Certified Professional Midwives (CPMs) are independent practitioners who specialize in providing maternity care during pregnancy, labor, birth, and the postpartum period -- primarily in out-of-hospital settings such as homes and freestanding birth centers. The CPM credential is awarded by the North American Registry of Midwives (NARM) and represents the only midwifery credential that requires specific training in out-of-hospital birth.

This guide covers the direct-entry / CPM pathway to midwifery -- not the nurse-midwifery (CNM) route, which requires nursing school and an advanced practice registered nurse (APRN) license. The legal landscape for CPMs varies enormously from state to state: some states license and regulate CPMs, others have no regulation at all, and a few effectively prohibit the practice. We have compiled verified data for all 51 states we track so you can compare requirements side by side.

What Does a Midwife Do?

Midwives provide care during pregnancy, labor, birth, and the postpartum period. Certified Professional Midwives (CPMs) specialize in out-of-hospital births, including home births and births at freestanding birth centers. Their scope of practice centers on normal, low-risk pregnancy and physiologic birth, with an emphasis on informed consent, shared decision-making, and minimal intervention.

CPM midwives typically provide:

• Prenatal care: Regular pregnancy check-ups, health screenings, nutritional guidance, and risk assessment throughout pregnancy.
• Labor and birth support: Continuous attendance during labor and delivery, fetal monitoring, and management of normal birth.
• Newborn care: Initial newborn assessment, Apgar scoring, and monitoring during the immediate postpartum period.
• Postpartum care: Follow-up visits for both mother and newborn in the days and weeks following birth, including breastfeeding support.
• Emergency management: Trained in neonatal resuscitation and stabilization, with protocols for transfer to hospital care when complications arise.

Step 1: Education Pathways

Unlike the CNM pathway, becoming a CPM does not require a nursing degree. There are multiple educational routes to the CPM credential, each designed to prepare students for competent out-of-hospital midwifery practice.

MEAC-Accredited Programs

The Midwifery Education Accreditation Council (MEAC) is the U.S. Department of Education-recognized accrediting body for direct-entry midwifery education. MEAC-accredited programs combine didactic coursework in anatomy, physiology, pharmacology, prenatal care, labor management, and newborn care with extensive clinical training. Programs typically take about 3 years to complete and culminate in a certificate, associate, or bachelor's degree in midwifery.

MEAC-accredited programs must meet rigorous standards for curriculum content, clinical experience requirements, faculty qualifications, and student outcomes. Graduating from a MEAC-accredited program is one of the primary pathways to NARM certification eligibility.

Portfolio Evaluation Process (PEP)

NARM offers a Portfolio Evaluation Process (PEP) for students who train through non-accredited programs, apprenticeships, or self-study combined with clinical experience. The PEP route requires candidates to document their education and clinical training through a detailed portfolio that demonstrates they have met NARM's core competencies. This pathway provides flexibility for students who learn through apprenticeship or a combination of educational experiences.

Apprenticeship Route

In some states, aspiring midwives can train through a structured apprenticeship under the supervision of a practicing midwife. The apprenticeship model is a traditional route to midwifery education and involves hands-on learning alongside an experienced practitioner. Apprenticeship-trained midwives typically use the PEP pathway to qualify for the NARM exam. Note that not all states recognize apprenticeship training for licensure purposes -- check your state's specific requirements.

Step 2: NARM Certification -- the CPM Credential

The North American Registry of Midwives (NARM) is the national certifying body for Certified Professional Midwives. The CPM credential is the only midwifery certification in the United States that requires specific knowledge and experience in out-of-hospital birth settings.

Certification Requirements

To earn the CPM credential, candidates must demonstrate competency through:

• Education: Completion of a MEAC-accredited program, or successful completion of the Portfolio Evaluation Process (PEP) documenting equivalent education and training.
• Clinical experience: A specified number of prenatal visits, births attended as primary midwife under supervision, continuity-of-care experiences, newborn exams, and postpartum visits. Exact numbers are set by NARM and may be updated periodically.
• Skills verification: Demonstration of clinical skills, including a hands-on skills assessment verified by a qualified preceptor.
• Written examination: Passing the NARM Written Examination, a computer-based multiple-choice test covering midwifery knowledge, clinical judgment, and professional responsibilities.

The NARM Written Examination

Key exam facts:

• Format: Computer-based multiple-choice exam administered at authorized testing centers.
• Content areas: Antepartum care, intrapartum care, postpartum care, newborn care, well-woman care, and professional issues.
• Eligibility: Candidates must complete all education and clinical requirements before sitting for the exam.
• Retakes: Candidates who do not pass may retake the exam after a waiting period, subject to NARM policies.

Legal Status of CPM Midwifery by State

The legal landscape for Certified Professional Midwives varies enormously across the United States. Some states have established comprehensive licensing frameworks for CPMs, while others have no regulation at all, and a few effectively prohibit the practice of direct-entry midwifery. Understanding your state's legal status is critical before investing time and money in midwifery education.

Of the 51 states we track:

• 35 states license or regulate CPM midwives, providing a formal framework for legal practice.
• 15 states have no specific regulation for direct-entry midwifery, meaning the practice may be legal but without formal oversight.
• 1 states effectively prohibit the practice of direct-entry midwifery.

States that license or regulate CPM midwives:

States where direct-entry midwifery is prohibited:

Physician Collaboration Requirements

Some states require CPM midwives to maintain a formal collaborative agreement or supervisory relationship with a licensed physician. This requirement varies in its specifics -- some states mandate a written collaborative practice agreement, while others require a consulting physician relationship or referral protocols.

Of the 51 states we track, 4 require physician collaboration for CPM practice. States requiring physician collaboration include:

Finding a collaborating physician can be challenging in some areas, as not all physicians are willing to enter into collaborative agreements with CPMs. This is an important practical consideration when planning your practice location.

State-by-State Midwife Requirements

Requirements vary significantly by state. Some states have comprehensive licensing frameworks for CPMs, while others have no regulation. Click any state name to see its complete guide with step-by-step instructions, fees, CE details, and more.

Data sourced from official state licensing board websites and NARM. Requirements change frequently -- always verify with your state board before applying.

Continuing Education Requirements

Maintaining your CPM certification and state license (where applicable) requires ongoing continuing education (CE). Requirements exist at two levels: NARM national certification renewal and state licensure renewal.

NARM Continuing Education

NARM requires CPMs to complete continuing education as part of the certification renewal process. CPM certification must be renewed every three years, and renewal requires documentation of continuing education activities, including peer review and skills updates such as current neonatal resuscitation (NRP) certification and CPR certification.

State License Continuing Education

States that issue a separate midwifery license often have their own CE requirements for license renewal, which may or may not align with NARM's renewal requirements. Across the 51 states we track, the average CE requirement is 22.2 hours per renewal cycle. Some states accept NARM-approved CE toward state license renewal; others require state-specific coursework.

Tips for managing CE requirements:

• Keep your neonatal resuscitation (NRP) and CPR certifications current at all times -- these are universally required.
• Attend midwifery conferences and workshops offered by organizations such as the Midwives Alliance of North America (MANA) and your state midwifery association.
• Track your hours year-round and maintain documentation, as both NARM and state boards may audit CE records.
• Look for CE activities that satisfy both NARM and state requirements simultaneously to reduce duplication.

Frequently Asked Questions

Sources

The information in this guide is compiled from official sources. We recommend verifying current requirements directly with these organizations before making career or educational decisions:

• North American Registry of Midwives (NARM) -- CPM Certification
• NARM -- How to Become a CPM
• Midwifery Education Accreditation Council (MEAC) -- Accredited Programs
• Midwives Alliance of North America (MANA)
• Individual state licensing board websites -- see each state page for direct links to official regulatory authorities.