The Differences Between Midwives

I’ve noticed from chatting with other moms that there is a misconception that all midwives are basically the same. There are a few different kinds of midwives. Within  the primary groups, there are also various degrees of specialties, schools of thought and degrees of experience.  For the sake of simplicity though, I will discuss only the primary differences.

Certified Nurse-Midwives

Many women give birth in a hospital and are attended by a midwife. What we often don’t understand is that usually, these are Certified Nurse-Midwives. These are not the same midwives that we moms generally think of when we imagine our very natural births. Certified Nurse-Midwives (CNMs) are very common in hospital settings.  According to, CNMs attend almost 8 percent of the births in the United States and 96 percent of these births are in hospitals. CNMs are schooled in both nursing and midwifery and (like most of the non-RN midwives listed below) are certified by the American Midwifery Certification Board. A CNM will have earned a RN degree  and will have completed a midwife certification program. Births attended by CNMs in a hospital setting have no difficulties getting insurance to cover the costs, though you  will often find more medical intervention with a CNM than you may have anticipated when you imagined a “midwife assisted birth.” It should be noted though that they still usually provide a more woman-centered, natural birth than an OB would, but hospitals have regulations about the birthing process that CNMs working within them still must follow and often these regulations are less conducive to the very natural births that many women seek.

Certified Professional Midwives

In general, when you hear of a woman delivering their child in their home or at a natural birthing center with a midwife attending, their midwife is very regularly a Certified Professional Midwife. A Certified Professional Midwife (CPM) is a skilled and independent midwifery practitioner who has also met the standards for certification set by the North American Registry of Midwives (NARM). Unlike Certified Nurse Midwives, Certified Professional Midwives carry the only international credential that requires experience in non-hospital births. CPMs are not nurses, but rather very specialized in her individual field. CPMs are guided by  the Midwives’ Model of Care which has been shown to reduce the incidence of birth injury, trauma and cesarean section over hospitalized births. Births attended by CNMs are more regularly becoming covered by health insurances and Medicaid as more and more safety studies back the professionalism of their practice.

Certified Midwives

A Certified Midwife (CM) is usually very similar to a CPM but this title is also used in certain states as a designation of certification by the state or midwifery organization. They are similar to CPMs except that their education is less standardized. Certified Midwives also follow the Midwives Model of Care guidelines. The main point of note of a CM is that they have received certification from a regulating body, often her state or local licensing board. These midwives are ever increasingly becoming covered by insurance companies.

Lay Midwives

Lay midwives are not required to get their certifications after years of schooling; they regularly learn their craft during an apprenticeship program. Lay midwives are also sometimes called Direct-Entry Midwives. A Direct-Entry Midwife (DEM) is an independent practitioner. Her education method will vary, but she will still be taught to practice the Midwives Model of Care just as the others were.  With a healthy normal birth, lay midwives can provide a wonderful safe birthing experience as they have for thousands of years, but getting an insurance company to reimburse you for a lay midwife’s fees will often prove a little challenging.

Midwifery is not not legal in every state, despite being proven a safer method of delivering babies than an OB assisted hospital delivery under normal circumstances.  In addition different states have different regulations about which kind of certification a midwife must have to practice.  Likewise, there will be different regulations pertaining to midwife assisted births in hospitals even. It can seem very confusing. You can find some of the specific state laws pertaining to midwifery here, thanks to the Midwives Alliance of North America.


If you are a midwife, feel free to let us know you’re out there by posting your contact info on this thread or on our Facebook. Everything Birth was founded on a passion for midwifery and would love to help support your practice.


  1. As a Certified Midwife I just wanted to let you know that CMs are certified by the American College of Nurse Midwives as well as CNMs. We have the same training as CNMs and pass the same exam administered by the American Midwifery Certification Board. The only difference is that we are not nurses and did not attend a nursing program prior to becoming a midwife. Here in NY where I practice I am considered the equivalent of a CNM and have the same scope of practice and prescriptive privilege. I can work in hospital or independently as I wish, and I have a private homebirth practice. Thanks for your article helping women to understand which kind of midwife may be right for them!

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