How to become a direct-entry midwife

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Hi there, I'm interested in becoming a direct entry midwife and I'm trying to understand the pathway to apply to a program in the United States. Could you explain what the typical application process looks like, and whether this area of study is offered as an undergraduate degree program? What is the difference between CNMs, CPMs, and CMs? I'm also curious how common or widespread direct entry midwifery programs are across the country, and which schools or institutions currently offer them. Any guidance would be greatly appreciated!

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2 Answers

Specializes in Tele, ICU, Staff Development.

Becoming a Direct-Entry Midwife (DEM) involves training and certification that allows you to practice midwifery without first becoming a nurse. DEM programs prepare individuals to become 

  • Certified Professional Midwives (CPMs), and
  • Certified Midwives (CMs),
  • but not Certified Nurse Midwives (CNMs).

The CPM pathway is the most popular for becoming a midwife without a nursing degree. 

My hairstylist just delivered her first child at a birthing center here in CA, owned by a CPM. I admit I was concerned, given my nursing background, but she said it was the most beautiful experience she had ever had. 

Difference in State Licensing 

States have different licensure requirements, so it is essential to confirm local regulations before starting your training. A big difference among the three is state licensing, which determines where you are allowed to practice. 

In some states, CMs and CPMs cannot be licensed, and home births are prohibited. Others allow practice without licensing or regulation, meaning CPMs can practice but lack legal protections, recognition, and the ability to obtain insurance. 

  • Certified Professional Midwife (CPM) Licensure. CPMs are licensed in 37 states and the District of Columbia but not in Alabama, Iowa, Indiana, Kansas, Louisiana, Michigan, Montana, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, and Wisconsin.
  • Certified Midwife (CM) Licensure. CMs are licensed in Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and the District of Columbia. 
  • Certified Nurse Midwives (CNMs). CNMs are licensed in all 50 states, plus the District of Columbia and U.S. territories, as midwives, nurse-midwives, advanced practice registered nurses, or nurse practitioners.

Direct-entry midwifery state-by-state legal status.  

The PushMap shows where CPMs are authorized to practice by state.

License requirements by state

Comparison of Certification Process and Practice Settings

Certified Professional Midwife (CPM) 

  • Complete an accredited program or approved apprenticeship.
  • Obtain state licensure. Thirty-seven states license CPMs.
  • Pass the North American Registry of Midwives (NARM) exam. NARM sets the standard for the competency-based CPM credential.
  • Practice settings. CPMs specialize in low-risk, out-of-hospital births (homes and birth centers).

Certified Midwife (CM) 

  • Complete an accredited Master's in Midwifery program. 
  • Obtain state licensure. Few states license CMs (but you're only going to live in one state :).
  • Pass the American Midwifery Certification Board (AMCB) exam (same as nurses).
  • Practice settings. Can practice in hospitals and out-of-hospital settings.

Certified Nurse Midwives (CNM) 

  • Complete an accredited Master of Science in Nursing (MSN) with a focus on midwifery. The CNM is an advanced practice RN (APRN) who is a graduate of a nurse-midwifery program and is nationally certified and licensed as a healthcare provider.
  • Obtain state licensure. All states license CNMs. 
  • Pass the AMCB exam. 
  • Practice settings. Can practice in hospitals and out-of-hospital settings.

Read Comparison of Certified Nurse Midwives, Certified Midwives, and Certified Professional Midwives by the American College of Nurse Midwives (ACNM).

Apprenticeship 

Some DEMs train through a 2-3 year apprenticeship under the guidance of an experienced midwife, gaining both didactic and clinical experience. 

Apprenticeships are flexible, affordable, and require dedication, offering personalized learning and mentorship. However, they may not provide the same level of theoretical knowledge or formal recognition as academic programs, which could limit career opportunities in some settings.

 NARM requires that the clinical component of the educational process must be:

  • at least two years in duration and
  • include a minimum of 55 births in three distinct categories.

Different Pathways

There are many ways to get there, and multiple options depending on your lifestyle and ultimate end goal.

  • Academically and lifestyle-wise, it could make sense to become a diploma or certified CPM and, after that, get your Bachelor's or Master's as a working CPM. Maybe the fastest track to a working CPM.
  • Alternatively, you could earn your Bachelor's degree in a non-midwifery field and then attend a school for your graduate degree.
  • You could also attend one of the few non-nursing Bachelor's midwife programs.

Find a school: Considerations When Choosing a Program 

  • Accreditation. Ensure the program is accredited by the Midwifery Education Accreditation Council (MEAC) or the Accreditation Commission for Midwifery Education (ACME).
  • Look at the school's pass rates.
  • Clinical experience. Look for programs with strong partnerships with birth centers or home birth practices where you can get hands-on experience.  

Prerequisites

Prerequisites for accredited programs vary, but typically include specific courses such as statistics, Microbiology, anatomy, and physiology, as well as relevant experience, such as childbirth education or doula certification. 

I recommend first choosing a school. Then, ensure that you meet your prerequisites, verifying that they are transferable and align with the school's specific application requirements.

Midwifery Program Overview

Undergraduate and certificate programs to qualify for CPM 

Graduate programs to qualify for CPM and CM

Bastyr University  (Seattle, Washington). MEAC-accredited. MSM. Pre-reqs include doula training. 

Thomas Jefferson University.  (Philadelphia, Pennsylvania) ACME-accredited. According to the site: "The Midwifery & Women's Health Programs at Jefferson is currently the only distance learning program offering the CM option to a national pool of qualified candidates. Because this credential is not yet widely recognized, students who take this educational pathway are true pioneers in the discipline. While we encourage all students to join their state professional association affiliate, this is particularly important for anyone considering the CM pathway." Pre-reqs are a Bachelor's degree and completion of specific science courses. MSM

I hope this helps shed some light on your path to becoming a midwife!

Very best wishes,

Nurse Beth

Resources

Article: Certified Nurse Midwife (CNM): Job Description, Salary, and How to Become One

The Accreditation Commission for Midwifery Education (ACME) accredits midwifery education programs and institutions. 

The Midwifery Education Accreditation Council (MEAC) accredits midwifery education programs and institutions. 

American Midwifery Certification Board (AMCB)    

American College of Nurse-Midwives (ACNM) primarily accredits nurse-midwifery programs; it also accredits some direct-entry midwifery programs.

North American Registry of Midwives (NARM) 

NARM Candidate Information Booklet

Specializes in CRNA, Finally retired.

Just Google  how to become a midwife without a nursing degree in the us.  There are programs in Florida.  If you want to become a CNM, you must get your BSN first, some experience and then you will be granted a nursing master's or doctorate degree.  You will need to be a CNM to work on an OB unit in hospitals.  States have different regulations re: practice and payment for non-nurse midwives.  You would have to check those regs out with the individual states.  Not all states allow CPM's.

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