What Midwives Do and Types of Midwifery Practice
Midwives are healthcare professionals who provide care during pregnancy, childbirth, and the postpartum period. The word "midwife" comes from Old English and means "with woman," which reflects the central role midwives play in supporting pregnant people through one of life's major events. In the United States, midwives work in hospitals, birth centers, and homes, depending on their credentials and local regulations.
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There are three main types of midwives in the United States, each with different training and scope of practice. Certified Nurse Midwives (CNMs) are registered nurses who complete additional midwifery training. According to the American College of Nurse-Midwives, CNMs attend approximately 8% of all births in the United States and manage care for over 11% of pregnant people. Certified Midwives (CMs) complete midwifery training but do not have nursing credentials first. Certified Professional Midwives (CPMs) typically specialize in out-of-hospital births and community-based care.
Each type of midwife has different responsibilities. CNMs can prescribe medications, manage complications, and practice in all settings. CMs have similar scope to CNMs but typically work in hospital or birth center settings in the states where they are regulated. CPMs focus on physiological birth and work primarily in homes and birth centers. According to data from the Centers for Disease Control and Prevention, approximately 35,000 midwives practice in the United States across all three categories.
The day-to-day work of a midwife involves multiple responsibilities. They perform prenatal examinations, order and interpret laboratory tests, provide health education, counsel clients on nutrition and lifestyle, monitor fetal development, and prepare birth plans. During labor and delivery, midwives assess progress, manage pain, deliver babies, and handle emergency situations. After birth, they provide newborn care, support breastfeeding, and monitor the postpartum recovery of the person who gave birth.
Practical Takeaway: Understanding the three types of midwifery helps you determine which career path aligns with your interests. If you want to work in hospitals and manage complex medical situations, CNM training may be appropriate. If you prefer community-based or home birth care, CPM or CM paths may interest you. Research job descriptions in your area to see which type of practice is most available.
Educational Pathways and Training Requirements
The educational requirements for midwifery careers vary significantly based on the type of midwife you want to become. For Certified Nurse Midwives, you must first become a registered nurse. This requires completing either a four-year Bachelor of Science in Nursing (BSN) or a two- to three-year Associate Degree in Nursing (ADN) program at a college or university, followed by passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN). After working as an RN for some period (often one to two years, depending on the program), you can then enroll in a CNM graduate program.
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CNM graduate programs are accredited master's or doctoral level programs lasting 18-24 months of full-time study. According to the Accreditation Commission for Midwifery Education (ACME), there are currently 29 ACME-accredited midwifery education programs in the United States. These programs include classroom instruction in anatomy, physiology, pharmacology, pathophysiology, and midwifery practice. They also include clinical training where students work with preceptors to gain hands-on experience with actual patients. Most programs require students to attend a minimum number of births (typically 50-75) and perform specific clinical skills before graduation.
For Certified Professional Midwives, the educational pathway is different. The North American Registry of Midwives (NARM) does not mandate specific educational institutions. Instead, CPMs can gain their education through various routes: direct-entry midwifery schools, apprenticeship with experienced midwives, self-study combined with mentorship, or hybrid programs combining classroom and hands-on training. CPM students must document at least 50 completed pregnancies, births, and postpartum experiences before taking the NARM certification examination. This flexibility allows people to enter midwifery from various backgrounds, though it requires more self-direction in structuring education.
Certified Midwives follow an educational path similar to CNMs in terms of attending accredited midwifery programs and meeting similar clinical requirements, but they enter these programs without nursing credentials. Some direct-entry midwifery schools offer CM-track programs. The time commitment and course content are comparable to CNM programs, typically 18-24 months of graduate-level study.
Practical Takeaway: Assess your current education and time availability. If you already have a nursing degree, CNM training may be a logical next step. If you have no nursing background but want to work in hospitals, look for direct-entry midwifery schools that lead to CM credentials. If you prefer apprenticeship-based learning and out-of-hospital birth, research CPM education options in your region, as requirements vary by state.
Licensing, Certification, and State Regulations
Once you complete your midwifery education, you must obtain certification and meet state licensing requirements. These requirements vary significantly by state, which can complicate careers for midwives who move between states. For Certified Nurse Midwives, you must pass the American Midwifery Certification Board (AMCB) examination after completing an accredited CNM program. The AMCB exam tests knowledge of midwifery practice, clinical skills, and decision-making across the full scope of midwifery care.
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After passing the AMCB exam, CNMs are certified for six years before recertification is required. Recertification involves either retaking the exam or accumulating continuing education credits and practice hours. According to AMCB data, the AMCB exam has a first-time pass rate of approximately 85-90%, though this varies by program. Candidates typically spend 2-3 months preparing for the exam using study materials, practice tests, and review courses.
Licensing requirements for CNMs differ by state. Some states automatically recognize AMCB certification as meeting state licensing requirements, while others have additional state-specific exams or applications. Approximately 47 states regulate CNMs through licensure, and in most of these states, CNMs can practice independently and prescribe medications. However, in some states, CNMs must work under physician supervision or with collaborative agreements. Before pursuing CNM education, research the regulations in your target state of practice.
For Certified Professional Midwives, credentials are managed by NARM through the North American Registry of Midwives. CPMs must pass the NARM examination, which covers midwifery knowledge, skills, and judgment, with emphasis on physiological birth and out-of-hospital settings. The NARM exam typically has a pass rate around 70-80%. CPM regulation varies dramatically by state—some states recognize and regulate CPMs, some explicitly prohibit CPM practice, and others have no specific regulation. Approximately 27 states have some form of CPM regulation or licensure. You must research your specific state's regulations before pursuing CPM credentials.
Certified Midwives must pass the AMCB exam like CNMs and meet state regulations where they practice. However, CM regulation is less widespread than CNM regulation, so fewer states have specific CM licensure pathways. Some states recognize CMs under broader midwifery licensure statutes, while others do not regulate this credential separately from CNMs.
Practical Takeaway: Before enrolling in any midwifery program, contact your state's health department or nursing board to understand current regulations for the type of midwife you want to become. Download state regulations and read them carefully. Join professional organizations like the American College of Nurse-Midwives or your state's midwifery association to stay informed about regulatory changes that may affect your career.
Cost, Funding, and Financial Considerations
Pursuing a midwifery career requires significant financial investment. For those pursuing CNM credentials, you first need nursing education. ADN programs at community colleges typically cost $10,000-$30,000 total, while BSN programs at four-year universities can range from $25,000-$120,000 or more depending on whether the school is public or private. After nursing school,