Legal Status of U.S. Midwives

While midwifery is an ancient profession that exists in almost all known cultures, thrives in most industrial countries, and is the central pillar of maternity care in those countries with the best mother/baby outcomes, in the United States midwifery has suffered social and political set-backs. Midwives safely and effectively attended the vast majority of births in the United States until the 1930s when the place of birth was moved from home to the hospital, and midwives were replaced with physician birth attendants. The United States is unique in the developed world in criminalizing the practice of midwifery rather than fostering collaboration between midwives and physicians, and successfully integrating midwifery into the prevailing maternity care model.

Certified Nurse Midwives (CNM)

CNMs are certified according to the requirements of the American Midwifery Certification Board (AMCB) and are able to practice legally in all 50 states. CNMs are independent practitioners in most states, however a few states require physician supervision.

Direct – entry Midwives 

Direct – entry Midwives are recognized as legal practitioners in some U.S. states but not in others.

Certified midwives (CM) take the same national certification examination as CNMs but receive the professional designation of certified midwife. They are only recognized and able to practice in a handful of states

Certified Professional Midwives (CPM)
In the United States, a national certification is available for the Certified Professional Midwife but national midwifery licensing does not exist as it does in many other countries. Rather, a Certified Professional Midwife is nationally certified through the North American Registry of Midwives (NARM), and if a license is available it is issued by the state(s) in which the midwife practices. Thus there are 50 separate and distinct jurisdictions, licensing laws, professional licensing boards, and sets of rules and regulations in the United States (and more if you consider all U.S. territories).

As of October 1, 2019, CPMs are legally authorized to practice in 35 states which includes New York, in which CPMs are qualified for licensure by statute, however have been excluded  from implementation of the law, leaving CPMs unable to be licensed in New York. This means that in 16 states, as well as the District of Columbia, Puerto Rico, Virgin Islands, and Guam, Certified Professional Midwives (CPMs) are at risk of criminal prosecution for practicing medicine or nursing without a license, (Licensure for CPMs: State Chart, The Big Push).

Some states have their own criteria for licensure of direct-entry midwives (LM). Of those, most use the CPM educational requirements and all use the CPM exam for licensure.

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