Certified nurse-midwives and certified professional midwives are the professionals who deliver babies at home in the United States. While doctors technically can attend home births, very few do. The vast majority of planned home births are managed by midwives who specialize in out-of-hospital care, and the type of midwife you hire affects everything from their training level to whether your insurance will cover the cost.
Certified Nurse-Midwives
Certified nurse-midwives (CNMs) hold a master’s or doctorate degree from a university-affiliated nursing and midwifery program. They are advanced practice nurses, meaning they can prescribe medications, order lab work, and manage complications that fall within their scope. CNMs are licensed in all 50 states and can practice in any birth setting: hospitals, birth centers, or homes.
Because CNMs often work within hospital systems, finding one who attends home births can take some effort depending on where you live. Many CNMs who do home births run independent practices and carry their own malpractice insurance. Their medical training makes them the most broadly credentialed option for a home birth provider, and their services are more likely to be partially covered by insurance or Medicaid compared to other midwife types.
Certified Professional Midwives
Certified professional midwives (CPMs) follow a different path. The CPM credential, issued by the North American Registry of Midwives, recognizes multiple routes of education, including direct-entry midwifery programs and apprenticeships. CPMs must meet clinical requirements, pass a skills evaluation, and complete a written exam. A key distinction: CPMs are specifically required to have out-of-hospital birth experience as part of their certification, which means home birth is central to their training rather than an add-on.
CPMs currently have a path to licensure in 37 states and the District of Columbia. In states where they’re licensed, they practice independently and carry the same professional obligations as any licensed healthcare provider. In states without licensure, the legal landscape is murkier. Some states explicitly prohibit CPM practice, while others simply don’t regulate it, which can leave families in a gray area regarding accountability and insurance coverage.
Traditional and Lay Midwives
Traditional midwives, sometimes called lay midwives, enter the profession through apprenticeship with a practicing midwife rather than through a formal school or certification program. They do not hold a nationally recognized credential. In some communities, particularly in rural areas or among cultural groups with long traditions of midwifery, lay midwives remain active birth attendants.
The practical difference is oversight. Without certification, there is no standardized exam, no required clinical hours, and no governing body to handle complaints. Some lay midwives are highly experienced, but there is no external verification of that experience. If you’re considering a lay midwife, the responsibility of evaluating their skills falls entirely on you.
Why Doctors Rarely Attend Home Births
OB/GYNs almost never attend planned home births. The American College of Obstetricians and Gynecologists (ACOG) does not recommend home birth as the safest setting, and most OB/GYNs are hospital-based with no infrastructure for home practice. A small number of family medicine physicians attend home births in certain regions, but they represent a tiny fraction of providers. For practical purposes, if you’re planning a home birth, you’re hiring a midwife.
How Doulas Fit In
Doulas often attend home births, but they do not deliver babies. A doula provides emotional support, physical comfort measures, and advocacy during labor. They cannot perform medical tasks: no cervical exams, no catching the baby, no suturing, no prescribing. Think of a doula as a support person you hire, not a medical provider. Many families planning a home birth hire both a midwife and a doula, with the midwife handling all clinical care and the doula focused on comfort and encouragement.
What Home Birth Midwives Bring
Home birth midwives don’t show up with just a pair of gloves and a towel. They carry professional-grade medical equipment, including oxygen tanks and infant resuscitation gear (resuscitator bags, masks, airways, and nasal cannulas), IV supplies, medications to manage postpartum bleeding, suturing kits for perineal tears, and tools for monitoring the baby’s heart rate throughout labor. The setup is portable but comprehensive enough to handle the most common emergencies while arranging a hospital transfer if needed.
Your midwife will also bring sterile supplies like gauze, hemostatic forceps for controlling bleeding, cord clamps, and basic lab equipment. Most midwives ask families to purchase a separate birth kit with disposable items like underpads, gloves, and plastic sheeting to protect surfaces.
Who Qualifies for a Home Birth
Not every pregnancy is a candidate. ACOG lists three absolute contraindications: breech or other abnormal fetal positioning, twins or higher multiples, and a prior cesarean delivery. Some researchers argue the list should be longer, recommending that first-time mothers and pregnancies past 41 weeks also be excluded due to higher transfer and complication rates.
Beyond those, most midwives will screen for conditions like preeclampsia, gestational diabetes requiring insulin, placenta previa, and significant heart or kidney disease. The general criteria for a safe home birth include a single baby in a head-down position, gestational age between roughly 37 and 41 weeks, spontaneous or outpatient-induced labor, and no serious maternal health conditions that developed before or during pregnancy.
Hospital Transfer Rates
A significant percentage of planned home births end with a transfer to the hospital, and the numbers vary dramatically based on whether you’ve given birth before. For first-time mothers, transfer rates range from 23% to 45%. For mothers who have previously delivered vaginally, the range drops to 6% to 12%. Most transfers are not emergencies. They’re for slow labor progress, exhaustion, or the desire for pain medication. Your midwife will have a transfer plan in place before labor begins, typically including a predetermined hospital and communication with a backup physician.
What It Costs
The average cost of a midwife-attended home birth in the United States is about $4,650, with most fees falling between $3,200 and $6,000. That’s a global fee covering prenatal visits, the birth itself, and postpartum care. For comparison, the average cost of a vaginal hospital birth is roughly $13,560 when you include facility, professional, and newborn fees. Even the out-of-pocket cost for women with employer-provided insurance averages about $4,945 for a vaginal hospital birth, which is comparable to the total cost of a home birth.
The catch is that many insurance plans don’t cover home births, or cover them only when attended by a CNM. CPM services are less consistently reimbursed. Most home birth midwives require payment upfront or on a payment plan, and families should ask specifically about what the global fee includes, since lab work, ultrasounds, and the birth kit are sometimes billed separately.
Postpartum Care at Home
One advantage of hiring a home birth midwife is the postpartum follow-up. Rather than a single six-week office visit, most midwives schedule multiple home visits: one in the first few days after birth, another at one to two weeks, a check at four weeks, and a final visit around six weeks. During these visits, the midwife monitors your blood pressure and watches for warning signs of postpartum preeclampsia and blood clots, checks the baby’s weight gain, evaluates breastfeeding, screens for postpartum mood disorders, and can refer you to a lactation consultant or other specialists. The six-week visit often includes a standard pelvic exam if needed.