

The national exam (AMCB for CNMs, NARM CPM for LMs) is enough to become certified nationally. However, you must still register with the appropriate Texas regulatory body — the Texas Board of Nursing for CNMs or the Texas Department of State Health Services for LMs — to practice in Texas. Registration is separate from the national exam and involves submitting your credentials to the state agency.