Monday, July 29, 2013

"Certified Midwives" Examining the CM Credential

What is a Certified Midwife?

A Certified Midwife (CM) is a health care professional who holds a credential in midwifery from the American Midwifery Certification Board. Certified nurse-midwives (CNMs) are the most prevalent type of midwife in the US and are certified by this same board.

The standards for education for CMs and CNMs are identical. Both must be educated in a graduate degree program, are trained in the same competencies, and must pass the same certification examination.

By credential, certified midwives are qualified to independently manage low-risk pregnancies and deliveries, provide routine well-woman care and screenings, diagnose and treat health conditions, and prescribe medications. 

How is a certified midwife CM different than the CPM or CNM?

Educationally, the only difference between CMs and CNMs is that CMs do not have degrees in nursing. It is an equivalent credential to the CNM.

The differences between CPMs and CMs are that CMs must be trained at a graduate level, CMs are integrated healthcare providers working alongside physicians, nurses and other healthcare providers, CMs are qualified to attend births in any setting, CMs are trained in pharmacology and prescribing medications.

The differences are so important, we felt a graph would be helpful:

Graduate degree required

Training in medical pharmacology required

Skilled in providing care in all birth settings

Providers of gynecology and well-woman care

Qualified to prescribe birth control and other medications

Trained with in the health care system among physicians, nurses, and other healthcare professionals

Self-purported “experts” in out-of-hospital birth

How are CMs and CPMs similar?
  • Neither CPMs or CMs are required to have a degree in nursing.
  • CMs and CPMs are not licensed in every state. The state of Michigan does not currently recognize either the CPM or the CM through licensing. 

But the differences between CPMs and CMs are vast and striking. Why are so many states 'pushing' for licensure of such poorly-trained midwives as CPMs, when there already is a high-quality, non-nurse credential? Why, when every state already recognizes and licenses CNMs, is it so difficult to enact licensing for the CM - an equivalent credential? Why, when it comes to midwifery licensing, should we reinvent the wheel - and an inferior wheel, at that -and license midwives with minimal training, minimal oversight, and minimal (or non-existent) standards of practice?

What we'd like to see in Michigan:

We would like to see Michigan take the lead on this very important issue, and license only the most qualified and highly-skilled midwives for women and their families, CNMs and CMs. We would like to see Michigan's nurse-midwifery programs, the University of Michigan and Wayne State, create pathways for training midwives who would become CMs in our state, and we would like to see not only the Michigan Affiliate of the ACNM but also the Michigan Midwives Association openly support improving the educational standards of midwives in our state by endorsing and promoting the CM credential.


  1. Two points:

    Most nurses who go for a CNM have already had extensive experience in hospital maternity wards, with inserting IVs, etc.

    CMs want to do homebirths, but we know that the home is a potentially high risk setting for birth, even if OBs are attending. When emergencies occur, hospitals are too far away and CMs have only two hands, not a team of professionals.

    CPMs are definitely a problem, but CMs are not the answer.

  2. Thanks for your comment Mother Voltaire. I don't think the CM is intended to be an answer to CPMs. Both CMs and CNMs are certified by AMCB, meaning they both meet a high degree of educational standards. If CMs do not already have the skills you mentioned above, they are expected to learn them as part of their graduate level education. Their scope of practice is identical to CNMs, meaning they can practice both in hospital or out.

    I don't disagree that OOH birth is risky. The goal from our perspective is that we aim to offer the safest possible care fort those women who choose OOH birth, and to make sure they are honestly educated (informed) about the risks they are taking in making that choice. Whether we (you or I) agree or disagree with the safety of OOH birth, we cannot eradicate it altogether. What we can do is advocate for the best care givers, high expectations for educational training, standards for practice, risking out criteria, etc that would improve the safety. It will always be a greater risk b/c of proximity alone, regardless of care giver for a birth outside a hospital. CMs would contribute to the highly educated population from which women can choose for their care. Educated, licensed, and regulated appropriately...that would be a vast improvement over what we currently have.