Inconsistent Standards: Education, Certification, and Oversight Gaps

Overview

The Certified Professional Midwife (CPM) credential is based on inconsistent and often inadequate educational preparation. Unlike other licensed health professionals, CPMs are not required to complete a degree, attend an accredited training program, or demonstrate proficiency in emergency care, pharmacology, or hospital-based collaboration.

The result? A patchwork system where licensure does not guarantee safety or competency—and families are often unaware of the risks.

Inadequate Educational Requirements

• No College Degree: CPMs are the only maternity care providers in the U.S. who can be licensed without a college degree.

• Non-Academic Apprenticeships: Many CPMs are trained exclusively through apprenticeships, without formal classroom instruction.

• No Hospital Experience: Most CPMs have never managed birth emergencies—like hemorrhage or neonatal resuscitation—in a hospital or accredited setting.

• Unqualified Preceptors: CPM students can be trained by unlicensed or legally problematic preceptors, including some under criminal investigation.

• Lower Standards Than Other Professions: In many states, barbers and tattoo artists face stricter training and testing requirements than CPMs.

Not Recognized Internationally: CPMs Fall Below Global Midwifery Standards

Globally, Certified Professional Midwives are not recognized as qualified providers. Their training, certification, and scope of practice do not meet the standards set by the International Confederation of Midwives (ICM).

“There is no such thing as a home-birth-only midwife in British Columbia or anywhere in Canada.”
— Louise Aerts, Registrar, Canadian Midwifery Regulators Council

International Standards Require:

• A bachelor’s degree or higher

• Accredited academic midwifery education

• Clinical training in both hospital and out-of-hospital settings

• Integration with the formal health care system

• Transfer agreements with physicians and hospitals

CPMs Do Not Meet These Minimums

• Most CPMs do not hold a college degree

• Many are trained through non-accredited, apprenticeship-only models

• They lack hospital training and clinical oversight

• They are not required to demonstrate competency in managing emergencies or pharmacologic care

• They often operate without physician collaboration, oversight, or malpractice insurance

According to the International Confederation of Midwives (ICM), CPMs do not meet the global definition of a midwife.

Not Meeting Basic International Standards Confuses Consumers

• Consumers are led to believe that CPMs are comparable to nurse-midwives or international peers.

• In reality, CPMs are a U.S.-only credential, developed outside the formal health system, and not held to internationally accepted standards or recognized in other countries.

• If the credential isn’t strong enough to be recognized abroad, even in areas with less developed healthcare systems, it should not be licensed as equivalent to other health professionals in the USA.

How Certified Professional Midwives Undermined the US MERA Agreement

In 2013, midwifery organizations—including the North American Registry of Midwives (NARM)—agreed to raise education standards for CPMs. They promised that by 2020, all new CPMs would graduate from a nationally accredited program aligned with global benchmarks. Read the MERA Agreement here

That did not happen.

• The majority of CPMs certified today have not completed accredited training.

• As many as 80% of CPMs do not meet the International Confederation of Midwives (ICM) standards followed by most countries worldwide.

The profession gained legal recognition by promising reform, but failed to deliver.

Certification Without Oversight

The NARM exam (North American Registry of Midwives certification exam) has faced significant criticism—particularly regarding its lack of rigor, limited clinical relevance, and failure to meet basic standards of professional healthcare testing.

CPMs are certified by NARM, a private credentialing body that:

• Does not require simulation-based testing or emergency skill verification.

• Does not conduct independent investigations without maternal consent—even in cases of death or injury.

• Has no mechanism to ensure consistent enforcement of standards across states.

Certification offers the appearance of professional regulation, but lacks the basic safeguards expected in other licensed health professions.

Why States Should Reconsider CPM Licensure

Licensing Certified Professional Midwives with low educational standards and weak accountability mechanisms puts families at risk.

• Consumers wrongly assume "licensed" means "qualified"

• Midwives may practice beyond their training, with no required path for improvement

• States carry liability without the tools to enforce clinical safety

Licensure should be reserved for providers who meet minimum public safety standards, not awarded due to historical precedent or political pressure.