Want To Become A Midwife? What The Different US Midwifery Credentials Mean

Midwives — literally "with women" in middle English — do pretty much exactly that. Though now primarily known as a profession that provides care to women before and during pregnancy, during labor and birth, and beyond, midwives are true primary care providers to women with female-specific needs at all stages of their lives. Midwifery, to midwives, is as much a calling as a profession.

Are you considering following this path and becoming a midwife in the US? You may be an ideal candidate if you are passionate about women's health, are able to keep a cool head during high-pressure situations, are committed to providing active patients with the best care possible, and don't shy away from difficult situations or non-standard working hours.

Midwifery in the US is unique in that several midwifery credentials are available, not all of which are licensed to practice in every state. Those who are interested in providing care to women and their babies first need to decide with path to midwifery they would like to take — wading, in the process, through a great deal of controversy regarding the merits of the different "tiers" of midwifery.

Certified Nurse Midwife

Certified Nurse Midwives are licensed as primary care providers across all 50 states as well as its territories. They're advanced practice registered nurses whose duties include providing prenatal care, assisting during labor and birth, offering counseling, giving nutritional advice, being primary care providers in the field of reproductive health by performing pelvic exams for instance, and ensuring the health of babies. By becoming a CNM, you would join the ranks of the most reputable midwives in the country.

Averaging $92,230 a year, Certified Nurse Midwives are among the most highly-paid nursing professionals in the US. As a CNM, you may practice in hospitals, birth centers, other clinics, and attend homebirths. Though births at home and at birth centers have been on the rise, the vast majority of CNM-assisted births, over 94 percent, take place in hospitals.

READ Choose Midwifery, Avoid A C-Section

The CNM credential is the most advanced midwifery credential in the United States, on par with similar credentials issued in other developed countries. As a CNM, you will be a reputable healthcare provider whose abilities are recognized not just across the country, but all over the globe. Though a longer path than the remaining midwifery credentials, becoming a CNM means you will be able to provide advanced professional care to your patients.

To become a Certified Nurse Midwife, you would first obtain your bachelor's degree in nursing, become a registered nurse, and gain work experience in a field related to women's care. You would then enter a midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME), offered by Baylor University, Bethel University, the Midwifery Institute at Philadelphia University, and the University of Cincinnati Nurse-Midwifery, and 34 other ACME-accredited programs. After completing this graduate degree, you would then become licensed with the American Midwifery Certification Board within two years of finishing your education, while also continuing to maintain your RN status. Recertification needs to be completed every five years.

Non-Nurse Midwife Midwifery Credentials In The US

Certified Midwife

Certified Midwives, like Certified Nurse Midwives, complete graduate programs accredited by ACME following the completion of their bachelor's degrees, however, they are not also registered nurses. Currently able to practice only in New York, New Jersey and Rhode Island, people who choose the CM path will have more limited career options as compared with CNMs. While the US currently counts over 11,000 CNMs, the number of Certified Midwives is much lower at nearly 100. As a CM, you would be a midwife without also being a nurse. Just like CNMs, CMs need to renew their accreditation once every five years.

Certified Professional Midwife

Certified Professional Midwives represent another tier of midwives. Licensed by the North American Registry of Midwives (NARM) and the National Association of Certified Professional Midwives (NACPM), these midwives are currently able to practice in 28 different states. Licenses, where available, are issued by the individual state in which a CPM works. The CPM credential will appeal most to those who would like to practice in out-of-hospital settings such as homes and birth centers, and out-of-hospital experience is required in order to become licensed as a CPM.

Interestingly, should you be considering becoming a CPM, two distinctly different roads are available to you. You could attend a school accredited by the Midwifery Education Accreditation Council (MEAC), including Birthwise Midwifery School in ME, Bastyr University in WA, and the National College of Midwifery in NM. These schools will equip you with the knowledge you need to pass the NARM examination, which, once obtained, needs to be renewed once every three years.

Another road towards becoming a CPM is apprenticing with an existing midwife. As an experienced direct-entry homebirth midwife, you can also qualify for the CPM credential. Note that the CPM credential is subject to controversy within the medical community, and that Certified Professional Midwives cannot use their skills and experience in other developed countries, where midwives are subject to more rigorous requirements.

READ Questions To Ask Yourself When Wanting To Study Medicine

Direct Entry Midwife

Direct-entry midwives or lay midwives are uncredentialed midwives who practice exclusively in out-of-hospital settings. Allowed to practice in 23 states across the US at the moment, direct entry midwives are not allowed to provide care to women and their babies in the remaining states — something that would be considered practicing medicine without a license and subject to severe penalties. 

Direct entry midwives gain their experience by learning from existing midwives through an appenticeship model. This may appeal to those who prefer to learn in a hands-on manner. Make no mistake though: all other paths to midwifery will better equip you with the knowledge you need to provide adequate care to your patients, as well as giving you better career opportunities.

How Do You Decide Which Path To Midwifery Is Right For You?

If you would like to provide care to women and their babies in a hospital setting as a professional whose credentials are recognized everywhere across the United States, there is no question that the Certified Nurse Midwife credential is the path you are looking for. Should you live in one of the states where CMs are allowed to practice, this road of becoming a professional midwife without also becoming a nurse is a reputable option to consider as well. Certified Professional Midwives and Direct Entry Midwives are more limited in the scope of care they are able to provide as well as in where they are allowed to practice.