You can become a midwife without a nursing degree through two main pathways: earning a Certified Professional Midwife (CPM) credential or a Certified Midwife (CM) credential. Both allow you to practice legally, but they differ in scope, education requirements, and where you can work. Which path makes sense depends on what kind of midwifery you want to practice and where you plan to live.
Two Credentials, Two Different Paths
The CPM (Certified Professional Midwife) credential is designed specifically for out-of-hospital birth. CPMs typically attend home births and work in freestanding birth centers. Most are self-employed. This credential does not require a bachelor’s degree or any nursing background. It’s the most common route for people who want to practice midwifery without going through nursing school first.
The CM (Certified Midwife) credential is closer in scope to a Certified Nurse-Midwife (CNM) but doesn’t require a nursing degree. CMs complete a graduate-level midwifery program and pass the same national certification exam that nurse-midwives take. They can provide a broader range of care, including gynecological services and primary care for women across the lifespan, not just pregnancy and birth. The tradeoff is a longer, more rigorous educational path.
Becoming a Certified Professional Midwife
To earn the CPM credential, you need to complete an education program accredited by the Midwifery Education Accreditation Council (MEAC), the only accrediting agency for direct-entry midwifery programs recognized by the U.S. Department of Education. MEAC currently accredits 13 programs across the country, including Bastyr University, the Florida School of Traditional Midwifery, Midwives College of Utah, National College of Midwifery, and several others.
These programs vary significantly in format. Some are campus-based, others are distance learning with clinical apprenticeships arranged locally. Program length ranges from about three to five years depending on whether you attend full or part time. Coursework covers anatomy and physiology, prenatal and postpartum care, newborn assessment, pharmacology relevant to birth, and emergency management. A substantial clinical component is required, where you attend births under supervision.
After completing your program, you sit for the North American Registry of Midwives (NARM) exam. Passing this exam earns you the CPM credential. There is also an apprenticeship route to the CPM that doesn’t go through a MEAC-accredited school, though this path is being phased out in some states and is harder to navigate.
Becoming a Certified Midwife
The CM pathway requires a bachelor’s degree in any field, plus completion of specific prerequisite courses. You’ll need a strong foundation in the basic sciences: biology, microbiology, chemistry, human anatomy and physiology. Programs also commonly require or recommend coursework in nutrition, algebra and statistics, lifespan development, English composition, sociology, and psychology. Prerequisites vary by program, so contacting schools directly is important.
After meeting prerequisites, you enter a graduate-level midwifery program (typically a master’s degree) that includes both didactic coursework and extensive clinical training. Upon graduation, you take the same certification exam administered by the American Midwifery Certification Board that nurse-midwives take. This is a rigorous, comprehensive exam covering the full scope of midwifery practice.
The CM credential is currently recognized in 13 states plus the District of Columbia: Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, Minnesota, New Jersey, New York, Oklahoma, Rhode Island, and Virginia. If you’re considering this path, check whether your state is on that list before investing in the education.
Where Each Credential Is Legal
State laws around non-nurse midwifery vary enormously, and this is one of the most important factors in choosing your path. Roughly 24 states license direct-entry midwives (the CPM pathway). At least eight of those states require the CPM credential specifically to obtain a state license: Delaware, Minnesota, New Jersey, Tennessee, Utah, Vermont, Virginia, and Wisconsin. In states like Colorado, Oregon, and Texas, holding a CPM makes you automatically eligible for licensure. Arkansas requires CPMs to pass an additional state exam.
Sixteen states neither prohibit nor regulate direct-entry midwifery, including Connecticut, Georgia, Hawaii, Idaho, Kansas, Maine, Massachusetts, Michigan, and Pennsylvania, among others. In these states, you can technically practice, but without a licensing framework you won’t have malpractice insurance options, Medicaid reimbursement, or the legal protections that come with licensure.
Ten states effectively prohibit direct-entry midwifery through laws, court decisions, or legal interpretations: Alabama, Iowa, Illinois, Indiana, Kentucky, Maryland, Missouri, North Carolina, South Dakota, and Wyoming. If you live in one of these states, the CPM pathway won’t give you a legal way to practice locally. The CM credential, while recognized in fewer states overall, may be an option in some places where the CPM is not (Maryland, for example, recognizes the CM but prohibits direct-entry midwifery).
Choosing Between CPM and CM
Your decision should come down to three things: where you want to practice, what kind of care you want to provide, and how much time and money you can invest in education.
If you want to attend home births and work in birth centers, and you live in a state that licenses CPMs, the CPM pathway is more direct. Programs are generally shorter and less expensive than graduate school, and many offer flexible scheduling for students who are working or raising families. The clinical training is focused specifically on physiologic, out-of-hospital birth.
If you want a broader clinical scope, the ability to provide well-woman care, prescriptive authority, or the option to work in hospitals, the CM pathway offers more. It’s also a stronger credential if you think you might eventually want to move between states, since the trend has been toward more states recognizing the CM. The cost is higher, the timeline is longer (typically two to three years of graduate school after prerequisites), and admission is competitive.
What the Career Looks Like
Most direct-entry midwives with a CPM are self-employed. They build their own practices, set their own fees, and manage the business side of care alongside the clinical work. Income varies widely depending on location, client volume, and whether your state allows Medicaid reimbursement for midwifery services. This is fundamentally entrepreneurial work, and financial stability can take time to build.
CMs have more flexibility in employment settings. Depending on state law, they may work in hospitals, clinics, birth centers, or private practice. Their earning potential is generally closer to that of nurse-midwives, though this varies by state recognition and employer willingness to credential CMs.
Both pathways require ongoing continuing education to maintain certification. CPMs recertify through NARM, and CMs recertify through the American Midwifery Certification Board. Most states with licensure also have their own renewal requirements.
Practical Steps to Get Started
- Research your state’s laws first. Everything else flows from whether your state licenses CPMs, recognizes CMs, or prohibits non-nurse midwifery entirely.
- Shadow a practicing midwife. Spend time at births and prenatal visits before committing to a program. Many MEAC-accredited schools expect applicants to have some birth experience.
- Start prerequisite courses. If you’re leaning toward the CM path, take your science prerequisites at a community college. For the CPM path, prerequisites vary by program but generally include basic anatomy, physiology, and biology.
- Contact programs directly. Admission requirements, clinical placement logistics, and tuition vary enough that you need specifics from each school. MEAC’s website lists all 13 accredited direct-entry programs with contact information.
- Connect with professional organizations. The Midwives Alliance of North America (MANA) and the American College of Nurse-Midwives both offer resources for prospective midwives, including mentorship networks and state-by-state legal guides.