Midwifery - What is a Midwife?

Midwifery is the art of safeguarding the natural process of pregnancy, labor and birth. A midwife is a trained professional with special expertise in supporting women in maintaining a healthy pregnancy, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle. 

 A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife's scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care. The Midwives Alliance of North America, the North American Registry of Midwives, the Midwifery Education Accreditation Council and Citizens for Midwifery agreed on a short definition of what "midwifery care" means. However, just because a person is a midwife does not guarantee that they provide this kind of care; consumers looking for a midwife should ask questions to determine if a prospective caregiver will be able to provide the kind of care they seek.  

Home Birthing Discussion
A discussion on the topic of Home Birthing and licensing midwives in North Carolina and other U.S. states with Russ Fawcett and Jennifer Block.

Brief Overview

Direct-Entry Midwives (including Licensed Midwives)
  • Not required to be nurses.
  • Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
  • May or may not have a college degree.
  • May or may not be certified by a state or national organization.
  • Legal status varies according to state.
  • Licensed or regulated in 21 states.
  • In most states licensed midwives are not required to have any practice agreement with a doctor.
  • Educational background requirements and licensing requirements vary by state.
  • By and large maintain autonomous practices outside of institutions.
  • Train and practice most often in home or out-of-hospital birth center settings.

Credential and the North American Registry of Midwives

  • Not required to be nurses.
  • Multiple routes of education recognized; direct entry midwives and certified nurse midwives can qualify for this credential.
  • Education programs accredited by the Midwifery Education Accreditation Council prepare students to meet the requirements for the CPM.
  • Out-of-hospital birth experience is required.
  • Have met rigorous requirements and passed written exam and hands-on skills evaluation.
  • Administered by the North American Registry of Midwives.
  • Legal status varies according to state.
  • Practice most often in homes and birth centers.

Certified Nurse Midwives (CNMs) / ACNM's CM Credential

Certified Nurse Midwives (CNMs)
  • Educated in both nursing and midwifery, primarily in the hospital setting; are "advanced practice nurses.
  • Must have at least a Bachelors Degree when training is complete.
  • Have successfully completed a university-affiliated nurse-midwifery program accredited by the American College of Nurse-Midwives, and passed the exam.
  • Out-of-hospital clinical experience is not required.
  • Are legal and can be licensed in all states.
  • Most practice in hospitals and birth centers.
  • In most states must have some kind of agreement with a doctor for consultation and referral; practicing without such an agreement can lead to loss of license.

Certified Midwife (CM)
The Certified Midwife (CM) is a new credential from the ACNM that does not require a nursing degree but is otherwise similar to the CNM credential. As of 1998 the CM is legally recognized in only one state (NY) and does not meet existing direct entry midwife licensing requirements in any other states.

Ina May Gaskin on Birth Matters: A Midwife's Manifesta