Midwives in the United States assist childbearing women during pregnancy, labor and birth, and the postpartum period. Some midwives also provide primary care for women including well-woman exams, health promotion, and disease prevention, family planning options, and care for common gynecological concerns. Before the turn of the 20th century, traditional midwives were informally trained and helped deliver almost all births. Today, midwives are professionals who must undergo formal training. Midwives in the United States formed the Midwifery Education, Regulation, and Association (US-MERA) task force to establish a framework for midwifery.
History Childbirth in the United States has traditionally been attended by midwives.
Early lay midwifery (colonial era–19th century) In colonial America, childbirth was largely managed by women, with midwives serving as the main caregivers across all communities. Enslaved African women, Indigenous healers, and immigrant women brought diverse practices to midwifery.
During the 17th century, the English colonies strictly had women midwives attend childbirths. Town records indicate some well-known midwives including Bridget Fuller (d. 1664) who practiced in the Massachusetts Bay Colony and Mrs. Wiat of Dorchester (d. 1705) who attended over 1,000 births. Others such as Ruth Barnaby (1664–1765) and Elizabeth Phillips (1685–1761) practiced for over forty years. While Elizabeth Phillips was trained in London before continuing her practice in Boston, other midwives such as Ann Eliot may have acquired medical skills through their husbands.
Similarly, in the Dutch colony of New Netherland, women were also established in midwifery practices. In 1633 in New Amsterdam, the colonists constructed a building for the official midwife. This position was held by Mrs. Trynje in 1644 and Hellegond Joris in 1655. Later in 1658, the Dutch councilors of New Amsterdam appointed midwife Hilletje Wilbruch to oversee a new hospital.
The English later took over New Amsterdam and renamed it New York, and women continued to be prominent in midwifery. New York City began licensing midwives in 1716. Midwives remained central in rural and marginalized communities into the 19th century.
Early 20th-century regulation of midwifery By the early 1900s, medical professionals began a campaign to professionalize childbirth, often framing midwives as unscientific or unsafe. Joseph DeLee and others promoted hospital birth and obstetric intervention, leading to a decline in midwife-attended births from around 50% in 1900 to 15% by 1930. The Sheppard–Towner Maternity and Infancy Act of 1921 funded midwifery training and regulation, which often marginalized traditional and "granny" midwives unable to meet new licensure requirements. These changes disproportionately impacted Black and Indigenous midwives.
Emergence of nurse-midwifery (1920s–1950s) Formal nurse-midwifery emerged in the U.S. in 1925 with the founding of the Frontier Nursing Service (FNS) by Mary Breckinridge in rural Kentucky, inspired by British nurse-midwifery models. The FNS aimed to address poor maternal and infant health outcomes in underserved Appalachian communities through skilled nursing and midwifery services.
Breckinridge's nurse-midwives were educated at the Lobenstine Midwifery School in New York and trained in England and Scotland before serving in the U.S. They combined public health nursing with midwifery and dramatically reduced maternal and infant mortality in their regions.
The American Association of Nurse-Midwives was founded in 1929 and later evolved into the American College of Nurse-Midwives (ACNM), formally incorporated in 1955. ACNM standardized midwifery education and certification, requiring a nursing degree, midwifery graduate education, and supervised clinical training. Nurse-midwives practiced in public health settings, Native American reservations, and urban clinics, maintaining strong ties to organized medicine and nursing.
Despite their contributions, nurse-midwives remained a small part of the healthcare system during this era. By 1955, only a few dozen nurse-midwives practiced in the U.S., constrained by limited educational programs and restrictive state regulations.
Homebirth revival and lay midwifery in the 1970s In the early 1970s, nearly all U.S. births occurred in hospitals, yet a countercultural homebirth movement emerged independently of formal nurse-midwifery pathways. These births were often attended by lay or self-trained individuals who self-identified as 'midwives' operating outside of established medical systems. Influenced by feminist ideals, natural health movements, and critiques of medicalized birth, this era saw a revival of community-based, non-institutional maternity care.
The movement produced influential figures and texts, including Ina May Gaskin's Spiritual Midwifery and Raven Lang's The Birth Book. Centers like the Farm Midwifery Center in Tennessee exemplified the model of communal, spiritual, and low-intervention childbirth. Events such as the 1974 "Bowland Bust" in Santa Cruz, where midwives were arrested for practicing without licenses, highlighted tensions between lay midwives and the state.
This revival filled a gap in maternity care for women seeking alternatives to hospital birth. However, the lack of standardized education, certification, or integration with emergency services prompted concern from medical institutions and professional midwifery organizations.
Professionalization of lay midwifery (1990s–2000s) Following the homebirth revival of the 1970s, lay midwifery ranged widely in training, oversight, and outcomes. A series of poor maternal and neonatal outcomes in unregulated settings, alongside high-profile legal cases, prompted concern among both advocates and policymakers. In states lacking licensure frameworks, direct-entry midwives could face charges such as practicing medicine without a license, and in some cases, criminal liability following adverse events.
These issues contributed to the push to formalize education, certification, and legal recognition through new credentials. The Certified Professional Midwife (CPM) was created in 1994 by the North American Registry of Midwives to provide a competency-based pathway for non-nurse midwives. In parallel, the Certified Midwife (CM) credential was launched by the American College of Nurse-Midwives in 1997 to offer a graduate-level, direct-entry route aligned with national CNM standards.
Contemporary midwifery Midwifery today includes three nationally recognized credentials: CNM, CM, and CPM as well as lay midwives and traditional birth attendants who are often referred to as midwives by consumers who use them. Consumers and even professionals often conflate these roles, leading to confusion and policy missteps. A 2020 ACNM‑member survey found that nearly one in three clinicians lacked full understanding of credential differences.
This confusion has hampered regulatory efforts, as state laws sometimes group all "midwives" under a single umbrella, inadvertently penalizing low‑risk, well‑trained providers or making licensure unnecessarily restrictive for some groups. A 2016 policy review identified a patchwork of state regulations that "tear every sect down," with several states creating overlapping or contradictory titles and scopes of practice between CNMs, CMs, CPMs, and traditional birth attendants.
Efforts like the US Midwifery Education, Regulation, and Association (US MERA) have called for unified educational standards and clear credential terminology to reduce confusion and better integrate midwives into healthcare systems.
Direct-entry midwives
Granny midwife History Granny midwife is a name used to refer to traditional African American midwives in the (typically rural) South. Though the term was used by federal and state governments derogatorily to suggest ignorance, it was also used by the midwives themselves and reclaimed from its derogatory connotation to instead connote the wisdom of age of the granny. Granny midwives were historically lay midwives, but many granny midwives who practice today combine nurse-midwife training with traditional granny midwifery methods.
According to scholar Sharon Robinson, the first black lay midwife arrived in what is now America in 1619. She came from Africa as an enslaved woman and served her community as a midwife and as a physical and spiritual healer. During the reign of slavery in the United States, nearly every large Southern plantation, particularly in South Carolina, had at least one knowledgeable midwife-healer. There is evidence that some freedwomen served as midwives on the plantations of their former masters for no charge to the plantation. In some cases, plantation masters even rented out their enslaved grannies to neighboring plantations for additional income.
Black midwives were not only common in slave communities, they were also revered as elder healers. Their spiritual and medicinal knowledge gained them special social status in their communities. An important component of granny midwifery was this spiritual knowledge and authority; granny midwives considered themselves to have been spiritually called to the work of healing and midwifery. In South Carolina, Angolan and Kongo constructions of ancestral spirits were important tenets of religion, and granny midwives had unique understandings of the workings of such spirits as they were keepers of spiritual knowledge.
Black lay midwives, or granny midwives, continued providing essential healthcare services to their communities after the abolition of slavery and into the 19th, 20th, and 21st centuries. At the start of the 20th century, specifically between 1900 and 1940, the professionalization of obstetrics and gynecology lead to a campaign against all lay midwives by the United States government, but especially the racialized figure of the granny midwife in the American south. Increased regulatory legislation of lay midwives at the state level between 1900 and 1930 was a key facet of the campaign against granny midwives.
In 1921, the Sheppard-Towner Maternity and Infancy Protection Act afforded federal funds for midwifery training programs to state health departments. States used this money to create training and regulatory programs for lay midwives. By the year 1933, most states passed mandatory birth registration and certificate laws. These laws complicated the work of granny midwives significantly, particularly because they lived in rural settings where illiteracy was common and access to registration filing facilities was more limited than in urban areas. In her dissertation tracing the history of African-American midwifery, scholar Kelena Reid Maxwell examined portrayals of African-American midwives in historical medical journals, the profiles of granny midwives serving in the 30s and 40s in the American South, and many other primary historical documents. She notes that both the training and regulatory programs and mandatory registration and certificate laws jointly contributed to the diminishing number of midwives in places like Macon County, Alabama. In her words, "Macon County, Alabama ran a well-documented campaign against African-American midwives," and tried to forbid midwives who could not or would not work with the state from practicing altogether.
Another facet of the campaign against midwives and towards greater professionalization and exclusivity in obstetrics was the development and expense of medical technology. Traditional midwifery techniques were constructed as inferior to newly marketed obstetric technology, such as forceps. The United States government developed pamphlets and posters to spread this message, among others, to the American population. Included in such publications was information equating black midwifery with "witchcraft" and "witch doctors" of West Africa, as well as with uncleanliness and ignorance.