Midwifery offers a pathway to providing comprehensive, personalized healthcare for women across their lifespan. This career encompasses a holistic model of care, including preventative screenings, family planning, and reproductive health counseling. Midwives are trained providers specializing in care during the prenatal period, labor, birth, and postpartum, as well as providing well-woman care. The demand for this type of care is growing, driven by evidence that the midwifery model is associated with improved maternal-infant outcomes and high patient satisfaction.
Understanding the Different Types of Midwives
The first step in pursuing a career in midwifery is understanding the distinctions between the three primary certified credentials in the United States. These credentials vary based on educational background and typical scope of practice. The choice among these credentials often dictates the settings in which a midwife will practice.
Certified Nurse-Midwife (CNM)
The Certified Nurse-Midwife is an advanced practice registered nurse (APRN) who has met both nursing and midwifery educational requirements. CNMs provide a broad scope of care, including primary care, gynecological services, family planning, and both low-risk and some high-risk maternity care. CNMs are able to practice in all 50 states and are typically employed in hospital systems, private physician practices, and birth centers. Their nursing background allows them to collaborate with obstetricians and other specialists.
Certified Midwife (CM)
The Certified Midwife credential was established to offer a path for individuals with a health-related background who do not have a registered nursing degree. CMs follow the exact same midwifery educational and clinical requirements as CNMs, resulting in an identical scope of practice. While their training is equivalent to that of a CNM, the CM credential is legally recognized and licensed in a more limited number of states. CMs generally work in similar settings as CNMs, including hospitals and birth centers.
Certified Professional Midwife (CPM)
A Certified Professional Midwife (CPM) is the only nationally-accredited credential requiring knowledge and experience specifically in out-of-hospital settings. CPMs are direct-entry midwives, meaning they do not require a nursing degree as a prerequisite. Their practice focuses primarily on providing prenatal, labor, birth, and postpartum care for healthy women with low-risk pregnancies in birth centers and home settings. The CPM path emphasizes an apprenticeship model of training, which is distinct from the structured clinical rotations of the CNM and CM pathways.
Educational Requirements for Certified Nurse-Midwives and Certified Midwives
The academic journey for both CNMs and CMs is rigorous and follows a graduate-level curriculum accredited by the Accreditation Commission for Midwifery Education (ACME). Aspiring CNMs must first earn a Bachelor of Science in Nursing (BSN) and obtain an active Registered Nurse (RN) license. They then proceed to an accredited graduate program, earning either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) degree with a specialization in nurse-midwifery.
Certified Midwives must hold a bachelor’s degree in a field other than nursing, along with specified health and science prerequisite coursework. These candidates then enroll in an ACME-accredited graduate program to earn their master’s degree in midwifery. Both CNM and CM programs involve didactic coursework in advanced pathophysiology, pharmacology, and health assessment, alongside specialized midwifery management of women’s and newborn care.
The clinical component of these graduate programs is extensive, typically requiring between 500 and 1,000 or more supervised clinical hours. Students gain hands-on experience across the full scope of practice, including gynecological exams, prenatal care, labor and delivery management, and newborn care. These supervised clinical rotations are usually completed in hospital labor and delivery units, community clinics, and birth centers.
Apprenticeship and Training Requirements for Certified Professional Midwives
The path to becoming a Certified Professional Midwife does not require a prior college degree, focusing instead on a competency-based model of training. Candidates pursue one of two primary routes: formal education through a program accredited by the Midwifery Education Accreditation Council (MEAC) or the Portfolio Evaluation Process (PEP). MEAC-accredited schools integrate classroom instruction with a structured clinical experience.
The Portfolio Evaluation Process (PEP) is an apprenticeship model involving extensive supervised clinical training with a qualified preceptor. This route requires candidates to document a minimum of 1,350 total clinical hours over at least two years. The required competencies include:
- 75 prenatal exams
- 40 postpartum exams
- 20 newborn exams
- 20 births attended as the primary midwife under supervision
The preceptor, who must be a NARM-Registered Midwife, verifies the student’s mastery of clinical skills. All candidates must demonstrate competence in the didactic and clinical skills required by the North American Registry of Midwives (NARM).
Achieving National Certification and State Licensure
After successfully completing an accredited education or training program, the mandatory next step is achieving national certification through a standardized examination. Certified Nurse-Midwives and Certified Midwives take the examination administered by the American Midwifery Certification Board (AMCB). Passing this comprehensive exam grants the CNM or CM credential, signifying competency for entry-level practice. Certified Professional Midwives seek certification through the North American Registry of Midwives (NARM) by passing the NARM written examination.
Following national certification, a midwife must obtain state licensure to legally practice. CNMs are licensed as Advanced Practice Registered Nurses (APRNs) in all 50 states, with licensure typically overseen by the State Board of Nursing. State licensure is more variable for CMs and CPMs. CMs are licensed in a growing but limited number of states. CPM licensure is governed differently, often through a separate Board of Midwifery or regulatory body, and legal recognition varies significantly across state lines.
Gaining Clinical Experience and Finding Employment
Once licensed, Certified Nurse-Midwives and Certified Midwives find employment in diverse settings, including large hospital systems, university academic centers, private women’s health clinics, and freestanding birth centers. The majority of CNMs and CMs attend births within a hospital environment, often working in a collaborative practice with obstetricians. Certified Professional Midwives typically establish careers in private home birth practices or independent birth centers, aligning with their out-of-hospital training focus.
Maintaining certification requires ongoing professional education. CNMs and CMs must complete the AMCB Certificate Maintenance Program every five years, which requires completing three practice-focused modules and 20 hours of approved continuing education. CPMs must recertify every three years with NARM, requiring 30 continuing education units, including five hours of peer review. Midwives must also secure professional liability insurance, which is necessary for independent practitioners and for obtaining hospital privileges.