Some midwives are nurses, but not all. In the United States, there are three main types of midwives, and only one requires a nursing degree and an active registered nurse (RN) license. The distinction matters because it affects where a midwife can practice, what services they can provide, and whether they can prescribe medication.
Certified Nurse-Midwives Start as Nurses
Certified Nurse-Midwives (CNMs) are the most widely recognized type of midwife in the U.S., and they are, by definition, nurses first. To sit for the CNM certification exam, candidates must hold an active RN license and complete a graduate degree from an accredited midwifery education program. This means every CNM has gone through nursing school, passed the nursing licensure exam, and then completed additional graduate-level training specifically in midwifery.
CNMs have legal authority to practice in all 50 states, the District of Columbia, and most U.S. territories. They can prescribe medication in every state, though the level of independence varies. About 93% of practicing CNMs hold prescriptive authority, and most employers require them to carry a DEA license for controlled substances. Their scope goes well beyond delivering babies: CNMs provide reproductive and primary care to women of all ages, perform limited ultrasounds, manage psychological and endocrine conditions, and handle complications like manual removal of the placenta. They spend several hours each week on tasks like reviewing lab results and completing referral forms, much like other advanced practice clinicians.
Certified Midwives Skip the Nursing Route
Certified Midwives (CMs) take the same national certification exam as CNMs and meet the same midwifery education standards, but they do not need a nursing degree or RN license. CMs typically enter midwifery through a graduate program with a different undergraduate background, such as biology or public health. If a CM later obtains an RN license, they can convert their credential to CNM.
The biggest limitation for CMs is geography. Only 11 states and the District of Columbia currently recognize the CM credential: Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, and Virginia. Prescriptive authority is even more restricted. As of the most recent national review, only New York had granted CMs the ability to write prescriptions.
Certified Professional Midwives Take a Different Path Entirely
Certified Professional Midwives (CPMs) follow a completely separate credentialing system with no nursing requirement. CPMs are certified through the North American Registry of Midwives (NARM) after completing training, supervised clinical experience, and passing both a skills assessment and a written exam. Some CPMs attend accredited midwifery schools, while others qualify through NARM’s Portfolio Evaluation Process, which verifies knowledge and skills through work with qualified preceptors.
The CPM is the only nationally accredited midwifery credential that requires out-of-hospital birth experience. This reflects the CPM’s primary practice setting: homes and freestanding birth centers rather than hospitals. As of late 2024, CPMs have a path to licensure in 37 states and D.C., though rules vary widely on what they can and cannot do. CPMs generally do not have prescriptive authority and do not provide the broader primary care services that CNMs offer.
Where Each Type Typically Works
CNMs practice in hospitals, birth centers, and home settings, though the majority work in hospitals or hospital-affiliated clinics. Their nursing background and graduate training give them the broadest scope of practice and the widest acceptance within the healthcare system. CMs work in similar settings where their credential is recognized, but their options are limited by the small number of states that license them.
CPMs are concentrated in out-of-hospital settings. Research on planned home births with registered midwives shows that roughly 79% of women who plan a home birth with a midwife deliver at home, while the rest transfer to a hospital during labor. In hospital settings, CPMs are rarely granted privileges.
Why the Distinction Matters for Care
Midwives of all types attended about 12% of all U.S. births in 2021, a number that has been climbing in recent years. Research consistently shows that midwifery-led care is associated with lower intervention rates. In one study comparing midwifery-led care to standard hospital care, first-time mothers in spontaneous labor under midwife care had a cesarean rate of about 6%, compared to 8.4% in the broader hospital population. The induction rate for first-time mothers was 36% in midwifery care versus 43% hospital-wide. Women who had a previous vaginal birth and were in spontaneous labor under midwife care had a cesarean rate below 1%.
These lower intervention rates held across multiple groups. Women who received continuous care from a small team of midwives throughout pregnancy and birth were also less likely to deliver prematurely. The pattern reflects a core philosophy shared across all midwifery types: treating birth as a normal physiological process and reserving medical intervention for situations that genuinely need it.
Quick Comparison of U.S. Midwife Types
- CNM (Certified Nurse-Midwife): Requires RN license and graduate midwifery degree. Licensed in all 50 states. Can prescribe medication. Works in hospitals, birth centers, and homes.
- CM (Certified Midwife): Requires graduate midwifery degree but no nursing license. Recognized in 11 states and D.C. Very limited prescriptive authority. Same certification exam as CNMs.
- CPM (Certified Professional Midwife): No nursing or graduate degree required. Certified through NARM. Licensed in 37 states and D.C. Practices primarily in out-of-hospital settings. No prescriptive authority in most states.
If you’re choosing a midwife, the credential tells you a lot about their training, where they can practice, and what level of medical care they can provide. CNMs offer the broadest clinical capabilities because they combine full nursing training with advanced midwifery education. CMs have equivalent midwifery training without the nursing foundation. CPMs specialize in physiologic birth outside hospitals and follow a distinct training pathway that prioritizes hands-on apprenticeship and out-of-hospital experience.