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Draft:Certified Midwife

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  • Comment: Many of the sources are primary and/or not independent (written or published by those affiliated such as Journal of Midwifery & Women's Health). Also, ResearchGate is not a reliable publisher so need a better source. S0091 (talk) 16:12, 16 June 2025 (UTC)
  • Comment: None of the sources meet the above criteria. S0091 (talk) 21:36, 15 June 2025 (UTC)

A Certified Midwife (CM) is a professional midwifery credential in the United States issued by the American Midwifery Certification Board (AMCB). Certified Midwives are trained to provide full-scope midwifery care, including prenatal, birth, postpartum, newborn, and well-person gynecologic care. CMs complete graduate-level education accredited by the Accreditation Commission for Midwifery Education (ACME), pass the same national certification exam as Certified Nurse Midwives (CNMs), and meet identical professional standards. The primary distinction is that CMs do not hold a nursing license and instead enter midwifery through a health-related or science-based academic background.[1]

History

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The Certified Midwife (CM) credential was launched in 1997 by the American College of Nurse-Midwives (ACNM) and the AMCB to create a graduate-level, academically rigorous midwifery pathway for individuals with relevant health or science degrees who are not nurses.[2][3]

The credential emerged around the same time as the Certified Professional Midwife (CPM), introduced in 1994–1995 by the North American Registry of Midwives (NARM), which provided certification for midwives trained via apprenticeship and competency-based methods.[4]

Both credentials fall under the category of direct-entry midwifery, but their pathways differ significantly. Unlike CPMs, Certified Midwives must complete a graduate-level program accredited by the Accreditation Commission for Midwifery Education (ACME) and pass a national board examination administered by the AMCB.[5][6]

The development of the CM credential was partly a response to the rise of the CPM, and was seen by some as an effort to offer a more standardized, academically grounded direct-entry midwifery alternative within regulated systems. Proponents of the CM model have emphasized its clinical rigor and institutional legitimacy, contrasting it with the CPM’s non-academic, apprenticeship-based preparation.[7][8][9]

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As of 2025, Certified Midwives are licensed in the following U.S. states and jurisdictions: Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, Minnesota, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and the District of Columbia.[10]

Numerous other states are actively considering legislation to license Certified Midwives, often using the CM credential as a way to expand the midwifery workforce while maintaining education and practice standards in line with international norms.

ACNM has called for states to license CMs under existing boards of nursing or medicine and supports full practice authority across all jurisdictions.[11]

Scope of practice

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In states where they are licensed, Certified Midwives have the same scope of practice as Certified Nurse-Midwives, including prescriptive authority, management of labor and birth, well-person gynecologic care, family planning, and primary care within their scope.[12]

CMs often work in hospitals, clinics, birth centers, and home birth settings, depending on local regulations.

Nursing tensions and the development of the CM credential

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The creation of the Certified Midwife (CM) credential by the ACNM in 1997 marked a pivotal shift in U.S. midwifery. Designed to open the profession to individuals with health or science degrees rather than nursing credentials, the CM pathway paralleled the CNM in education standards and national board certification but removed the requirement of a nursing license. While intended to expand access, the move caused significant friction within academic nursing.

This tension emerged most clearly after the passage of the New York Midwifery Practice Act of 1992, which authorized licensure of non-nurse midwives under the state's Board of Education. In response, SUNY Downstate Medical Center developed a dual-track program, with one pathway for nurses and another for direct-entry students who completed additional coursework to achieve “nursing equivalency.”[13][14]

Dorothea Lang, a past ACNM president and influential figure in New York midwifery policy, was instrumental in advocating for this separation. Her early exposure to non-nurse midwifery in Japan shaped her belief that professional midwives need not also be nurses. Under her leadership, a coalition of CNMs pushed for independent midwifery regulation outside the nursing board’s authority.[14]

However, these developments alarmed many in academic nursing. ACNM’s decision to remove the word “nurse” from much of its branding—such as renaming the Journal of Nurse-Midwifery to the Journal of Midwifery and Women’s Health—fueled fears that midwifery was moving away from nursing entirely. In a 2003 article in Nursing Outlook, advanced practice nursing leaders expressed concern that the inclusion of non-nurses created confusion and undermined cohesion within the broader field of Advanced Practice Nursing (APN). They wrote:

"The movement of the American College of Nurse Midwives to include midwives who are not nurses but who complete a certified midwifery program that is not nurse driven makes for confusion... It is a professional imperative for ACNM leaders to differentiate the competencies expected of APN midwives from those expected of midwives who are not nurses or who lack graduate degrees."[15]

This divide has persisted, with some leaders calling for clearer distinctions in regulatory frameworks for CNMs versus CMs. Others, including Rooks, have framed the development of the CM credential as a professional response to the Certified Professional Midwife (CPM) credential launched in 1994–1995 by the North American Registry of Midwives. By offering a university-based, accredited, and medically recognized pathway for non-nurses, the CM route was seen as an attempt to maintain professional control over direct-entry midwifery without aligning with the apprenticeship-based CPM model.[16]

Tensions between CM and CPM: legislative and educational impacts

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State and national debate around the CM credential has often impacted the recognition and legislation of Certified Professional Midwives (CPMs). A comparative analysis of midwifery education programs noted that CNM/CM education is rooted in graduate-level university systems accredited by ACME, while CPM training typically relies on apprenticeship and MEAC-accredited models that vary widely in structure and state practice environments, with CNM/CM programs achieving higher standardization and hospital integration.[3] [17]

In many states, efforts to enact licensing for CPMs have been undermined by the existence of the CM credential. In New York—one of the earliest adopters of CM licensure—the justification that CMs fulfill the need for direct-entry midwifery has been cited repeatedly to oppose CPM legislation. A 2025 Senate testimony argued:

“Thirty years ago NY put its faith in the American College of Nurse-Midwives (ACNM) to create a non-nurse direct-entry pathway to the midwifery profession; however, this has been a failed effort, with a paltry 150 candidates credentialed nationally in three decades, while in the same time period over 4700 CPMs have been educated and credentialled nationally. Passage of a single CPM licensing bill would dramatically increase New York’s maternity care workforce. It is time for NY to realize that they put their eggs in the wrong basket.”[18]

During the COVID-19 pandemic, New York temporarily authorized out-of-state CPMs to practice under an executive order—demonstrating safe, quality care in rural areas—but permanent legislation stalled, with CM licensure cited as a sufficient alternative.[19]

CPM advocates maintain that while CMs are hospital-trained, CPMs offer unique community-based care crucial for underserved populations, and argue that the CM pathway has been used to justify excluding CPMs from state licensure and reimbursement frameworks.[20]

Uptake

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Although Certified Midwives (CMs) were created to offer a formally educated, direct-entry midwifery pathway comparable to Certified Nurse-Midwives (CNMs), uptake has remained limited. Since the credential’s inception in 1997, fewer than 500 individuals have ever been certified as CMs, and as of 2025, fewer than 150 are actively practicing across the United States.[21][22] Despite meeting accredited graduate-level educational standards and being qualified for hospital-based care, CMs have not become the dominant direct-entry midwifery pathway. In contrast, Certified Professional Midwives (CPMs) — a credential based on apprenticeship and competency evaluation — have become more widely used to fill the role of direct-entry midwives in many communities.[23]

Some scholars and professional observers note that the growth of CPMs may have unintentionally limited the viability of the CM credential, despite the latter's greater clinical scope and formalized education standards. The CPM model, which remains largely restricted to out-of-hospital birth, lacks standard hospital privileges and often experiences higher attrition and variable outcomes, yet has been more readily adopted due to political momentum and a lower barrier to entry.[4] [3]

Nevertheless, efforts to raise the profile and legitimacy of the CM credential continue. In 2025, during a presentation to the National Advanced Practice Provider (APP) Week Advisory Board, ACNM President, Jessica Brumley, PhD, CNM, FACNM, noted that Certified Midwives were omitted from the APP credential listings. Following the presentation, which emphasized the alignment between CMs and CNMs in training, certification, and scope of practice, the Executive Committee approved the formal inclusion of CMs in the National APP Week mission statement and promotional materials. This recognition marked a symbolic but important milestone in efforts to integrate CMs more fully into the advanced practice provider community.[24]

Workforce data and diversity

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A 2023 national workforce analysis of AMCB-certified midwives found that there were 12,997 certificants between 2016 and 2020, with Certified Midwives comprising fewer than 2% of this group. The workforce was predominantly white, female, and employed in hospital settings, with limited racial diversity and geographic distribution. Researchers have cited CM expansion as a promising strategy to increase the availability of midwifery care.[25]

Tracking Challenges and National Data

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A 2023 study published in BMC Pregnancy and Childbirth found that only about 60% of AMCB-certified midwives were accurately captured in the National Provider Identifier (NPI) registry due to coding inconsistencies. The authors developed a recoding method using credential text to more accurately identify CNMs and CMs in national datasets, improving workforce tracking for policy and planning purposes.[26]

Comparison between credentials

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Credential Education Requirements Licensing Exam Certifying Exam Licensure Status
Certified Nurse-Midwife (CNM) Bachelor’s degree in nursing (BSN) + ACME-accredited graduate midwifery program NCLEX-RN American Midwifery Certification Board (AMCB) Licensed in all 50 states and U.S. territories
Certified Midwife (CM) Bachelor’s degree (health-related or equivalent) + ACME-accredited graduate midwifery program none American Midwifery Certification Board (AMCB) Licensed in 13 jurisdictions
Certified Professional Midwife (CPM) High school diploma or equivalent + MEAC-accredited program or NARM Portfolio Evaluation Process (PEP) None North American Registry of Midwives (NARM) Licensed in 36 states (with varying limitations)

See also

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References

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  1. ^ Thumm, E.B., Emeis, C.L., Snapp, C., Doublestein, L., Rees, R., Vanderlaan, J., & Tanner, T. (2023). The Certified Nurse-Midwife and Certified Midwife Workforce. Journal of Midwifery & Women’s Health, 68(5), 563–574. https://doi.org/10.1111/jmwh.13499
  2. ^ AMCB – American Midwifery Certification Board
  3. ^ a b c Marzalik PR, Feltham KJ, Jefferson K, Pekin K. "Midwifery education in the US—Certified Nurse-Midwife, Certified Midwife and Certified Professional Midwife." Midwife. 2018;60:9–12.
  4. ^ a b Vedam S, Stoll K, MacDorman MF, Cramer R, Cheyney M, Declercq E, Kennedy HP. "Mapping integration of midwives across the United States: Impact on access, equity, and outcomes." PLOS ONE. 2018;13(2):e0192523. [1]
  5. ^ Niemczyk NA, Cutts A, Perlman DB. "Prior Work and Educational Experience Are Not Associated with Successful Completion of a Master's-Level, Distance Education Midwifery Program." J Midwifery Women’s Health. 2018;63(2):161–167.
  6. ^ Stec MA, Arbour MW. "Labor and Delivery Nursing Experience: A Prerequisite for Midwifery Education?" J Midwifery Women’s Health. 2018;63(2):157–160.
  7. ^ Rooks JP. Midwifery and Childbirth in America. Temple University Press, 1997.
  8. ^ Jefferson K, MacKenzie RK, Hackley B, Perlman D. "Knowledge of US midwifery credentials among ACNM members." J Midwifery Women’s Health. 2019;64(2):158–166. PMID: 31600026.
  9. ^ Fullerton JT, Bash M. "Integration of qualified nurses and non-nurses in midwifery education: Editorial review." J Midwifery Women’s Health. 2000;45(1):45–54.
  10. ^ ACNM – American College of Nurse-Midwives
  11. ^ American College of Nurse-Midwives (ACNM). (2022). Position Statement: Independent Midwifery Practice. Retrieved from https://www.midwife.org
  12. ^ American College of Nurse-Midwives (ACNM) & American College of Obstetricians and Gynecologists (ACOG). (2018). Joint Statement of Practice Relations between Obstetrician–Gynecologists and Certified Nurse-Midwives/Certified Midwives. Retrieved from https://www.acog.org
  13. ^ Davis-Floyd, R. (2005). Certified Professional Midwives in the United States. In V. Tritten, K. R. Davis-Floyd, & J. Chalmers (Eds.), Birth Models That Work (pp. 315–349). University of California Press.
  14. ^ a b Rooks, J. P. (2005). Relationships Between CNMs and CMs and Other Midwives, Nurses, and Physicians. Retrieved from https://www.researchgate.net/publication/265758801_Relationships_Between_CNMs_and_CMs_and_Other_Midwives_Nurses_and_Physicians
  15. ^ Hanson, C. M., & Hamric, A. B. (2003). Reflections on the continuing evolution of advanced practice nursing. Nursing Outlook, 51(5), 203–211. doi:[10.1016/S0029-6554(03)00154-7](https://doi.org/10.1016/S0029-6554(03)00154-7)
  16. ^ Rooks, J. P. (2000). Professional midwifery and interprofessional relationships. In: F. W. Marshall & E. M. Raynor (Eds.), Professional Issues in Midwifery. Sudbury, MA: Jones & Bartlett.
  17. ^ Niemczyk, N.A., Cutts, A., & Perlman, D.B. (2018). Prior work and educational experience are not associated with successful completion of a master's-level, distance-education midwifery program. Journal of Midwifery & Women’s Health, 63(2), 161–167. DOI:10.1111/jmwh.12675.
  18. ^ "Testimony in Support of Certified Professional Midwifery Bill A1125" (PDF). New York State Senate Committee on Higher Education. February 2025. Archived from the original (PDF) on April 18, 2025. Retrieved June 15, 2025.
  19. ^ Arpey, Jack (January 23, 2024). "Advocates push bill that would allow certified professional midwives in New York". Spectrum News 1 Central New York. Retrieved June 15, 2025.
  20. ^ Jefferson, Karen; Bouchard, Mary Ellen; Summers, Lisa (January 1, 2021). "The Regulation of Professional Midwifery in the United States". Journal of Nursing Regulation. 11 (4): 26–38. doi:10.1016/S2155-8256(20)30174-5. Retrieved June 15, 2025.
  21. ^ AMCB 2023 Annual Report, American Midwifery Certification Board. Retrieved June 15, 2025.
  22. ^ Archived AMCB CM Registry Search.
  23. ^ Jefferson, Karen; Bouchard, Mary Ellen; Summers, Lisa (2021). "The Regulation of Professional Midwifery in the United States". Journal of Nursing Regulation, 11(4): 26–38. doi:10.1016/S2155-8256(20)30174-5.
  24. ^ National APP Week. "Mission Update: Inclusion of Certified Midwives." Internal correspondence and advisory board presentation summary, May 30, 2025.
  25. ^ Thumm, E.B., et al. (2023). The Certified Nurse-Midwife and Certified Midwife Workforce. Journal of Midwifery & Women’s Health, 68(5), 563–574. https://doi.org/10.1111/jmwh.13499
  26. ^ Vanderlaan, J. & Jefferson, K. (2023). Evaluation of a method to identify midwives in national provider identifier data. BMC Pregnancy and Childbirth, 23(809). https://doi.org/10.1186/s12884-023-06122-2
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