A CNM, or Certified Nurse-Midwife, is an advanced practice registered nurse who specializes in pregnancy, childbirth, and reproductive health care. CNMs hold graduate degrees in midwifery, maintain registered nursing licenses, and must pass a national certification exam administered by the American Midwifery Certification Board. There are roughly 7,000 actively employed nurse-midwives in the United States, and their scope of practice extends well beyond delivering babies.
What a CNM Actually Does
CNMs provide care across the full spectrum of reproductive health. During pregnancy, they manage prenatal visits, order and interpret lab work, monitor fetal development, and create birth plans with their patients. They attend births, managing labor and delivery for uncomplicated pregnancies. After delivery, they handle postpartum care for both parent and newborn.
Outside of pregnancy, CNMs perform annual gynecological exams, prescribe and manage birth control (including implant procedures), provide STI screening and treatment, and guide patients through menopause and hormone therapy. They are one of only two types of midwives in the U.S. whose professional training formally includes reproductive and primary care for women of all ages, not just those who are pregnant. In a workforce study of CNM practice, the most common clinical responsibilities were antepartum care (64%), intrapartum or labor-and-delivery care (61%), and gynecologic care (52%).
Where CNMs Practice
Most CNMs work in hospitals, where they manage labor and delivery within an obstetric unit alongside physicians. Others practice in freestanding birth centers, which operate on a midwifery and wellness model separate from a hospital setting. A smaller number attend home births. Some CNMs work primarily in outpatient clinics providing gynecological and primary care without attending births at all.
In freestanding birth centers, roughly one in five people admitted in labor will need to transfer to a hospital during labor, postpartum, or for newborn care. This is one reason birth centers maintain transfer agreements with nearby hospitals.
How CNM Training Differs From Other Midwives
The title “midwife” covers several different credentials in the U.S., and the training behind each one varies significantly.
- Certified Nurse-Midwife (CNM): Requires a registered nursing license plus a graduate degree from an accredited midwifery program. CNMs are licensed to practice independently in all 50 states.
- Certified Midwife (CM): Also holds a graduate degree in midwifery and provides the same level of care as a CNM, but enters from a non-nursing background (with prerequisite science and health coursework). CMs are only licensed in certain states.
- Certified Professional Midwife (CPM): Does not require a graduate or academic degree. Certification is based on demonstrated knowledge and skills, with a high school diploma as the minimum educational prerequisite. CPMs are certified through the North American Registry of Midwives, and their practice privileges vary widely by state.
The key distinction is that CNMs and CMs share the same accreditation pipeline and national certification exam, while CPMs follow an entirely separate credentialing path. For patients, this means a CNM has both nursing clinical training and graduate-level midwifery education, which is why they can prescribe medications and manage complex care.
Prescribing and Practice Authority
CNMs can prescribe medications, including controlled substances, in every state. However, the degree of independence they have varies. As of February 2025, 27 jurisdictions (including 25 states, Washington D.C., and Guam) grant CNMs full independent practice and prescriptive authority with no physician oversight required. In the remaining states, CNMs may need a collaborative agreement with a physician or some form of supervision arrangement, even though their day-to-day clinical work looks largely the same.
States with full independent authority include New York, California’s neighbors like Arizona and Oregon, and a wide geographic spread from Alaska to Delaware. If you’re considering care with a CNM, checking your state’s practice environment gives you a sense of how autonomously they can manage your care.
Birth Outcomes With Midwifery-Led Care
Research consistently shows that midwifery-led care is associated with lower rates of surgical delivery and medical intervention for low-risk pregnancies. In one study comparing a community midwifery service to standard hospital care, the overall cesarean section rate for midwifery patients was 9.75%, and for first-time mothers in spontaneous labor, it dropped to about 6% compared to 8.4% in the hospital’s general population. Induction rates were also lower: 36% for first-time mothers under midwifery care versus 43% in the hospital overall.
These differences reflect the midwifery model’s emphasis on supporting physiologic birth, meaning allowing labor to progress naturally when possible and reserving interventions for when they’re medically needed. CNMs are trained to recognize when a pregnancy or labor moves outside the normal range and to refer patients to an obstetrician or maternal-fetal medicine specialist at that point.
How to Become a CNM
The path starts with earning a registered nursing license, either through a bachelor’s degree in nursing or an accelerated nursing program. From there, you apply to a graduate-level midwifery program accredited by the Accreditation Commission for Midwifery Education. These programs typically take two to three years and combine coursework in advanced physiology, pharmacology, and midwifery care with extensive clinical rotations in prenatal clinics, labor units, and gynecology practices.
After graduating, you must pass the national certification exam through the American Midwifery Certification Board. Certification isn’t a one-time event. CNMs must meet ongoing maintenance requirements to keep their credential active, which includes continuing education and periodic re-certification.