Important Facts Addressing Concerns about Licensing Midwives
Information Provided by the North American Registry of Midwives
The largest study of home births attended by Certified Professional Midwives has found that
home birth is safe for low risk women and involves far fewer interventions, such as cesarean sections
and inductions, than similar births in hospitals. “Outcomes of planned home births with certified professional
midwives: large prospective study in North America.” Kenneth C Johnson and Betty-Anne Daviss. BMJ 2005;330:1416 (18
“Recognizing the evidence that births to healthy mothers, who are not considered at medical risk
after comprehensive screening by trained professionals, can occur safely in various settings,
including out-of-hospital birth centers and homes. ...Therefore, APHA supports efforts to
increase access to out-of-hospital maternity care services...” American Public Health Association,
“Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-
Entry Midwives (Policy Statement)”. American Journal of Public Health, Vol 92, No. 3, March 2002.
The low CPM rates of intervention are benchmarks for what the majority of childbearing women
and babies who are in good health might achieve. The Milbank Memorial Fund, a nonpartisan institute devoted
to health policy analysis, issued a new report titled “Evidence-Based Maternity Care: What It Is and What It Can Achieve.”
An economic analysis of the cost benefits of a licensed midwife program indicate that “The cost
savings to the health care system (public and private) is estimated to be ten times the cost of the
program.” Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits, (A report
to the Washington Department of Health), Health Management Associates, October, 2007
All but three of the states that license direct-entry midwives allow those midwives to carry and
administer a specific list of emergency or routine medications. This is NOT prescriptive authority.
Midwives administer these medications only in pre-determined situations, following the
instructions set out in the rules. No pain medications are in the formulary. The medications are
either routine (eye meds and vitamin K for the baby) or for limited emergency use, such as to
prevent excessive bleeding in the mother. Use of emergency medications is rare and strictly
controlled and accountable.
Important Facts about the Education of the Certified Professional Midwife
The education of the CPM follows an extensive curriculum of over 750 topics. All educational
routes to the CPM must follow the same curriculum, which may be verified through diplomas
from accredited midwifery schools, licenses from states with equivalent requirements, or an
extensive evaluation of alternative pathways through the Portfolio Evaluation. Students from all
routes to certification must meet the SAME extensive educational goals, follow the same
curriculum, and pass the same nationally standardized examinations. These are equivalent routes
to the same education.
Instructors and preceptors are responsible for the education and supervision of student CPMs,
which may occur in classroom, private, and clinical settings. Instructors must verify that the
student has mastered all knowledge and skills and has demonstrated competency in the clinical
setting before proceeding through the testing process. Students then must pass a hands-on Skills
Assessment and an 8-hour Written Examination.
The clinical training for CPM certification must cover a minimum of at least one year of
supervised clinical work, which is equivalent to 1350 hours of supervision. The average length of
clinical training is 3-5 years. All students must document this supervised clinical work, regardless
of route of education.
The excellent outcomes documented in the CPM 2000 study were a result of over 5,000 births
attended by CPMs, 99% of which were attended by midwives who received the CPM credential
through the NARM Portfolio Evaluation Process. The results of this study attest to the safety of
births attended by CPM and the significant cost savings of reduced intervention in birth.
The process used to create and administer the CPM has been evaluated and accredited by the
National Commission for Certifying Agencies, the same organization that accredits the credentials
for the Certified Nurse-Midwife and many other advanced practice nursing credentials.
All states that license direct-entry midwives to provide home birth services accept the CPM
credential as meeting all or part of their licensure requirements, and all of these states use the
NARM exam as the state licensure examination. States with older program that precede the
establishment of the CPM credential may have some state-specific additional requirements, but all
states with licensure programs established after 1993 have accepted the CPM credential as the
eligibility criteria for licensure. This saves the state the administrative expense of evaluating
varied educational pathways, assures reciprocity with other licensed states, and follows the
national standards for midwifery education and training.
Twenty-five states license direct entry midwives to attend home births using the CPM credential
or equivalent. Many programs have been in existence for over 20 years, and no state has sought to
terminate the licensure program. This is testimony to the excellence of midwifery care by the
Certified Professional Midwife.