The Five Types of Midwives
Throughout history, midwives have helped women through pregnancy and childbirth. Today, five types of midwives provide varying levels of care to women and newborn babies:
Medically trained midwives:
Certified Nurse-Midwife (CNM)
Certified Midwife (CM)
Direct-entry midwives: trained and certified
Certified Direct Entry Midwife (CDEM)
Certified Professional Midwife (CPM)
Lay Midwife/Traditional Midwife
Medically Trained Midwives
Certified Nurse-Midwife (CNM) and Certified Midwife (CM)
Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) are highly trained healthcare professionals who provide comprehensive care for women, not only during pregnancy and childbirth, but also throughout adolescence, pregnancy, childbirth, and the postpartum period, as well as into the end of life.
CNMs are nurses who have completed a graduate-level nurse-midwife program and passed a certification exam from the American Midwifery Certification Board. At the same time, CMs are non-nurses who have completed a graduate-level midwifery degree program and passed a certification exam from the American Midwifery Certification Board.
CNMs and CMs are qualified to provide the same level of care. All states license CNMs for independent practice, but not all states permit CMs. The American College of Nurse Midwives reports that CNMs and CMs attended 312,129 births in the U.S. in 2010, representing 11.6% of all vaginal births and 7.8% of total births.
Direct-entry Midwives
Certified Direct-Entry Midwife (CDEM)
A Certified Direct Entry Midwife (CDEM) is a professional midwife who has completed a structured course of education, clinical training, and demonstrated competencies in the care of childbearing women and their newborns. Unlike nurse-midwives, CDEMs are not required to hold a nursing degree; their training pathway is a direct-entry program, meaning they enter midwifery without first becoming nurses.
The CDEM credential is conferred by the National Fellowship of Direct Entry Midwives (NFDEM) to midwives who meet defined educational, clinical, and proficiency standards, ensuring they are skilled, accountable providers for families choosing home birth or other out-of-hospital birth settings. A candidate qualifies to become a CDEM by completing the NFDEM Proficiency Program, including a structured education program, fulfilling hands-on clinical training requirements, demonstrating proficiency in midwifery skills and emergency response, completing the NFDEM credentialing process, and passing the CDEM written examination. Once certified, a CDEM must engage in ongoing professional development and peer review to maintain certification.
The NFDEM is currently pursuing accreditation through the NCCA. The CDEM practice privileges are limited to unregulated states as of September 2025.
Certified Professional Midwife (CPM)
A Certified Professional Midwife (CPM) has met the certification requirements of the North American Registry of Midwives (NARM). Applicants can qualify to take the NARM exam by either apprenticing with a qualified midwife and completing an Entry-Level Portfolio Evaluation Process or graduating from a midwifery program or school. If the Midwifery Education Accreditation Council doesn’t accredit the program or school, applicants must complete the Entry-Level Portfolio Evaluation Program.
The practice privileges of CPMs vary by state.
Both CDEMs and CPMs are committed to providing the Midwives Model of Care:
Monitoring a woman’s complete (not just physical) well-being from pre-natal through post-natal
Identifying women who need to see an obstetrician and giving them appropriate referrals
Giving each mother individualized education, counseling, and prenatal care, assisting during labor and delivery, and supporting the mother and newborn after the birth
Using as few technological interventions as possible
Lay Midwife
A lay midwife, also known as a traditional midwife, refers to an uncertified or unlicensed midwife, practicing within the Midwifery Model of Care, who often has an informal education, such as an apprenticeship or self-study, rather than a formal education. Some states have licensing requirements for lay midwives, while others don’t.
