Certified Professional Midwife vs. Certified Nurse-Midwife (CPM vs CNM)

REVISED: This blog has been edited based on feedback from the Hearthside Online Midwifery Study Group on Facebook.

Once I decided to become a midwife, the next step was determining what type of midwife to become. It was challenging to find thorough information about the different options. I basically could only find a surface-level overview, which I found completely unsatisfying when making a decision that would impact the rest of my career! To help future aspiring midwifes, I’ve decided to share an overview of the CPM vs. CNM option (Certified Professional Midwife vs. Certified Nurse-Midwife) based on my research.

A variety of opinions

  • The U.S. is unique in that it offers a variety of routes for becoming a midwife. While the primary licensing organizations are nationwide, each state sets their own regulations. Which means there is a LOT of variety between midwifes with different certifications in different states. A “licensed midwife” is someone who has met the requirements set by the state for licensure. Some states allow for non-licensed midwifes (sometimes called Traditional Midwifes).
  • There are also different camps of people who are working towards establishing nationwide definitions/regulations and increasing the scope of what midwifes are allowed to do. This leads to a significant amount of debate, and sometimes defensiveness, within the midwifery community.

Certified Professional Midwives (CPM)

  • Licensed and trained in midwifery only.
  • You can become a CPM without going to a school. This is accomplished via apprenticeship and licensure requires PEP (Portfolio Evaluation Process).
  • If you go to school, you can go to an MEAC accredited school or one that isn’t accredited. Non-accredited schooling requires PEP as well.
  • Entry-level education for an MEAC accredited school seems to range from Associates to Master’s Degrees
  • Can practice in most states, but some states will not license CPMs
  • Can only deliver OOH (Out of Hospital) in the home (if legal in the state) or in a birth center
  • Does not require physician oversight
  • Cannot write prescriptions
  • Care is limited to pregnant or post-partum women in some states. Other states allow well-woman care as well.

A few observations:

  • This seems to be the preferred route for women who are highly committed to home birth and/or natural birth.
  • The schooling is regulated, but it seems like training can be inconsistent and highly dependent on the preceptor who trains you (a preceptor is a midwife who trains new midwives). This article has an interesting perspective on “black holes” of knowledge for CPMs.
  • The autonomy of not having physician oversight is appealing
  • CPMs typically also become business owners. Some aspiring midwifes prefer the CNM route because they don’t want to own their own business. Others prefer this type of autonomy
  • CPMs typically practice in 24/7 on call roles and as the years add up they can suffer from burnout. This lifestyle can be challenging on families
  • The cost of training can vary greatly. Schools I’ve seen can range from $15k to $60k.
  • The prerequisites for training vary greatly: some schools have no prereqs, others have similar prereqs to nursing schools and other require attending training to become a doula and/or child birth educator.
  • I met some students who started nursing school and discovered it was not a good fit for them, so they changed to the CPM route so they could focus solely on birth in their education instead of “jumping through the nursing school hoop” (which is a very expensive thing to do)

CPM schools
I looked into a lot of CPM schools. Here’s my personal top picks based on what I found:

For CPMs it looks like a lot of the Masters and PhD programs are primarily focused on research.

Nurse-Midwife (CNM)

  • Licensed and trained as Registered Nurse and in midwifery. 
  • Entry-level education: Master’s Degrees
  • Can practice in all states, although their scope (what they’re allowed to do) varies from state to state.
  • Can deliver in all settings (home, birth center or hospital) depending on state regulations.
  • Can provide care from “menarche through menopause” (menarche being the first menstrual cycle).
  • Needs physician oversight in most states
  • Can write prescriptions

A few observations:

  • A lot of information I read seems to assume someone is already a nurse when they want to become a midwife, which makes it challenging to figure out what to do if you know you want to be a midwife and nursing is simply part of the journey.
  • Education requires an RN and a Master’s in Midwifery. There are a variety of ways to accomplish this and as a result the educational path can seem overwhelming to navigate.
  • Some RN programs require CNA training as a prereq. A few CNMs recommend the CNA training even if it’s not required because it helps reduce the culture shock of nursing school.
  • The practice on CNM seems to range from the Midwifery Model of Care to the Medical Model (where the CNM practices similar to an OB). This article has an interesting take on the necessity for midwifes to be midwifed, which seems less common for CNMs because of the adage “nurses eat their young”
  • Doula training is incorporated into the midwifery training so it isn’t a prerequisite.
  • In states where physician oversight is required it seems like a midwife’s experience is greatly dependent on the model of care of the physician (for example: a mother is 42 weeks, the midwife thinks they should wait for labor to start naturally but the doctor wants to induce)
  • This option offers career flexibility: a midwife can practice 24/7 on call for a while, then work shifts at a hospital, can move out of midwifery and do other types of nursing or after a few years of experience can become a professor.
  • The training is expensive (in some cases ranging from $60k-100k)
  • The prereqs between programs can vary (because there are so many different routes) but along the way it looks highly likely that you’ll take Anatomy & Physiology, Microbiology, Chemistry and some upper division Psychology courses.
  • I ran into several CPMs who had decided to become CNMs for one reason or another. However, there doesn’t seem to be a smooth way to become a CNM. It’s a lot like starting completely over (educationally speaking).

Certified Midwife

In my research I also came across this option. There seems to be two different definitions: one that is similar to a Licensed Midwife* and one that is similar to the CNM but without the RN. There seems to be some controversy about the existence of the latter option (here is an article I found interesting that touched on this subject and also provides some insight on the history of certification in the U.S.) and when I contacted a school that offered this program they practically encouraged me not to apply since you can only practice in 5 states and it’s hard to find positions since it’s a “pioneering” role.

The most commonly recommended resources

midwife-pathsThroughout my research I consistently saw links to these two resources:

A few additional actions that helped me make a decision:

  1. I visited a local birthing center and talked to a CPM student
  2. I found a group on Facebook that was very responsive to explaining why they chose the CPM vs. CNM route
  3. A midwife asked me to answer these questions: What are your goals? How do you see yourself practicing?

UPDATE: I chose to attend nursing school! You can learn more about what I love about nursing here.

41 thoughts on “Certified Professional Midwife vs. Certified Nurse-Midwife (CPM vs CNM)

  1. I have been going insane trying to decide what the best route for me to take is and although I have yet to decide between the cnm or cpm, I feel like this summed up alot of my questions and concerns. I feel there is more security with the cnm but the reason I am teaching this career path is because of my passion for natural birth. I strongly believe our bodies are made to birth and have all components to do so ready on deck. (Obviously on some cases intervention is needed). I feel as a cnm I may feel restricted or not able to really practice what I believe in… But again, the security of the cnm and the flexibility with a family is appealing. I want to be able to make about of time for my family when I have children in the next couple years but I also want to be able to financially provide for them without burning myself out. I am so very torn. 🙁

    • Thanks for the comment, Brittany. It’s a tough choice to make. I decided to go to nursing school and I am very happy with this path. Nursing alone offers so many options and so much flexibility. I wish you the best in deciding what’s going to work best for your life. If you want to chat more, feel free to message me on Facebook.

      • Do you feel there are more mandatory restrictions applied to the CNM career path (physician oversight)? Or is this based on how and where you choose to practice? As in could I operate on more of a CPM capacity with my CNM licensure, or are regulations state mandated and enforced?

        • Welcome back, Sarah! I think the answer to this greatly depends on where you practice. Before I started researching midwifery (and then going to nursing school) I thought healthcare was regulated at the federal level, not the state level and I had no idea how complex regulations could be! Even as a Registered Nurse the scope of practice is different across state lines.
          Connecting with practicing CNMs and CPMs in the state where you plan to practice will probably get you the best information. I learned a LOT from posting questions in this Facebook group: https://www.facebook.com/groups/Hearthside/
          Also, in states that require physician oversight I think that your experience will depend on the philosophy and personality of the physician you work with.

          With all that being said, as I near the end of nursing school, my perspective on having oversight and restrictions has greatly changed. I used to feel like this would impinge on my autonomy to do what I thought was best for my patient. Now I appreciate regulatory bodies that look at all the available research, define best practice and work towards policies that ensure providers follow those practices so that our patients are safe. I’ve also learned that in healthcare very little is black and white.

          You may also be interested in reading my response to Simon below.

  2. Thank you so much for this information! This is exactly what I am trying to decide. I have never been interested in nursing but I am leaning going this route for many of the reasons you listed. I did most of a traditional distance learning program for almost 5 years until they stopped communicating, ect. I never did an internship because I am single and my children were small at the time. I am back in college now and have been doing some research on my options. Again, thank you for summing this up. 🙂
    PS. I would be interested to hear your experience in nursing school so far.

    • Hi Carri, Thanks for the comment! I love nursing school; it’s a great fit for me. It’s as intense as everyone said it would be–primarily because of the volume of content that is covered in a short period of time. I wish you the best as you decide on the path that works best for you.

  3. Thank you for this summary! I am currently an RN working in Labor and Delivery. My passion has always been for natural childbirth and empowering women to trust their own bodies. I am leaning toward the CPM because I see myself in that light as opposed to clinical practice. Could you share which facebook group you collaborated with? I am currently looking at Birthingway School of Midwifery in Portland.

  4. Where have you been the last 3 years? guess I wasnt looking hard enough you helpped me make my decisions about school in a matter of the time it took to read this

  5. Do you know if it’s possible to have licensure as *both* a CPM and a CNM? I’m training as a midwife in the UK, where we assist and support births both in and out of hospital and operate from a natural and undisturbed birth paradigm, but are also trained to work within a medical model as required (or preferred by mum). I want to be able to come back to the US to practice as well, and ideally would want to have both the ability to work in hospital *and* the autonomy to work without the supervision of a doctor for OOH births… Can that be done?

    • Hi Rachel! Congrats on training to be a midwife in the UK.

      I apologize for not responding sooner — I just found out that I haven’t been receiving notifications about comments 🙁

      Interesting question. I don’t know the answer. I imagine that being licensed as a CPM and CNM simultaneously would create some strange dynamics especially if you were in a state that required physician oversite for the CNM license. I’d recommend reaching out to some midwife groups/forums and seeing if you find anyone who is practicing like this. Good luck on your journey!

  6. This is a really great post ~ Thank you Krista! I am returning to school for midwifery, after 12 years of being a doula and growing my own family. I am becoming a midwife because I live in an area where there are no midwives of color and we have the highest infant mortality rate in the nation ~ I am in Michigan. I am going the CNM to reach as many people as possible.

    Your writing is clear and informative ~ stay blessed! Sokhna Heather

  7. After reading all the comments I think my options are: Do I want to be supervised in delivery situations or do I want autonomy in delivery? If I want to do natural child birth I would need the autonomy therefore leading to both options still. CNM are well rounded and versatile even though they are under the supervision of a doctor (when complications arise) otherwise they are autonomic. So that’s the route I will choose. In September 2017 I will finish my ADN and I will continue toward the MSN program which will give me access to the CNM.

  8. Hi Krista,

    Thank you for this helpful summary – Do you have a personal opinion on which of both (CPM or CNM) is more qualified?

    Best,

    Simon

    • Hi Simon, That’s a great question. The more I learned, the more concerned/unsettled I felt about the CPM route.
      1) The biggest red flag was a couple articles I read by CPMs who talked about holes in the educational process and how every CPM they knew had at least one important thing that was completely left out of their education. And since we don’t know what we don’t know, that hole only became apparent when a situation required the knowledge that they didn’t have. As a provider, I don’t want to end up in that type of situation.
      2) I’ve talked to a lot of people that prefer the CPM route because of a deep distrust of western medicine. Going through nursing school has given me a different perspective. As a patient, I used to feel distrust, but a lot of that was because my providers didn’t take the time to explain what was going on or listen to my concerns. Having learned about the nursing process–which is so different from the medical process–I’ve become a huge fan of advanced nurse practitioners like CNMs.
      3) I think some of the appeal for the CPM route is a desire for autonomy. As an independent person, I get this. But nursing school has shown me how much I don’t know and how much I need to be able to collaborate effectively with a variety of care providers. There is naturally friction when people come from different perspectives, but if they communicate effectively it can lead to better care because no one has all the answers.
      So, to answer your question: I strongly feel that the CNM is the route that will provide the safest patient care.

      • Thank you! Your post and responses are so helpful to me as I am looking into both options fervently. Have you found in nursing school that they are more “patient-centric” then probably doctors are? Where are you at now on the nursing journey? And autonomy can be realized on the CNM path… you just have to wait until after graduation if you work at a birth center.

        • I’m glad that this post was helpful to you! I’ve been working as an ER RN for a year and a half. So, nowhere near midwifery… it’s interesting how plans change as you learn more about yourself and what connects with you. Honestly, the more I see and learn, the more nervous I feel about CPMs and homebirths. I’ve seen a postpartum hemorrhage transferred from a homebirth. I’ve cared for patients (and have a nephew) with rare congenital birth issues that needed immediate life-saving interventions. I had a patient with a life-threating pregnancy complication and a midwife (non-nurse) I know had never heard of that complication. An acquaintance had an Amniotic Fluid Embolism which frequently causes maternal death even in a hospital setting. In nursing, the two top priorities (other than airway, breathing and circulation… the ABCs) are infection control and safety. I have been trained to think of all the safety implications of every decision/circumstance. Two of my siblings were born at home (one before the midwife arrived). It was a beautiful family experience and looking back I’m so thankful that there were no complications. But what blows me away now is that my parents decided to do this despite my mom having a postpartum hemorrhage requiring a transfusion at a previous birth. So being trained to always think in terms of safety has changed my perspective significantly.

  9. Relevant to CNM – I got a a BS in Engineering, but I always felt like nursing would be a good fit. (My university didn’t have a nursing school and it eventually got to the point where I just needed to finish.) Several schools offer accelerated BSN programs if you have a BS, which are usually about 15-month full time programs. Based on my own research in the areas of my geographic preference, I know that University of California San Fransisco and Shenandoah University (1.5 hour west of D.C.) both have accelerated programs that can lead you into their MSN-Midwifery programs.

    I would want to do CNM because I would also want to advise on medication and write presciptions. Could CNM overlap with general women’s health or would that vary by State? For example, I am also very interested in endocrine disorders as I suffer from thyroid autoimmune disease, and I want to be involved in this area of healthcare as well.

  10. hi i am currently trying to decide which way would be best for me to go, i am currently in pre reqs for my RN but i am strongly against a lot of the things involved in nursing, yea i am pretty natural minded so i am leaning more toward cpm but i also know cnm would provide more stability and such, any insight?

    • Hi Jeanna, thanks for commenting. If you’re strongly against a lot of things involved in nursing, then I think nursing school will present a lot of challenges. Not to mention difficulties if you need to gain experience as a nurse in order to be accepted into a CNM program (some but not all programs require work experience as an RN). And as a CNM you’ll need to effectively collaborate with RNs and MDs if you’re in a hospital setting. Nursing is about patient-centered care which requires collaboration and making clinical decision based on evidence and research. So if you already have your mind made up about something and are not open to other ideas or input nursing may not be a good fit. I have seen a post-partum hemorrhage from a home birth that required medical intervention and thankfully the patient arrived in the hospital in time. In birth emergencies are rare, but when they happen changes can occur quickly. When I started my journey that led to nursing I was pro home birth; I watched my brothers birth at home and my sister was delivered at home (caught by my dad as the midwife was stuck in traffic). I personally know someone that had a Amniotic Fluid Embolism and barely survived even with immediate medical attention. My sister had a placental abruption and my niece did not survive. So while these events are rare, I have personally seen and experienced their impact. I think it’s prudent to be close to resources that can save mom and baby if necessary. I’m very supportive of decreasing interventions in birth and think there is room for change within the currently medical/nursing model.
      – Krista

  11. I’ve been battling the decision of which route to take. I was in college for four years in a nursing program but I’d gotten so drained and lost my drive, so I dropped out before this spring semester started, to train as a midwife’s assistant, which I’m currently still working on. I’m torn because I like the idea of stability and lack of “black holes” that being a CNM would offer. However, I’m not as school driven as I used to be which is why being a CPM is more appealing. I’m also a student worker so I have to be mindful of what I can financially accomplish. I’m all about natural and home births, however, I also would never want to overstep my limits and put a mother and baby in danger. I’d prefer to work in a birth center more than doing home births, for example, Ochsner’s Alternative Birthing Center. It’s like the perfect balance of clinical and natural for me, if that makes sense. CNMs work there as well, along with other medical professionals outside of midwifery, so there’s always that fallback of protection in case of emergencies. I’m not really interested in the idea right now of owning my own business and I’m really keen on the idea of being a midwife that focuses mainly on working in a birthing center. I like the idea that CNMs can work shifts and not necessarily have to stick to being on call 24/7. If a CPM works in a birthing center, do you think she’d have that kind of flexibility? Also, I’ve been in the process of finding a midwife to train under. In Louisiana, there’s a lot of CPMs, LMs and some CNMs. If I trained under a CNM would it lessen the black hole incidents or give me more tools to be prepared for them? I’m going on this journey pretty much on my own and any help would be great. It can be so overwhelming. Thank you!

    • Valencia, thanks for sharing. It sounds like you’d benefit from connecting with some midwifes in person or online (I found several Facebook groups where members were willing to dialogue with me). I did not end up pursuing midwifery… I’m now an Emergency Nurse. Best of luck on your journey. ~Krista

  12. Thank you for taking the time to share your excellent research! Such helpful and thorough information. Best wishes on your nursing career!

  13. Wow! What an amazing article that really answered some questions in regards to either becoming a CNM or CPM. I’m interested in becoming a midwife and want to open my own birthing center. I’m looking at the Nizhoni Institute of Midwifery in San Diego. Are you familiar with this school at all? How will I know that my certification will work and it will all be legal?

    The program can be completed in 38 months. I will only have a certificate but no degree which I am aware of.

    Do you recommend going to school and getting a Master’s degree or going to this private school and just getting my CPM cert? This has been my challenge on figuring out which route to take! What do you think are the pros and cons? Thanks so much! I look forward to hearing from you!

    • Hi Jacquelyn, thanks for commenting! And congratulations on your journey to become a midwife. I became a Registered Nurse – and ended up focusing on emergency nursing instead of midwifery. I chose the nursing route because after my research I did not feel that the CPM route was safe enough for me to feel comfortable in a scenario where two lives were in my hands and things could rapidly deteriorate. After what I’ve seen and experienced, I continue to feel very strongly that the CNM route is the safest option. Plus, if you’re having a hard time making ends meet as a midwife it’s easy to pick up shifts as an RN.

  14. Hello! Thank you so much for this valuable info!

    Do you have any insight into the salary comparisons of a CNM vs a CPM?

  15. Hi Krista,

    I’m going through the same struggle that many above are describing- I’m split between CPM and CNM. I’m drawn to the flexibility of the CNM route, but I have some hesitations. My first concern is that I know I want to do home births or work in a birth center, and I know that realistically the vast majority of CNMs work in hospitals. I’m worried if I go that route, despite my intentions to work out of hospital, I’ll end up working in a hospital because that will be the training I feel most familiar with.
    A second major concern is the possibility that if I go the CNM route, I’ll inevitably drink the “birth is dangerous” kool-aid, adopt a fear of birth mindset, and lose sight of the reason I wanted to get into midwifery in the first place, which is to support natural birth. Can you speak about this a little bit?

    • Hi Nina,
      Thanks for dropping by. I’ve tried to be neutral on most of my previous responses, but I’m going to share my opinion here: believing that birth can be dangerous isn’t “drinking the kool aid.” I’ve seen a post partum-hemorrhage come to Emergency Room after a home birth. My sister almost died from a placental abruption and my niece did die. Births CAN be dangerous and the people who do births in hospital are prepared to respond to these dangers in seconds to increase the likelihood that mom and baby survive. Are all C-sections necessary? No. Are there sometimes unnecessary interventions. Yes. But being fully aware and training for those situations isn’t being overly cautious. It’s taking full responsibility for the real life and death consequences. And let me tell you this: PTSD for medical providers is a real thing. I’m an Emergency Nurse. After seeing several patients crash after a specific presentation, you can bet I’m more anxious and prepared when the next patient presents similarly. I have seen a woman almost die in my care as we tried to save her pregnancy when infection spread to her uterus and she went into septic shock. It scared the shit out of me. I prayed that she and her baby wouldn’t die in my care and unfortunately the baby didn’t make it. I’ve internally panicked as I waited for blood to arrive for a patient with a ruptured ectopic who was sheet white as her husband sobbed in the corner of the room and I couldn’t reassure him because I didn’t speak the same language as him and the interpreter hadn’t arrived yet. And these descriptions are not melodramatic. The details are etched on my brain.

      Being a medical provider means being open to information and adjusting your belief system and practice based on research and your experience. Whether you become a CPM or a CNM if you are so committed to a specific belief system that you aren’t open to a different perspective, you are a dangerous provider. It’s dangerous to have fixed belief when others lives are in your hands.

      I applaud those that champion natural births and are leading the way towards improving births. The US has a long ways to go in improving our birth statistics, especially with black mothers. But please do it safely and with mental flexibility. Please don’t avoid CNM training because you’re afraid to have your beliefs and perspectives challenged.

      Best of luck on your journey. ~Krista

      • Great post!
        I am a aspiring midwife, but I am not sure if I should go for CNM or CPM. I am only considering CNM because I have always wanted to practice internationally like a travel nurse, but it seems like a lot of college years and money. I know CPM are still quite new even in the US and I’m sure if they can practice globally. Do you think you could help me?
        Thank you.
        – Taylor Page

  16. Hello, what a great post! It has helped me tons. But I still have a question that I cannot seem to find the answer to anywhere.
    I am an aspiring midwife and I have always wanted to practice internationally like a travel nurse does. I was wondering if I needed to become a CNM to do so or could I just become a CPM?
    Thank you.

    – Taylor Page

  17. Thank you for this post. It and your comments have definitely given me a lot to think about in regards to my own journey. Just so you’re aware, the links in your post aren’t working.

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