Certification agencies are made up of consumers and experts in the profession. They develop criteria for education, training and clinical experience based on what experts in the field determine is necessary for someone to practice safely as an “entry level” practitioner. An “entry level” midwife has completed education and training to know how to care for healthy women with a normal pregnancy, labor and delivery, how to risk screen for problems, when to consult, refer or transfer care, and how to handle emergencies while getting medical help. Certification agencies administer a written examination and in some cases also a skills practicum examination.


The two organizations in the United States that provide national certification
for midwives are:

A Certified Professional Midwife (CPM) has earned national certification through the North American Registry of Midwives. Client continuity of care and clinical birth experiences in out-of-hospital settings (birth center or home) are required for certification. Education can be obtained through a MEAC accredited or non-accredited school or program, or through apprenticeship. Midwifery practice guidelines, an informed consent document, and an emergency care plan are required. Graduates of a MEAC accredited program must pass the NARM national written certification examination. Graduates of other educational programs or routes must complete the NARM PEP Process and pass a skills practical examination in addition to the written examination.

A Certified Nurse-Midwife or Certified Midwife has earned national certification through the American Midwifery Certification Board. They must complete a graduate-level educational program accredited by the Accreditation Commission for Midwifery Education that provides clinical birth experiences in hospitals, and pass the AMCB national certification examination.

The National Commission for Certifying Agencies (NCCA) was created in 1987 by the National Organization for Competency Assurance to ensure the health, welfare and safety of the public through accrediting a variety of certification program/agencies that assess professional competence. NCCA accredits over 200 programs from more than 100 organizations. NCCA accredited programs certify individuals in a wide range of professions and occupations. Both The North American Registry of Midwives and the American Midwifery Certification Board are recognized by the National Commission for Certifying Agencies (NCCA).


These are separate organizations with separate boards of directors. Each supports the work of the other organizations but they function independently. They meet jointly twice a year at the MANA conference in the fall and at a joint board meeting in April. Each Board has a representative to a “Liaison Group” which meets periodically by telephone.



To practice legally in any community, a midwife must apply for a license. Midwives are licensed differently in each jurisdiction (country, province, state). In the US, a midwife must be licensed to practice by each individual state. Nurse-midwives are licensed in all 50 states. The legal status and requirements for direct-entry (non-nurse) midwives vary from state to state. The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives.

Each state’s law will require that the applicant for a midwife license do some
or all of the following:

  • complete specific education
  • pass an examination
  • obtain national certification
  • submit practice protocols
  • identify a physician to back up the midwife’s practice
  • pay certain licensing fees
  • some jurisdictions allow reciprocity, meaning a midwife can use a license from another state or country to get a license in that state/country.

The state law identifies what agency regulates midwives, usually part of the state’s Department of Health. Typically states have laws against licensing anyone who has had a health care practitioner license revoked in another state or has been convicted of a felony which could impact safe practice.

Disclaimer: All information contained on this page is intended to be used as a resource only. Although every attempt is made to provide quality references to the users of this site, the information has been provided by multiple sources and therefore the Association of Midwifery Educators (AME) does not assume liability for the accuracy or integrity of the information contained here. This information may or may not meet any regulatory or accrediting requirements and is not intended for that purpose.