Midwives vary both in their licensure and in their scope of practice.
Certified Nurse Midwives (CNM)
Certified Nurse Midwives (CNM)
Some midwives have training both as nurses and as midwives. They are called certified nurse midwives (CNM). Their certification is regulated by the American College of Nurse-Midwives.
Direct-Entry Midwives (DEM)
Other midwives are like physician's assistants or physical therapists. They are not nurses and enter the field of midwifery directly. These midwives are called direct-entry midwives (DEM).
Some of these midwives are licensed by professional organizations. Those licensed under the auspices of the North American Registry of Midwives (NARM) created by the Midwives Alliance of North America (MANA) are called certified professional midwives (CPM). Those registered under American College of Nurse-Midwives are called certified midwives (CM).
Some of these midwives practice without certification or licensure. Often they train as apprentices to established midwives. These are called lay midwives.
Midwifery and the Law
The practice of certified nurse midwives is legal in all 50 states. Government regulation of direct-entry midwifery varies from state to state. Midwives licensed by state legislation are called licensed midwives (LM).
Currently 24 states in the United States have legislation for the regulation of direct-entry midwives. Some states have legislation permitting direct-entry midwives to attend births without explicit regulation. Others prohibit direct-entry midwives from attending births.
California has legislation in place and The California Association of Midwives represents midwives statewide.
What Midwives Do
The CDC report based on birth certificate data shows that in 2006, about 8% of births in hospitals were attended by certified nurse midwives. It is not clear by birth certificate data how many out-of-hospital births are planned and attended by midwives. Not all midwives attend births. Many have office practices caring for women before and after childbirth.
According to ACNM, the majority of CNMs attend births in hospitals with only 2% in freestanding birth centers and 1.3% at homebirths. By contrast, a larger percentage of DEMs have training in out-of-hospital births and most go on to practice in these settings.
