A Short Guide to Midwifery in the United States

Guide to Midwifery

The profession of midwife – a person who helps a woman deliver her baby – may be one of the oldest professions on the planet. The word “midwife” comes from Middle English and means “with woman.”

Before the 1930s or so, when births almost always took place at home rather than in a hospital, midwives were the usual person helping with a birth in the United States. Today, midwives are healthcare professionals who specialize in primary care and reproductive healthcare for women, as well as childbirth care. They work at birthing centers and hospitals, and many deliver babies at home. A midwife is the primary healthcare provider for many women.

The percentage of births attended by certified nurse-midwives (CNMs) or certified-midwives (CMs) has gone up nearly every year for the past 25 years. In 2013, more than 8% of all births in the United States were attended by CNMs or CMs. They attended 12% of all vaginal births in the United States that year.

Who is a Midwife?

The term “midwife” covers several types of healthcare professionals. In the United States there are three types of midwives: certified nurse-midwives, certified midwives, and direct-entry or lay midwives, some of whom are certified. There are about 15,000 practicing midwives in the United States, according to the Midwives Alliance of North America (MANA), a professional group.

Part of the confusion is from a lack of national midwife licensing. There are two major organizations that offer certification, the American Midwifery Certification Board and the North American Registry of Midwives, but licensing for health professionals is on the state level, with different regulations governing midwives in each state.


A certified nurse-midwife (with the initials CNM after her name) is a registered nurse who has gone through an additional graduate education program. She (or occasionally he) has also passed a national certification examination. The professional organization for CNMs is the American College of Nurse-Midwives.

CNMs can prescribe medications in all states and are defined as primary care providers under federal law. Although all CNMs attend births, more than half say the majority of their practice is in reproductive health care and primary care.


A certified midwife, a relatively new designation, is someone with a background in health care other than nursing who has gone through a graduate program in midwifery. She takes the same certification examination as a CNM and has the initials CM after her name. CMs are also members of the American College of Nurse-Midwives, but while there are more than 11,000 CNMS, there are only 88 CMs. They are legally recognized in only three states, New York, Massachusetts, and New Jersey.

Lay Midwives

Lay midwives or direct-entry midwives went through what is called direct training in taking care of women during childbirth. This means they either studied midwifery by themselves, they apprenticed with another midwife, or they studied in an academic program that is not affiliated with nursing. Lay midwives are sometimes called traditional midwives.

Some lay midwives become certified through the North American Registry of Midwives and can call themselves certified professional midwives (CPMs). Most direct entry midwives in the United States are CPMs, according to the Midwives Alliance of North America. CPMs specialize in births outside of hospital settings. They are legally recognized to practice in 28 states.

If you are interested in finding a midwife to assist you with your birth, be sure to inquire about their experience, qualifications, and certification. Ask for referrals from people you trust and contact the organizations mentioned in this post for additional information and assistance.

Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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