Midwife qualifications vary by country and state, but in the United States, you must complete an accredited midwifery program, pass a national certification exam, and meet state licensing requirements

The path to becoming a midwife depends on where you practice. In the U.S., there are three main routes: becoming a Certified Nurse-Midwife (CNM), a Certified Midwife (CM), or a Certified Professional Midwife (CPM). Each requires different education, has different scope of practice, and is recognized differently across states. Some states license all three; others recognize only CNMs; a few recognize none at all.

The fastest route is typically the CNM path if you already have a nursing background. The longest is the CPM route if you start from scratch. All three require passing a national certification exam administered by the American Midwifery Certification Board (AMCB). None of these paths is "easier" — they are different in structure and cost, and which one makes sense depends on your existing education and where you want to work.

Key Takeaways

  • Certified Nurse-Midwives (CNMs) must first become a registered nurse, then complete a graduate midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME).
  • Certified Midwives (CMs) complete a midwifery-specific graduate program without the nursing requirement, but this route is only available in a handful of states.
  • Certified Professional Midwives (CPMs) typically complete apprenticeships or direct-entry programs and are recognized in some states but not others.
  • All three routes require passing the AMCB certification exam, and state licensure rules vary — some states require it, others do not recognize midwives at all.
  • The entire process from high school to certification typically takes 4 to 8 years depending on your starting point and which credential you pursue.

The Certified Nurse-Midwife (CNM) path

This is the most widely recognized credential in the U.S. To become a CNM, you must first earn a Bachelor of Science in Nursing (BSN) and pass the NCLEX-RN exam to become a registered nurse. This takes four years of undergraduate study. You then work as an RN for a period (some programs require one year of experience, others do not), and then enroll in a graduate midwifery program.

Graduate CNM programs are accredited by ACME and typically last 18 to 24 months of full-time study. They combine classroom work in anatomy, pharmacology, and obstetrics with clinical rotations where you attend births under supervision. After graduation, you sit for the AMCB certification exam. Once certified, you can use the credential CNM in all 50 states, though the scope of what you can do varies by state law.

The total time from high school to CNM certification is usually 6 to 7 years. The cost varies widely: nursing school ranges from $20,000 to $120,000 depending on whether you attend a public or private institution, and graduate midwifery programs range from $30,000 to $80,000. Many CNMs work in hospitals, birth centers, or private practice.

The Certified Midwife (CM) path

A Certified Midwife is someone who has completed midwifery education but is not a nurse. This credential exists in only a few states: New York, New Jersey, Rhode Island, and Delaware currently license CMs. If you live outside these states, this path is not available to you.

To become a CM, you must complete a graduate midwifery program accredited by ACME — the same programs that CNMs attend, or programs designed specifically for non-nurses. These programs typically last 24 to 36 months because they include some of the basic nursing science that CNM students already have. After graduation, you pass the same AMCB certification exam as CNMs.

The main advantage of the CM path is that you do not need to spend four years becoming a nurse first. The main disadvantage is that it is only recognized in four states, and even in those states, the scope of practice is often narrower than a CNM's. If you think you might move or want maximum flexibility, the CNM credential is more portable.

The Certified Professional Midwife (CPM) path

A Certified Professional Midwife is trained through direct-entry programs or apprenticeships rather than university graduate programs. CPMs are recognized in about 27 states, though recognition varies — some states license them, others straightforward do not prohibit them, and a few actively restrict them. Before pursuing this path, check the laws in the state where you want to work.

There are two main ways to become a CPM. The first is to complete a direct-entry midwifery program, which is a formal educational program (usually 2 to 3 years) offered by schools like the Midwifery Institute or similar organizations. The second is to complete an apprenticeship under an experienced midwife, which typically takes 3 to 5 years and involves structured learning, clinical experience, and mentorship. Both routes culminate in sitting for the AMCB certification exam.

The cost of direct-entry programs ranges from $15,000 to $40,000. Apprenticeships vary widely in cost — some are unpaid or low-paid, others charge tuition. The CPM credential is most common among midwives who attend home births or work in birth centers. In states where CPMs are not licensed, they may still practice but have no legal protection and cannot bill insurance.

National certification and the AMCB exam

Regardless of which path you take, you must pass the American Midwifery Certification Board (AMCB) exam to use the title "certified." This is a written exam that tests knowledge of pregnancy, labor, delivery, postpartum care, and newborn care. You can only sit for the exam after you have completed your educational program and met the AMCB's specific requirements for your credential type.

The exam costs between $500 and $700 and is offered multiple times per year. Most people pass on their first attempt, but if you do not, you can retake it. The exam is computer-based and takes about four hours. After you pass, you receive your certification and must renew it every three years by paying a renewal fee and meeting continuing education requirements.

Passing the AMCB exam does not automatically mean you can practice in your state. You still need to meet your state's specific requirements, which may include state licensure, registration, or straightforward notification to the state health department. Some states have no midwife regulations at all.

State licensure and scope of practice

After certification, you must understand your state's rules. Some states require licensure (you must pass an exam or meet specific criteria to legally practice), some require registration (you must notify the state but do not need to pass an additional exam), and some have no regulation at all. A few states actively prohibit midwifery or restrict it to nurses only.

Scope of practice also varies. In some states, CNMs can prescribe medications, order lab tests, and manage most pregnancies independently. In others, they must work under a physician's supervision. CPMs typically have a narrower scope and are usually limited to low-risk pregnancies and home or birth center births. CMs fall somewhere in between, depending on the state.

Before you commit to a midwifery program, research the laws in the state where you want to work. The American College of Nurse-Midwives (ACNM) website has a state-by-state breakdown of regulations. If you are considering a CPM credential, the North American Registry of Midwives (NARM) website lists which states recognize CPMs.

Continuing education and maintaining your credential

Once certified, you must complete continuing education hours every three years to renew your AMCB certification. The number of hours varies by credential type but is typically 15 to 20 hours per three-year period. These hours can come from conferences, online courses, journal clubs, or other approved educational activities.

Many states that license midwives also require state-specific continuing education. Some require CPR certification, some require training in specific protocols like neonatal resuscitation, and some require a certain number of births attended per year to maintain licensure. These requirements are separate from AMCB renewal and vary widely.

Maintaining your credential is ongoing work, but it is also an opportunity to stay current with evidence-based practice and connect with other midwives. Many midwives find that the professional community around continuing education is one of the most rewarding parts of the job.

Frequently Asked Questions

Can I become a midwife without going to nursing school first?

Yes, through the Certified Midwife (CM) or Certified Professional Midwife (CPM) routes. However, CM is only available in four states, and CPM recognition varies by state. If you want the most portable credential and the broadest scope of practice, the CNM route (which requires nursing school) is the most practical choice in most of the U.S.

How long does it take to become a midwife?

The timeline depends on your starting point. If you already have a nursing degree, a CNM program takes 18 to 24 months. If you start from high school, expect 6 to 7 years for a CNM. A CM program takes 24 to 36 months. A CPM through direct-entry takes 2 to 3 years; through apprenticeship, 3 to 5 years.

Do I need to work in a hospital as a midwife?

No. Midwives work in hospitals, birth centers, private practices, and home settings. Your options depend on your credential type and your state's regulations. CNMs have the broadest range of settings. CPMs typically work in birth centers or attend home births. Where you want to work should influence which credential you pursue.

What if I want to move to a different state after I become a midwife?

Your AMCB certification is portable across all states, but state licensure and scope of practice are not. You may need to explore for licensure in your new state, and your scope of practice may change. Before moving, check the regulations in your new state — some recognize all three credential types, others recognize only CNMs, and a few recognize none.

Is there a difference between a midwife and a nurse-midwife?

Yes. A nurse-midwife (CNM) is a registered nurse who has completed additional midwifery training. A midwife (CM or CPM) has completed midwifery training but may not be a nurse. CNMs are recognized in all 50 states; CMs and CPMs are recognized in fewer states. The terms are not interchangeable.