Certified Professional Midwife
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Certified Professional Midwife (CPM) is a credential issued by the North American Registry of Midwives (NARM) for direct-entry midwives in the United States who specialize in out-of-hospital maternity care including home birth.[1] Established in 1994, the CPM credential was developed to formalize and regulate the practice of lay midwifery, which had previously operated without standardized national oversight.[2] The legal recognition, educational requirements, and permitted scope of practice for CPMs vary widely across U.S. states.
Certified Professional Midwives (CPMs) are a type of direct-entry midwife, meaning they are not required to hold a nursing degree prior to entering midwifery training. This distinguishes them from Certified Nurse Midwives (CNMs), who must be registered nurses and complete a graduate-level program at a regionally accredited university. In contrast, CPMs may qualify through multiple non-nursing pathways, including apprenticeship-based training or completion of programs accredited by the Midwifery Education Accreditation Council (MEAC). MEAC programs typically confer certificates or associate degrees and are not required to be affiliated with regionally accredited academic institutions.[3][4]
Among licensed maternity care providers in the United States, CPMs are unique in being eligible for independent clinical practice without holding a regionally accredited academic degree.
Certification and education
[edit]CPMs earn their credential by completing one of two primary pathways:
- Graduation from a MEAC-accredited midwifery program (most commonly a certificate or an associates degree) which represents ~36.9% of CPMs[5]
or
- Through the Portfolio Evaluation Process (PEP), a non-didactic apprenticeship-based route.[3]
While MEAC programs offer a structured curriculum, the PEP route allows for individualized training under preceptors in individual communities. PEP educational experiences can vary significantly in rigor, setting, and patient exposure since it is dependent on the preceptor and their knowledge and clinical skill base.
MEAC is national program accrediting body recognized by the U.S. Department of Education but is not a regional accrediting body.[6] colleges and universities in the U.S. utilize regional accreditation with oversight from one of six regional accrediting agencies that assess overall institutional quality.[7] MEAC, by contrast, accredits only CPM-specific programs, many of which offer certificates or associate degrees and are not affiliated with regionally accredited institutions. As a result, MEAC-accredited coursework may not be transferable to traditional academic institutions, and students may have limited access to federal financial aid.[8] [9] These issues are barriers to receiving a MEAC accredited education for some CPMs and have been critiqued as limiting future educational opportunities for CPMs who may want to switch careers.
All CPMS are required to take the North American Registry of Midwives (NARM) certification exam. The exam includes a written component and a hands-on skills assessment, both designed to evaluate competencies related to out-of-hospital midwifery care. The written portion consists of 350 multiple-choice questions and is administered in a computer-based format at approved testing centers.[10]
The exam is developed and overseen by NARM, the same organization that grants the CPM credential. While NARM publishes summary statistics on exam performance, such as pass rates and reliability coefficients,[11] comprehensive data on the exam's psychometric design and validation process are not independently reviewed or widely available.
Scope of practice and licensure
[edit]The legal recognition and scope of practice of CPMs vary by state. Some states license CPMs to provide prenatal, intrapartum, postpartum, and newborn care independently, while others impose restrictions or prohibit their practice altogether. In certain jurisdictions, CPMs may have the ability to administer medications such as oxytocin and anti-hemorrhagic agents, while in others, they are legally barred from doing so.
State requirements for CPM licensure vary widely. Some states require completion of a MEAC-accredited midwifery program, while others allow licensure through alternate routes such as apprenticeship or the PEP process without specifying formal education standards. This variation reflects differing state-level approaches to credentialing and has prompted discussion about consistency in training and oversight across jurisdictions.
As of 2025, 32 U.S. states and the District of Columbia, license Certified Professional Midwives (CPMs) for legal practice.[12] In addition, 5 states (Colorado, Missouri, New Hampshire, Rhode Island, and Tennessee) allow CPM practice through certification, registration, or statutory exemption, but do not formally issue a "license." [12] These alternate pathways function similarly to licensure but use different legal terminology or regulatory mechanisms.
| State | CPM Legal Status | Notes |
|---|---|---|
| Alabama | ✓ Licensed | |
| Alaska | ✓ Licensed | |
| Arizona | ✓ Licensed | |
| Arkansas | ✓ Licensed | |
| California | ✓ Licensed | |
| Colorado | ◑ Registered | Registration required, functions similar to licensure; per Colo. Rev. Stat. § 12‑225‑104[13] |
| Connecticut | ✗ Unregulated | No licensure or certification for CPMs |
| Delaware | ✓ Licensed | |
| Florida | ✓ Licensed | |
| Georgia | ✗ Unregulated | |
| Hawaii | ✓ Licensed | |
| Idaho | ✓ Licensed | |
| Illinois | ✓ Licensed | |
| Indiana | ✓ Licensed | |
| Iowa | ✓ Licensed | |
| Kentucky | ✓ Licensed | |
| Louisiana | ✓ Licensed | |
| Maine | ✓ Licensed | |
| Maryland | ✓ Licensed | |
| Massachusetts | ✗ Unregulated | |
| Michigan | ✓ Licensed | |
| Minnesota | ✓ Licensed | |
| Mississippi | ✗ Unregulated | |
| Missouri | ◑ Exempt | Allowed via statutory exemption, no licensure |
| Montana | ✓ Licensed | |
| Nebraska | ✗ Unregulated | Only those with a state-recognized credential may legally provide maternity care.[14] |
| Nevada | ✗ Unregulated | |
| New Hampshire | ◑ Certified | State calls it “certification” under RSA 326‑D, but functions like licensure[15] |
| New Jersey | ✓ Licensed | |
| New Mexico | ✓ Licensed | |
| New York | ✗ Unregulated | CNMs/CMs only. CPMs are prosecuted. |
| North Carolina | ✗ Unregulated | Statute title protects CNM |
| North Dakota | ✗ Unregulated | |
| Ohio | ✗ Unregulated | |
| Oklahoma | ✓ Licensed | |
| Oregon | ✓ Licensed | |
| Pennsylvania | ✗ Unregulated | |
| Rhode Island | ◑ Certified | Certification required (not labeled licensure) |
| South Carolina | ✓ Licensed | |
| South Dakota | ✓ Licensed | |
| Tennessee | ◑ Certified | Certification required (not labeled licensure) |
| Texas | ✓ Licensed | |
| Utah | ✓ Licensed | |
| Vermont | ✓ Licensed | |
| Virginia | ✓ Licensed | |
| Washington | ✓ Licensed | |
| West Virginia | ✗ Unregulated | |
| Wisconsin | ✓ Licensed | |
| Wyoming | ✓ Licensed |
Attendance at home births
[edit]Certified Professional Midwives are most known for their attendance at home births. Tracking the number of home births attended by CPMs is difficult due to limitations in national birth certificate data, which do not consistently differentiate CPMs from other non-nurse midwives. One national cohort study found that approximately 29.4% of planned home births in the United States were attended by AMCB-certified midwives (Certified Nurse-Midwives [CNMs] or Certified Midwives [CMs]), while about 50.7% were attended by other midwives.[17] This "other midwives" category is likely predominately CPMs but may also encompass lay midwives and unlicensed birth attendants, particularly in states where CPMs are not legally recognized. In such jurisdictions, births may be attended outside any formal licensure system, complicating efforts to quantify CPM involvement or compare outcomes across provider types.
Home birth neonatal mortality by attendant
[edit]A longitudinal study using CDC linked birth–infant death data from 2010–2017 evaluated neonatal mortality among full-term, normal-weight, singleton births across different birth settings and attendants.[18] Hospital births attended by Certified Nurse-Midwives (CNMs) had a neonatal mortality rate of 3.27 per 10,000 live births. In comparison, planned home births attended by direct-entry midwives (including CPMs) had a rate of 12.44 per 10,000, corresponding to an odds ratio (OR) of 3.81 (95% CI: 3.12–4.65), indicating nearly a fourfold increase in risk in mortality for none nurse-midwife attended births. The rate for home births attended by CNMs was 9.48 per 10,000 (OR 2.90; 95% CI 2.17–3.89).[18] Additionally, a comprehensive meta-analysis in 2010 by Wax et al. identified a threefold increase in neonatal mortality associated with planned home birth attended by non-nurse midwives compared to hospital births.[19]
The largest outcomes study of CPM-attended home births in the United States analyzed data from 16,924 planned home births between 2004 and 2009, submitted voluntarily primarily by CPMs to the Midwives Alliance of North America (MANA) Stats Project.[20] The overall neonatal death rate in this dataset (excluding lethal anomalies) was reported as 0.41 per 1,000 births.[20] However, the study identified significantly elevated risks for specific high-risk conditions commonly managed in out-of-hospital settings by CPMs: For breech presentations, the neonatal mortality rate was 10.7 per 1,000, more than 25 times higher than for vertex (head-down) births in the same dataset.[20] For vaginal birth after cesarean (VBAC), the neonatal death rate was 2.85 per 1,000, compared to 0.4 per 1,000 for nulliparous women.[20] For twin births, the neonatal mortality rate was 13.4 per 1,000, compared to 1.3 per 1,000 across the full sample.[20] These findings, drawn from the largest CPM-focused outcomes dataset published to date, have contributed to ongoing discussions regarding the appropriateness of management of high-risk pregnancies in out-of-hospital settings by midwives. A 2015 study published in AJOG found that non-AMCB-certified midwives (primarily CPMs) were significantly more likely to attend higher-risk planned home births—including breech, VBAC, twins, and postdates—compared to AMCB-certified nurse-midwives.[21]
Education standards and international recognition
[edit]The CPM credential has been the subject of ongoing debate regarding educational standards, clinical oversight, and alignment with international norms.
The CPM credential does not meet the International Confederation of Midwives (ICM) global educational standards for midwifery practice. ICM defines a midwife as someone who has completed a formal midwifery education program that is recognized in the country where it is located, is at least three years in duration, and results in a recognized academic qualification.[22] Most CPM educational pathways do not meet these criteria in terms of length, academic level, or institutional affiliation. However, the National Association of Certified Professional Midwives (NACPM) does hold affiliate membership in ICM, allowing participation in some ICM activities. This affiliation does not constitute endorsement of the CPM credential itself.
In 2015, several midwifery organizations in the United States—including representatives from the CPM community formed the U.S. Midwifery Education, Regulation, and Association (US MERA) workgroup to explore alignment with the International Confederation of Midwives (ICM) global standards. US MERA initially endorsed a plan to require all new CPMs to graduate from a midwifery education program accredited by the Midwifery Education Accreditation Council (MEAC), with the intent of meeting ICM's minimum criteria for formal education.[23] However, the plan was never implemented, and the Portfolio Evaluation Process (PEP) an apprenticeship-based route remains a recognized path to certification. The reversal drew criticism from stakeholders who viewed it as a retreat from professionalization and international accountability.
Organization positions on CPMs
[edit]American Academy of Pediatrics (AAP)
[edit]The American Academy of Pediatrics (AAP) does not endorse planned home birth, citing increased neonatal risks.[24] While acknowledging the right of patients to choose their birth setting, the AAP recommends that home births only occur under specific conditions: they must be planned, involve a singleton pregnancy at term with no risk factors, and be attended by two qualified professionals—one of whom is solely responsible for neonatal resuscitation.[24] AAP emphasizes that midwives attending home births should be certified by nationally recognized bodies and trained in accordance with international standards, though it does not explicitly endorse or reject the CPM credential. In a 2020 statement issued during the COVID-19 pandemic, the AAP reaffirmed that hospitals remain the safest setting for birth and reiterated the need for all newborns—including those born at home—to receive immediate postnatal care consistent with AAP guidelines.[25] The AAP stresses that providers must be capable of initiating neonatal resuscitation and transferring the newborn to a higher-level care if needed. While its guidance refers to credentialed midwives, it does not specify CPMs, instead aligning with the expectation that all attendants meet nationally and internationally accepted training standards.
American College of Nurse Midwives (ACNM)
[edit]ACNM, representing CNMs and CMs, developed the Certified Midwife (CM) credential as an alternative direct-entry midwifery path. ACNM publicly opposed granting CPMs federal recognition in 2009 due to concerns about variable educational standards [26] [27] [28] However, ACNM is a participating member in US MERA to align educational standards across midwifery credentials, advocating for independent practice with structured collaboration. Its more recent statements emphasize support for midwives educated to ICM standards, while avoiding direct commentary on the CPM credential.
American College of Obstetricians and Gynecologists (ACOG)
[edit]ACOG supports an integrated maternity care model, stating that hospitals and accredited birth centers are the safest settings for childbirth.[29] ACOG recognizes the ICM global standards as the minimum educational benchmark for all midwives, including CPMs, and maintains that only midwives certified by the American Midwifery Certification Board (AMCB) or educated to ICM standards should provide maternity care. In its Committee Opinion No. 697, ACOG stated that home birth may be reasonable in certain cases, but that midwives attending such births should meet ICM standards, be integrated into a regulated health care system, and have access to consultation and safe, timely transport.[29] In its 2018 Joint Statement of Practice Relations Between Obstetrician–Gynecologists and CNMs/CMs, ACOG reaffirmed its support for accredited education, national certification, and formal collaboration between OB-GYNs and CNMs/CMs—without mention of CPMs.[30]
March of Dimes
[edit]March of Dimes advocates for expanding access to midwifery care integrated into the U.S. maternity system and emphasizes that all midwives should meet International Confederation of Midwives (ICM) global standards—specifically, “midwifery refers to certified nurse midwives (CNMs), certified midwives (CMs) or midwives whose education and licensure meets the International Confederation of Midwives (ICM) Global Standards for Midwifery Education.”[31] It explicitly states that it "welcomes the movement towards CPMs meeting the ICM standards," and advocates that all births be attended by providers with licensed, ICM compliant training and access to consultation pathways and safe transport systems.[32] March of Dimes also encourages state-level policies granting full practice authority to midwives educated and credentialed under ICM-equivalent training, which may include CPMs who align with those standards.
Selected cases and investigations
[edit]Washington Post investigation: Karen Carr
[edit]The Washington Post did ian investigative series focused on CPM oversight and regulatory concerns in the US. It featured the case of a November 2021 home birth in Maryland attended by midwife Karen Carr that resulted in a stillborn baby, Sophie Rose DiVincenzo. The story highlighted that despite prior felony charges and investigations in multiple jurisdictions—including a 2010 guilty plea for involuntary manslaughter in Virginia, Carr continued practicing with minimal professional oversight. Critics argue this underscores systemic flaws in tracking midwife histories and enforcing accountability when outcomes are fatal.[33]
USA Today "Failure to Deliver" series
[edit]A USA Today investigative series reported on home birth and types of midwives. USA Today reported that infants delivered at home by CPMs were three times more likely to die than those born in hospitals under midwife care—a trend that was even more pronounced in higher-risk situations.[34]
Texas midwife accused of performing illegal abortions
[edit]In 2025, Texas-based CPM Maria Margarita Rojas was arrested and charged with performing illegal abortions and practicing medicine without a license. The case, which involved the provision of abortion-inducing medication outside of physician oversight, raised new questions about the legal boundaries of CPM practice in states with strict abortion laws.[35]
Sociopolitical perspectives
[edit]The rise of the Certified Professional Midwife (CPM) credential in the United States is often framed within broader conversations about feminism, bodily autonomy, and resistance to medicalization in childbirth. Supporters of CPMs argue that the credential enables women to exercise choice over how and where they give birth, including the right to pursue home birth and reject hospital-based interventions. They contend that the model reflects a grassroots, community-centered approach rooted in reproductive autonomy and historical midwifery traditions.[36][37]
The CPM credential has also raised questions about the balance between autonomy and regulation in healthcare. While some advocate for licensure to ensure public accountability, others suggest that licensing CPMs when their training does not meet international midwifery education standards, can create public confusion about the standard of care they can expect from the different types of midwives. The ICM does not recognize the CPM as meeting global midwifery standards, which typically require a university-based degree and formal integration into the healthcare system.[38]
The role of CPMs has also intersected with abortion rights and reproductive justice debates. Some midwifery advocates position CPMs within a broader reproductive rights framework, emphasizing their support for client autonomy, bodily integrity, and access to a full spectrum of reproductive healthcare, including abortion. This framing aligns CPM practice with broader movements advocating for reproductive self-determination and resistance to state control over pregnancy and birth.
See also
[edit]Midwifery in the United States
References
[edit]- ^ North American Registry of Midwives. “About NARM.” https://narm.org/about-narm/
- ^ Rooks, Judith P. Midwifery and Childbirth in America. Temple University Press, 1997. ISBN 9781566395646.
- ^ a b North American Registry of Midwives. “Certification Process.” https://narm.org/certification/
- ^ Midwifery Education Accreditation Council. https://www.meacschools.org
- ^ Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. "Practitioner and Practice Characteristics of Certified Professional Midwives in the United States: Results of the 2011 North American Registry of Midwives Survey." Journal of Midwifery & Women’s Health. 2017;62(3):339–349. doi:10.1111/jmwh.12634.
- ^ U.S. Department of Education. “Database of Accredited Postsecondary Institutions and Programs.” https://ope.ed.gov/dapip/
- ^ U.S. Department of Education. “Accreditation in the United States.” https://www2.ed.gov/admins/finaid/accred/accreditation_pg3.html
- ^ Council for Higher Education Accreditation. “Transfer and the Public Interest: A Statement to the Community.” 2001. https://www.chea.org/transfer-and-public-interest
- ^ U.S. Department of Education. “Federal Student Aid: Accreditation.” https://studentaid.gov/help-center/answers/article/accreditation
- ^ North American Registry of Midwives. “Certification Exam.” https://narm.org/certification/exam/
- ^ North American Registry of Midwives. “Written Exam Statistical Overview.” https://narm.org/statistics/exam-statistics/
- ^ a b North American Registry of Midwives. “State-by-State Regulation Chart.” (PDF). North American Registry of Midwives. Retrieved June 2025. https://narm.org/pdffiles/statechart.pdf
- ^ Colorado Revised Statutes § 12‑225‑104 (2024).
- ^ State v. Jones, 315 Neb. 523 (2024). https://supremecourt.nebraska.gov/sites/default/files/sc/opinions/s24-187.pdf
- ^ NH Rev Stat § 326‑D:6 (2023).
- ^ North American Registry of Midwives. "State‑by‑State Regulation Chart" (PDF). North American Registry of Midwives. Archived from the original (PDF) on 14 July 2024. Retrieved 15 June 2025.
- ^ Declercq E, Sakala C, Corry MP, Applebaum S, Herrlich A. "Planned Home Birth: Benefits, Risks, and Opportunities." Am J Obstet Gynecol. 2019 Dec;221(6):499–500. PMC6642827.
- ^ a b MacDorman MF, Declercq E, et al. “Neonatal mortality in the United States is related to location of birth—hospital versus home—rather than the type of birth attendant.” Am J Obstet Gynecol. 2020;222(3):273.e1–273.e12. doi:10.1016/j.ajog.2020.02.059.
- ^ Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J. “Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis.” Am J Obstet Gynecol. 2010 Sep;203(3):243.e1–8. doi:10.1016/j.ajog.2010.06.070.
- ^ a b c d e Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. "Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009." J Midwifery Womens Health. 2014 Jan-Feb;59(1):17–27. doi:10.1111/jmwh.12172.
- ^ Grünebaum, A., McCullough, L.B., Brent, R.L., Arabin, B., Levene, M.I., & Chervenak, F.A. (2015). Planned home births: the need for additional regulatory oversight. American Journal of Obstetrics and Gynecology, 212(3), 312.e1–312.e4. https://doi.org/10.1016/j.ajog.2014.11.006
- ^ International Confederation of Midwives. "Global Standards for Midwifery Education (2021)" (PDF). International Confederation of Midwives. Archived from the original (PDF) on 6 February 2025. Retrieved 15 June 2025.
- ^ US MERA. “Joint Position Statement on Midwifery Education.” 2015. https://usmera.org/index.php/2015/11/20/principles-for-model-u-s-midwifery-legislation-regulation/
- ^ a b "Planned Home Birth". American Academy of Pediatrics. May 2013. Retrieved June 15, 2025.
- ^ "Hospitals Remain the Safest Option for Birth, Even Amid COVID-19". HealthyChildren.org, American Academy of Pediatrics. April 20, 2020. Retrieved June 15, 2025.
- ^ "ACNM Letter to Congress Re: Minimum Educational Standards for Midwives" (PDF). American College of Nurse-Midwives. July 2009. Archived from the original (PDF) on February 6, 2011. Retrieved June 15, 2025.
- ^ "CPM FAQs – ACNM Statement on Federal Recognition of CPMs" (PDF). American College of Nurse-Midwives. July 31, 2009. Archived from the original (PDF) on September 3, 2013. Retrieved June 15, 2025.
- ^ "ACNM Letter to Membership Re: Federal Recognition of CPMs" (PDF). American College of Nurse-Midwives. 2009. Archived from the original (PDF) on February 6, 2011. Retrieved June 15, 2025.
- ^ a b "Committee Opinion No. 697: Planned Home Birth". American College of Obstetricians and Gynecologists. April 2017. Retrieved June 15, 2025.
- ^ "Joint Statement of Practice Relations Between Obstetrician–Gynecologists and CNMs/CMs". American College of Obstetricians and Gynecologists and American College of Nurse-Midwives. February 2018. Retrieved June 15, 2025.
- ^ "Midwifery Care: Improving Health Outcomes for Moms and Babies" (PDF). March of Dimes. March 2022. Retrieved June 15, 2025.
- ^ March of Dimes. "Midwifery Position Statement (August 2019)" (PDF). American College of Nurse-Midwives. Archived from the original (PDF) on 24 March 2025. Retrieved 15 June 2025.
- ^ Taylor, Derrick Bryson (March 26, 2023). ""Home-birth midwife's scope of care masked risk to mothers and infants, records suggest"". The Washington Post. Retrieved June 15, 2025.
- ^ Ungar, Laura; Szabo, Liz; Frankenberry, Chris (December 30, 2018). ""Midwives outside hospitals pose risks, oversight gaps as home births rise"". USA Today. Retrieved 15 June 2025.
{{cite web}}: CS1 maint: multiple names: authors list (link) - ^ Walker, Jackson (March 18, 2025). ""Texas midwife arrested for allegedly providing illegal abortions"". NBC News. Retrieved June 15, 2025.
- ^ De Vries, Raymond. A Pleasing Birth: Midwives and Maternity Care in the Netherlands. Temple University Press, 2005.
- ^ Davis-Floyd, Robbie. “The Technocratic, Humanistic, and Holistic Paradigms of Childbirth.” International Journal of Gynecology & Obstetrics, 2001.
- ^ International Confederation of Midwives. “Global Standards for Midwifery Education.” 2019. https://www.internationalmidwives.org/assets/files/general-files/2019/10/icm-standards-2019.pdf
External links
[edit]Professional organizations:
- North American Registry of Midwives (NARM): Issues the CPM credential and maintains certification standards.
- Midwifery Education Accreditation Council (MEAC): Accredits educational programs for direct-entry midwives.
- National Association of Certified Professional Midwives (NACPM): Advocates for CPMs and policy development.