Pregnant woman and midwifeThe last type of midwife we have in the USA is the NARM certified midwife. These midwives are as follows:

1. Licensed Midwives

A state licensed midwife is essentially a Certified Professional Midwife (CPM) who is licensed to work in a particular state, though requirements may be a little different than the typical CPM route. The title varies depending on the state: Licensed Midwife (LM), Licensed Direct-Entry Midwife (LDEM), Certified Direct-Entry Midwife (CDM), etc. These midwives take the same NARM exam after completing the requirements specified in their particular state.

2. Certified Professional Midwife (CPM)

The Certified Professional Midwife credential was issued for the first time in 1994. It was developed as a direct-entry route to become an out-of-hospital midwife. CPMs are not authorized to work in a hospital setting.

Certified Professional Midwives do not have any degree requirements. The only educational requirement is to have a high school diploma, which was not a requirement until September 1, 2012.

The Portfolio Evaluation Process (PEP) is a popular route to become a CPM. It is an apprenticeship where the student midwife follows and learns from a preceptor midwife. After attending 40 births (and the prenatal exams leading up to it), the student midwife can qualify to take the NARM exam. Anyone with a desire to become a midwife can seek out a preceptor. Half of CPMs have earned their credential through the PEP route.

Another route to become a CPM is to graduate from a Midwifery Education Accreditation Council (MEAC) school. There are nine MEAC schools in the USA, some of which award certifications, some diplomas and some degrees. Discussing MEAC schools is rather tricky and really deserves a post on its own, so we’ll cover this more in depth in another piece.

CPMs are not legally recognized in every state. In fact, they are legally authorized in only 28 states and they do not have prescriptive authority in any states (in certain states, CPMs are able to obtain certain medications, such as Pitocin, Cytotec, antibiotics, etc but CPMs cannot write prescriptions). CPMs also would not qualify to practice midwifery in other developed countries due to the lack of formal education requirements; the CPM requirements also do not meet the International Confederation of Midwives (ICM) standards.

The lack of educational requirements and classes such as anatomy, physiology, microbiology, etc does not sit well with certain people, namely certain other health care professionals. The president of the American College of Obstetricians and Gynecologists (ACOG), John C. Jennings MD, recently wrote a statement about ACOG’s support of midwifery (click here to read it) and in it he says “CNMs and CMs who are credentialed by AMCB meet the ICM standards, however, many certified professional midwives do not. ACOG is committed to working with ACNM to ensure that educational and training standards are applied universally across midwifery.” In the comments, he adds “ACOG supports setting a minimum standard for education and training that all midwives must meet. While “more” may not always be better, creating a minimum standard for all midwives is important for patient safety and quality of care.”


This sums up the different types of midwives we have in the USA! Hopefully this helps clear up some confusion. After the holiday, I’ll pick up where we are leaving off and we are going to dive into MEAC schools. Happy Thanksgiving!

Click to read more of this series:

American Midwives, Part 1

American Midwives, Part 2 

American Midwives, Part 3 (currently reading)

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