Certified Professional Midwife (CPM) is a credential issued by the North American Registry of Midwives (NARM) for direct-entry midwives in the United States who specialize in out-of-hospital maternity care including home birth.North American Registry of Midwives. “About NARM.” https://narm.org/about-narm/ Established in 1994, the CPM credential was developed to formalize and regulate the practice of lay midwifery, which had previously operated without standardized national oversight.Rooks, Judith P. Midwifery and Childbirth in America. Temple University Press, 1997. . The legal recognition, educational requirements, and permitted scope of practice for CPMs vary widely across U.S. states.
Certified Professional Midwives (CPMs) are a type of direct-entry midwife, meaning they are not required to hold a nursing degree prior to entering midwifery training. This distinguishes them from Certified Nurse Midwives (CNMs), who must be registered nurses and complete a graduate-level program at a regionally accredited university. In contrast, CPMs may qualify through multiple non-nursing pathways, including apprenticeship-based training or completion of programs accredited by the Midwifery Education Accreditation Council (MEAC). MEAC programs typically confer certificates or associate degrees and are not required to be affiliated with regionally accredited academic institutions.North American Registry of Midwives. “Certification Process.” https://narm.org/certification/Midwifery Education Accreditation Council. https://www.meacschools.org
Among licensed maternity care providers in the United States, CPMs are unique in being eligible for independent clinical practice without holding a regionally accredited academic degree.
Certification and education CPMs earn their credential by completing one of two primary pathways:
Graduation from a MEAC-accredited midwifery program (most commonly a certificate) which represents only 36.9% of CPMsCheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. "Practitioner and Practice Characteristics of Certified Professional Midwives in the United States: Results of the 2011 North American Registry of Midwives Survey." Journal of Midwifery & Women’s Health. 2017;62(3):339–349. doi:10.1111/jmwh.12634. or Through the Portfolio Evaluation Process (PEP), a non-didactic apprenticeship-based route. All CPMs are required to take the North American Registry of Midwives (NARM) certification exam. The exam consists of 350 multiple-choice questions and is administered in a computer-based format at approved testing centers.North American Registry of Midwives. “Certification Exam.” https://narm.org/certification/exam/
The exam is developed and overseen by NARM, the same organization that grants the CPM credential. While NARM publishes summary statistics on exam performance, such as pass rates and reliability coefficients,North American Registry of Midwives. “Written Exam Statistical Overview.” https://narm.org/statistics/exam-statistics/ comprehensive data on the exam's psychometric design and validation process are not independently reviewed or widely available. Professional organizations have raised concerns about the rigor of the CPM credentialing process, noting that the examination is developed and administered by the same organization, NARM, that confers the credential, which may limit independent oversight.American College of Nurse-Midwives (July 2009). ACNM Letter Re: Minimum Educational Standards for Midwives. Archived from the original on 6 February 2011. Retrieved 5 August 2025 – via Wayback Machine. https://web.archive.org/web/20110206034223/http://www.midwife.org/siteFiles/legislative/ACNM_re_Minimum_Educational_Stds_for_Midwives_7_09.pdf.
While MEAC programs offer a structured curriculum, the PEP route allows for individualized training under preceptors in individual communities. PEP educational experiences can vary significantly in rigor, setting, and patient exposure since it is dependent on the preceptor and their knowledge and clinical skill base.
Midwifery Education Accreditation Council (MEAC) MEAC is a programmatic accrediting agency for CPM midwifery education in the United States. MEAC is not recognized by the United States Department of Education or the Council for Higher Education Accreditation (CHEA) and is not a regionally accrediting agency.U.S. Department of Education. “Database of Accredited Postsecondary Institutions and Programs.” https://ope.ed.gov/dapip/ Colleges and universities in the U.S. utilize regional accreditation with oversight from one of six accrediting agencies that assess overall institutional quality.U.S. Department of Education. “Accreditation in the United States.” https://www2.ed.gov/admins/finaid/accred/accreditation_pg3.html MEAC, by contrast, accredits only CPM-specific programs, many of which offer certificates only and are not affiliated with institutionally accredited institutions. As a result, MEAC-accredited coursework may not be transferable to traditional academic institutions, and students may have limited access to federal financial aid.Council for Higher Education Accreditation. “Transfer and the Public Interest: A Statement to the Community.” 2001. https://www.chea.org/transfer-and-public-interest U.S. Department of Education. “Federal Student Aid: Accreditation.” https://studentaid.gov/help-center/answers/article/accreditation These issues are barriers to receiving a MEAC accredited education for some CPMs and have been critiqued as limiting future educational opportunities for CPMs who may want to switch careers. Further, it has led to criticism of the quality and rigor of their educational programs.
Loss of U.S. Department of Education recognition MEAC received initial recognition by the U.S. Department of Education (USDE) as a specialized accrediting agency for direct-entry midwifery education in 2001 and lost USDE recognition in 2026.
In March 2025, the U.S. Department of Education initiated an inquiry into MEAC's continued recognition under 34 C.F.R. § 602.33 after receiving information concerning the agency's compliance with the federal Criteria for Recognition. In September 2025, the Department announced that the inquiry had identified noncompliance with 34 C.F.R. § 602.15(a)(1).
In 2026, U.S. Department of Education staff recommended denying continued federal recognition to the Midwifery Education Accreditation Council (MEAC). The Department's final staff report identified multiple areas in which MEAC did not meet federal recognition criteria. The report cited staffing vacancies and turnover, delayed accreditation activities and site visits, untimely federal tax and state filings, delayed financial reviews and audits, incomplete historical records, and deficiencies in the conduct and documentation of site visits.
On July 2, 2026, NARM and the National Association of Certified Professional Midwives (NACPM) informed accredited programs that MEAC had elected not to seek renewed recognition from the U.S. Department of Education and advised that the decision could affect licensure pathways in jurisdictions whose laws reference accreditation by a U.S. Department of Education recognized accrediting agency.
North American Registry of Midwives (NARM) The North American Registry of Midwives (NARM) is a U.S. nonprofit organization that develops and administers the certification process for the CPM credential. Founded in the early 1990s, by Midwives Alliance of North America, NARM establishes eligibility requirements, oversees the national certification examination, maintains a registry, and manages recertification processes for CPMs.
NARM has been the subject of scrutiny regarding the independence and scope of its oversight functions. Investigative reporting has noted that NARM operates as a self-regulating body and that individuals disciplined by state authorities have, in some cases, retained NARM certification and that NARM “continued to certify midwives who were practicing illegally”, or in states where it was illegal for them to practice.
In 2024, NARM reported identifying potential fiduciary misconduct by a board member, which led to the resignation of the remaining board and prompted an internal review.
Questions have been raised about the nature of NARM’s accreditation. NARM’s certification examination is accredited by the National Commission for Certifying Agencies (NCCA), but NCCA accreditation applies only to the NARM administered exam and not to the CPM credential itself. Despite not having the accreditation to do so, the NARM organization operates as though its accreditation is inclusive of clinical training pathways, preceptor authorization, and disciplinary authority. In published appeals, midwives reported being informed by NCCA that NARM is not accredited to authorize clinical preceptors, despite NARM’s role in registering and sanctioning preceptors for CPM training. Analysts have noted that this separation between exam accreditation and full credential oversight differs from international midwifery standards, which require accredited education programs, regulated clinical supervision, and independent governance.
NARM recently introduced a membership structure, a change that critics argue complicates organizational neutrality by aligning the certifying body with the practitioners it certifies. Taken together, these features reflect a model in which examination validity is externally accredited, while certification standards, clinical training approval, preceptor authorization, and disciplinary governance are controlled by the same private organization that certifies and collects dues and membership fees from CPMs. The combination of regulatory authority and member representation within a single entity raises conflict-of-interest concerns that differ from the governance structures typical of most U.S. health professions.
Scope of practice and licensure The legal recognition and scope of practice of CPMs vary by state. Some states license CPMs to provide prenatal, intrapartum, postpartum, and newborn care independently, while others impose restrictions or prohibit their practice altogether. In certain jurisdictions, CPMs may have the ability to administer medications such as oxytocin and anti-hemorrhagic agents, while in others, they are legally barred from doing so.
State requirements for CPM licensure vary widely. Some states require completion of a MEAC-accredited midwifery program, while others allow licensure through alternate routes such as apprenticeship or the PEP process without specifying formal education standards. This variation reflects differing state-level approaches to credentialing and has prompted discussion about consistency in training and oversight across jurisdictions.
As of 2026, 32 U.S. states and the District of Columbia, license Certified Professional Midwives (CPMs) for legal practice.North American Registry of Midwives. “State-by-State Regulation Chart.” (PDF). North American Registry of Midwives. Retrieved June 2025. https://narm.org/pdffiles/statechart.pdf In addition, 5 states (Colorado, Missouri, New Hampshire, Rhode Island, and Tennessee) allow CPM practice through certification, registration, or statutory exemption, but do not formally issue a "license." These alternate pathways function similarly to licensure but use different legal terminology or regulatory mechanisms.