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Legal Status of U.S. Midwives

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Types of Credentialed Midwives

There are three types of credentialed midwives in the United States: Certified Professional Midwives (CPMs), Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs.) Read more here.

Certified Nurse-Midwives are dually trained in midwifery and nursing. Their training is hospital-based since the vast majority of CNMs practice in that setting. Certified Midwives have similar training to CNMs, conform to the same standards as CNMs, but are not required to have the nursing component. Although most CNMs practice in clinics and hospitals, the CNM/CM scope of practice allows them to practice in any birth setting.

The vast majority of direct-entry midwives in the United States are Certified Professional Midwives, who are specialists in birth outside of the hospital, particularly in private homes and at freestanding birth centers. They are the only U.S. birth attendant whose education and clinical training focuses specifically and exclusively on out-of-hospital birth settings.

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. At that time the legal status of midwifery was jeopardized amidst a growing competitive medical market. Nonetheless, the United States is unique in the developed world in its history of criminalizing the practice of midwifery rather than fostering collaboration between midwives and physicians, and successfully integrating midwifery into the prevailing maternity care model. 

Nurse-Midwives practice legally in all 50 U.S. states and the District of Columbia. Certified Professional Midwives are legally authorized to practice in 28 states. Certified Midwives practice legally in only three states.

Direct-entry midwives (CMs and CPMs) are recognized as legal practitioners in some U.S. states but not in others. In some states the practice of direct-entry midwifery is illegal due to archaic laws or marketplace competition that pits medical doctors against midwives.

Certified Professional Midwives

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).

Currently, CPMs are legally authorized to practice in 28 states; 13 states have pending CPM legislation; 4 states are planning CPM legislation; and 5 states are organizing advocacy efforts. Click here for more information on direct-entry midwifery legality in the United States. The Certified Professional Midwife, the newest U.S. midwifery credential, was developed in the 1980s, and was first issued in 1994 by NARM as a credential specific for midwives who specialize in providing in safe, skilled, full-scope out-of-hospital maternity care. Based on the MANA Core Competencies, a scope of practice derived from the NARM Job Analysis, and state laws and regulations, the guiding principles of the practice for CPMs are to work with women to promote a healthy lifestyle, and provide education to help them make informed decisions about pregnancy, childbirth and parenting. 

In partnership with their clients CPMs carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other healthcare providers when necessary. The key elements of these education, monitoring, and decision-making processes are based on evidence-based practices and informed consent.

Advocacy for Licensing Midwifery in the United Stares

Coalitions of stakeholders that include citizens, midwifery supporters, midwives and other health professionals are currently advocating for regulation of direct-entry midwifery in every U.S. state and territory, and are working to ensure licensing, collaboration and integration of midwives within the U.S maternity care system.

In recent years, there have been an increasing number of advocacy groups lobbying for the rights of women to make informed decisions about where and with whom they give birth. Grassroots advocacy efforts are primarily led by women of reproductive age and their families at the state level, and national efforts are spearheaded by consumer groups such as Citizens for MidwiferyWhere’s My Midwife?, the Big Push for Midwives, the MAMA Campaign, and BirthNetwork, to name a few. These organizations and stakeholders proactively solicit legislators, policy makers, media, and private and government insurers to advocate for the high-value, high-quality, low cost of midwifery care and the undeniable benefits to mothers, infants, families and society.