Texas offers two distinct paths to practicing midwifery: becoming a Licensed Midwife (LM) through the Texas Department of Licensing and Regulation, or becoming a Certified Nurse-Midwife (CNM) through the Texas Board of Nursing. The path you choose depends on whether you want to start from a nursing background or pursue direct-entry midwifery training. Here’s what each route requires.
Two Paths: Licensed Midwife vs. Certified Nurse-Midwife
A Licensed Midwife in Texas is a direct-entry credential. You don’t need a nursing degree. You complete midwifery-specific education and clinical training, then apply through the TDLR. Licensed Midwives primarily attend out-of-hospital births at birth centers or in clients’ homes.
A Certified Nurse-Midwife takes a longer route. You first become a registered nurse, then earn a graduate degree (master’s or doctorate) in nurse-midwifery, pass a national certification exam, and apply for advanced practice licensure through the Texas Board of Nursing. CNMs can practice in hospitals, birth centers, and home settings, and they have broader prescriptive authority. If you already have a nursing degree or want to work in hospital settings, this is the more versatile credential. If you want to focus on out-of-hospital birth and get into practice sooner, the Licensed Midwife path is more direct.
Becoming a Licensed Midwife in Texas
The TDLR accepts three education pathways for initial licensure. You only need to complete one:
- Option 1: Earn your Certified Professional Midwife (CPM) credential through the North American Registry of Midwives (NARM).
- Option 2: Complete a midwifery program accredited by the Midwifery Education Accreditation Council (MEAC).
- Option 3: Complete a TDLR-approved education course. Texas currently approves two programs: the Association of Texas Midwives Midwifery Training Program and MTC School of Midwifery.
MEAC-accredited programs like Mercy In Action College of Midwifery confirm that their curriculum meets Texas licensing requirements. Some of these programs offer distance learning with hands-on clinical components, which can help if you don’t live near a school. The CPM route through NARM is popular because it combines education and national certification into one process, and Texas accepts it directly.
Clinical Training Requirements
Regardless of which education option you choose, your training must include a minimum amount of hands-on clinical experience. Texas requires at least:
- 40 births total: 20 as an active participant and 20 more as the primary midwife under supervision, with at least 10 of those being out-of-hospital births
- 75 prenatal exams, including at least 20 initial history and physical exams
- 20 newborn exams
- 40 postpartum exams
At least 3 of the 20 births where you serve as primary midwife must be continuity-of-care experiences. That means you provided primary care for the client during a minimum of 4 prenatal visits, attended the birth, performed the newborn exam, and conducted at least one postpartum exam. This requirement ensures you experience the full arc of midwifery care before practicing independently.
The Jurisprudence Exam
Every applicant for an initial Texas midwife license must pass a jurisprudence exam covering Texas midwifery law and regulations. The exam costs $34, paid directly to the testing vendor. Once you pay and register, you have 30 days to complete it. If you don’t finish within that window, your registration expires and you’ll need to pay again. You also need to pass this exam again within the four years before each license renewal, so it’s not a one-time requirement.
Pre-License Continuing Education
Before submitting your application, you must also complete a continuing education course on the Texas Midwifery Basic Information and Instructors Manual. This is a state-specific requirement that covers the regulations, protocols, and standards you’ll be expected to follow as a Texas Licensed Midwife. Proof of completion goes in with your application materials.
Becoming a Certified Nurse-Midwife in Texas
The CNM path starts with becoming a registered nurse. That means earning either an associate’s or bachelor’s degree in nursing and passing the NCLEX-RN. Most nurse-midwifery graduate programs require a bachelor’s degree for admission, so a BSN is the practical starting point.
From there, you’ll complete a graduate program in nurse-midwifery, typically a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) with a midwifery focus. These programs run two to three years for full-time students and include extensive clinical rotations in prenatal care, labor and delivery, postpartum care, and gynecology. After graduating, you sit for the national certification exam administered by the American Midwifery Certification Board.
With certification in hand, you apply to the Texas Board of Nursing for recognition as an Advanced Practice Registered Nurse. The Board licenses nurse midwives alongside nurse practitioners, nurse anesthetists, and clinical nurse specialists under the APRN umbrella. CNMs in Texas can prescribe medications and manage a broader scope of care than Licensed Midwives, and they’re eligible to work in virtually any birth setting.
Timeline and What to Expect
The Licensed Midwife path can take anywhere from two to four years depending on your program and how quickly you accumulate clinical hours. Programs that use an apprenticeship model sometimes take longer because finding 40 supervised births depends on client volume. MEAC-accredited programs with established clinical sites tend to move faster.
The CNM path is longer. A BSN takes four years if you’re starting from scratch, and the graduate program adds two to three more. Accelerated second-degree nursing programs can shorten the timeline for people who already hold a bachelor’s degree in another field. All told, expect six to eight years from the start of a nursing program to independent CNM practice, or three to four years if you’re already an RN.
Keeping Your License Current
Texas Licensed Midwives renew their license every two years. Each renewal cycle requires 20 contact hours of approved midwifery continuing education covering new developments or current knowledge in the field. Retired midwife licenses have a reduced requirement of 5 hours. You’ll also need to pass the jurisprudence exam again within the four years leading up to renewal.
CNMs maintain both their Texas APRN license through the Board of Nursing and their national certification through the American Midwifery Certification Board, each with its own renewal requirements including continuing education.
Choosing the Right Path
Your decision comes down to a few practical factors. If you want to attend out-of-hospital births and prefer a shorter, more focused training path, the Licensed Midwife route gets you there. If you want hospital privileges, prescribing authority, and the flexibility to work across settings, the CNM credential opens more doors but requires significantly more time and tuition. Both credentials are legally recognized in Texas, and both allow you to provide prenatal, birth, and postpartum care as a primary provider.