You have decided you want a midwife. That is a wonderful starting point. But now comes a question that can feel surprisingly confusing: what kind of midwife?

In the United States, the two most common nationally credentialed midwife types are Certified Nurse-Midwives (CNMs) and Certified Professional Midwives (CPMs). They share a core philosophy. They both believe in the power of physiologic birth, informed consent, and whole-person care. But their training, practice settings, and legal status are meaningfully different.

Here is a clear, honest comparison to help you figure out which type of midwife might be the best fit for your birth.

Training and Education: Two Paths to the Same Calling

CNM Training

CNMs follow a healthcare-system pathway:

1. Bachelor of Science in Nursing (BSN) and RN licensure

2. Graduate degree (master's or doctorate) in nurse-midwifery from an ACME-accredited program

3. National certification exam through the American Midwifery Certification Board (AMCB)

This pathway typically takes six to eight years and includes extensive clinical hours in hospital, birth center, and outpatient settings. CNMs are trained in both normal and complicated pregnancies, and their nursing background gives them fluency in the medical system.

CPM Training

CPMs follow a midwifery-specific pathway:

1. MEAC-accredited midwifery school or structured apprenticeship (Portfolio Evaluation Process) under an experienced midwife

2. National certification exam through the North American Registry of Midwives (NARM)

CPM education focuses specifically on midwifery rather than nursing. The apprenticeship pathway, in particular, emphasizes learning through direct, hands-on experience in community settings. All CPM candidates must meet the same clinical benchmarks and pass the same national exam.

What This Means for You

Neither pathway is inherently better. They produce different kinds of expertise:

  • CNMs tend to have broader clinical training, including experience with medical complications, pharmacology, and hospital systems.
  • CPMs tend to have deeper training specifically in out-of-hospital birth, physiologic labor support, and community-based care.

The question is not which training is superior. It is which expertise matches the kind of birth you are planning.

Practice Settings: Where Each Type Works

This is one of the clearest practical differences between CPMs and CNMs.

CNMs Practice In:

  • Hospitals. The majority of CNMs attend births in hospital settings. Many have admitting privileges and work on staff.
  • Birth centers. Some CNMs own or work in freestanding birth centers.
  • Homes. A smaller number of CNMs attend home births, depending on their practice and state regulations.
  • Outpatient clinics. CNMs provide gynecological care, contraception, and primary reproductive healthcare in office settings.

CPMs Practice In:

  • Homes. Home birth is the primary setting for most CPM practice.
  • Birth centers. Many CPMs own or staff freestanding birth centers.
  • CPMs generally do not practice in hospitals.

What This Means for You

  • If you want a hospital birth with a midwife, a CNM is your choice. CPMs are not credentialed for hospital practice.
  • If you want a home birth, both CPMs and CNMs can attend, but CPMs are specifically trained for this setting. Finding a home birth CNM may be more challenging depending on your area.
  • If you want a birth center birth, either type of midwife may be available, depending on the center.

Scope of Practice: What Each Can Do

CNMs Can:

  • Prescribe medications in all 50 states (including birth-related medications, contraceptives, antibiotics, and more)
  • Order and interpret diagnostic tests, labs, and imaging
  • Provide full-spectrum reproductive healthcare, including gynecological care, contraception, fertility support, and menopause management
  • Manage both normal and some complicated pregnancies (in collaboration with physicians)
  • Hold hospital privileges

CPMs Can:

  • Provide comprehensive prenatal, birth, and postpartum care for low-risk pregnancies
  • Order and interpret routine labs (blood work, GBS cultures, urinalysis)
  • Carry and administer emergency medications (like anti-hemorrhagics), depending on state regulations
  • Perform newborn exams and screening
  • Refer for ultrasound and other diagnostics
  • Suture minor perineal tears (in most states)

What CPMs Generally Cannot Do:

  • Prescribe medications (with limited exceptions in some states)
  • Practice in hospitals
  • Independently manage high-risk pregnancies

What This Means for You

If you want a single provider who can serve as your primary reproductive healthcare provider across your lifespan (not just during pregnancy), a CNM has a broader scope for that. If you are specifically seeking a midwife for pregnancy, birth, and postpartum care in a community setting, a CPM's focused scope may be exactly what you need.

Legal Status: The State-by-State Factor

CNMs

CNMs are legally recognized and licensed in all 50 states, the District of Columbia, and U.S. territories. The degree of practice autonomy varies (some states require a collaborative agreement with a physician), but the credential is universally accepted.

CPMs

CPM licensure varies significantly from state to state:

  • Fully licensed states have clear regulatory frameworks, continuing education requirements, and in some cases, Medicaid coverage for CPM services.
  • Legal but unregulated states allow CPMs to practice without formal state oversight.
  • Restricted or prohibited states either do not recognize the CPM credential or have laws that effectively prevent CPM practice.

This patchwork means that whether you can access CPM care depends, in part, on where you live. If you are in a state where CPMs are not licensed, your out-of-hospital birth options may be limited to CNMs or other providers.

How to Check Your State

The North American Registry of Midwives (NARM) and advocacy organizations like the Big Push for Midwives maintain current maps and databases showing CPM legal status by state. Checking this early saves you time and helps you understand your realistic options.

Philosophy: More Alike Than Different

Here is the important thing: despite their differences in training and setting, CPMs and CNMs share a core philosophy. Both types of midwives generally:

  • View pregnancy and birth as normal physiologic events
  • Prioritize informed consent and shared decision-making
  • Provide continuous labor support
  • Use a whole-person approach that includes emotional and psychosocial care
  • Favor minimal intervention when the pregnancy is healthy
  • Respect the birthing person's autonomy

The differences in philosophy tend to be more about individual providers than about credential type. You will find CNMs who are deeply holistic and CPMs who are clinically rigorous. The credential tells you about training and setting. The individual tells you about philosophy.

Choosing Based on Your Birth Plan

Here is a practical framework for matching midwife type to birth vision:

You Might Choose a CNM If:

  • You want to give birth in a hospital with a midwife
  • You want a provider who can prescribe medications
  • You have a health condition that needs medical co-management
  • You want your midwife to also provide gynecological care outside of pregnancy
  • You are in a state where CPMs are not licensed
  • You want the flexibility of a provider who can work across multiple settings

You Might Choose a CPM If:

  • You are planning a home birth and want a provider specifically trained for that setting
  • You want deep expertise in physiologic, out-of-hospital birth
  • You are drawn to the apprenticeship model of midwifery education
  • You value the community-based, relationship-centered model of CPM care
  • You are in a state where CPMs are licensed and regulated

You Might Want Both If:

  • You are planning a birth center birth. Both CPMs and CNMs may be available, and some birth centers employ both types.
  • You want a CPM for your birth but also want a CNM for gynecological care, contraception, or postpartum prescriptions.

Questions to Ask Either Type of Midwife

Regardless of credential, here are questions worth asking any midwife you are considering:

  • What is your experience level? How many births have you attended?
  • What is your transfer rate, and what are the most common reasons for transfer?
  • Who is your backup or collaborating physician?
  • How do you handle emergencies?
  • What is your philosophy on intervention?
  • Will you be the one at my birth, or do you share call with others?
  • What does your postpartum care look like?

The answers to these questions will tell you more about the quality of your care than the letters after someone's name.

The Bottom Line

CPMs and CNMs are both legitimate, credentialed, skilled midwives. The right choice depends on where you want to give birth, what kind of care you are looking for, and what is available in your state. Neither choice is inherently safer or better. They are different tools for different situations, and both are grounded in the same deep respect for the birthing process.

Finding Your Midwife

Whether you are leaning toward a CPM, a CNM, or still figuring it out, BAABY can help. Browse midwife profiles in your area, filter by credential type and birth setting, and find a provider who aligns with your values and your vision for this birth.