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Is a Midwife as a Care Provider During Your Pregnancy Best for You?

Katrina Wharton | 4, December 2014


With the United States facing a shortage of ob-gyns, the need for midwives has increased and may present solutions for the shortage.

However, it's important to understand the training, background and legalities of the different types of midwives, and how they can assist in childbirth.

First, you need to understand the distinction between a certified nurse-midwife, or CNM, a certified midwife or CM, or a certified professional midwife or CPM.

Education and Certification

First of all, both CNMs and CMs are certified by the American Midwifery Certification Board or AMCB while CPMs are certified by a different agency, the North American Registry of Midwives or NARM.

CNMs and CMs require graduate degrees, while CPMs may get certification without a degree.

CNMs must graduate from a nurse-midwifery program accredited by the Accreditation Commission for Midwifery Education or ACME, as well as be verified by the program director of the completion of the program, and have an active RN or registered nurse license.

CMs must graduate from an education program accredited by ACME as well as have verification of completion of program by the program direction.

A CPM must complete the NARM's Portfolio Evaluation Process or PEP pathway, or graduate from a midwifery program accredited by ACME, or be an AMCB certified CNM or CM, or complete a state licensure program.

CPMs and CMs must be recertified every five years, while a CPM must be recertified every three years.

CNMs are registered nurses and are trained by practicing CNMs in a hands-on clinical program. CMs, however, have a bachelor's degree in another field than nursing and then pursue their graduate level midwifery degree.

CPMs on the other hand have an apprenticeship program rather than a degree program, and then take a certification exam from NARM.

Work settings and Practice Limitations

CNMs and CMs practice in hospitals, birth centers, health centers, private practices, and homes. They can prescribe medications and treatments and provide primary care. In fact, 95 percent of CNM-attended births are in hospital settings.

However, CPMs, generally provide pregnancy, birth and postpartum care to women outside the hospital setting, usually in a home or birth center. They cannot prescribe medications are not permitted to provide the same range of services that CNMs and CMs can.

CNMs are licensed to practice in all 50 states, while CMs are licensed to practice in New Jersey, New York and Rhode Island. CPMs are regulated in 26 states.

CNMs have full practice authority in 25 states, meaning they are allowed to assume full responsibility for their practice under their practice's scope and can consult a provider with different skills if they decide. CNMs have to work under a physician in 6 states, or under a legal collaborative agreement in 14 states which stipulates what services they may provide and when they must consult. Another six states require a collaborative agreement for providing prescription medications.

What this Means for You

In deciding who to attend your child's birth, you need to determine some things in advance. Will you be giving birth in a hospital, birth center, or at home? CNMs and CMs are generally practicing in hospital settings while CPM's are outside of hospital settings.

Do you have a physician who already has a midwife provider he or she works with regularly? If you already have your medical doctor lined up, it is worthwhile to see if there is a relationship already in place. This would help ensure no bumps in the road in setting up a cooperative care agreement.

Do you want a CNM or CM because they have more leeway in setting up treatments and prescribing medications? CMs typically don't have as much input in these areas.

Is there someone you've gotten rave reviews about, from family or friends? If there is a highly rated midwife in your area, you may be more inclined to use that person regardless of which accreditation they have received, and whether or not they are an RN.

Make sure your provider is licensed in your state, and has good references as well as credentials. Next, talk to the midwife to see if the practice guidelines fit into what you have planned for your birth. Finally, always have a meeting upfront to discuss the normal practice, procedures, costs and insurance issues, and where they can deliver and care for mom and child.

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