There is a lot of confusion about what the various maternity care provider designations mean. Some contend this is intentional on the part of some of the less-educated care providers. This page is intended to provide information as to what the training and experience for various designations/certifications entails. For more information about the different kinds of midwives, see this comparison put out by the American College of Nurse Midwives (ACNM).
Obstetrician/Gynecologist (OB/GYN):
  • Completed a four-year undergraduate degree with excellent grades, including required classes like calculus, physics, and organic chemistry
  • Passed the MCAT,  an intensive, day-long exam that tests students on biology, chemistry and physics, in addition to reading and writing skills
  • Completed a strenuous application to medical school and beat out at least half of the other applicants (only about half the number of people that apply to medical school are accepted). Medical school applications require up to 10 recommendations from health care providers and community members.
  • Completed four years of medical school; OB/GYNs take many of the same courses as general physicians, but may choose classes with a concentration in obstetrics and gynecology. Medical school programs also include extensive hands-on practice through clinical rotations in which students can gain experience in OB/GYN.
  • Completed a 3-7 year medical residency. During a medical residency, OBGYN students may evaluate patients, create treatment plans and observe patient progress as employees of a teaching hospital
  • Obtained state licensure. Only students who are licensed can legally begin medical practice in the United States. Licensure requires passing the United States Medical Licensing Examination (USMLE), which tests a physician’s ability to relate medical concepts and principles to their practice.
  • Some OB/GYNs take the additional step of becoming board-certified. The American Board of Obstetrics and Gynecology certifies graduates of approved OB/GYN residency training programs as board eligible. In order to be board certified, the physician must successfully pass a comprehensive written exam, usually done at the completion of the final year of residency. After two years in practice, the doctor must then complete an oral exam before a national examining board. It is only after successfully passing both tests that a physician can be considered board certified as a specialist. An obstetrician/gynecologist requires recertification every 10 years.
  • Before an OB/GYN is licensed to practice, she will attend close to a thousand births of all kinds as a caregiver.
Family Practice Physician: has much the same training as an OB/GYN but fewer maternity-specific experiences and probably no surgical fellowship. A family practice doctor who specializes in maternity care will have attended close to two hundred births before receiving a license to practice.
Certified Nurse-Midwife (CNM):
  • Completed a 4-year nursing degree with excellent grades (Nurses may not pass with less than a ‘B’ grade), including courses in microbiology, anatomy and physiology, human development, nutrition, chemistry, pathophysiology, pharmacology, and statistics.
  • Usually has a year or more of experience as a labor and delivery nurse
  • Has taken the Graduate Record Exam (GRE) which establishes baseline competence in mathematics, language, and communication.
  • Has completed a graduate degree (either MSN or DNP) in nursing, which is 2-3 years of additional coursework and clinical education
  • Must pass the AMCB certification exam
  • Most CNMs have attended more than 100 births as caregivers before they are licensed to practice
  • A CNM requires re-certification every five years
  • CNMs are recognized nation-wide

Certified Midwife (CM):

  • Same requirements as a CNM, including prerequisite courses, but no RN required. CMs are currently only recognized in New York, New Jersey, and Rhode Island, and have prescriptive authority only in New York.

Certified Professional Midwife (CPM):

  • There are two paths to the CPM.
    • Completing coursework at an “accredited” (by MEAC, not by any real educational accreditation institution) school. Those midwives who choose this option are required to have a high school diploma. There are no grade requirements to take the exam.
    • The Portfolio Evaluation Process. These midwives apprentice with another CPM and achieve the didactic portion of their education on their own or through non-NARM accredited institutions. Those midwives who choose this option are not required to have a high school diploma. The vast majority of CPMs received their certification through the PEP process.
  • The CPM is required to attend 20 births as an “active participant” (i.e. doula or assistant) and 20 births in the primary midwife role. Only 10 of these births as primary need to have been in the three years prior to exam application, for an average of 3.34 births in one year.
  • Must pass the NARM exam

 Licensed Direct Entry Midwife (LDEM): Licensed by the state to provide midwifery services. In Oregon, a license requires a CPM and five additional births as a primary attendant and five additional as an “active participant.” Each state with licensed midwives has different licensing requirements.

Direct Entry Midwife: any midwife who is not a nurse first. This would include CMs, CPMs, LDEMs, and lay midwives

Lay Midwife/Traditional midwife: Anyone who calls herself a midwife and attends births as one.