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Essential Facts about Midwives

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Midwives & Birth in the United States

The American College of Nurse-Midwives (ACNM) is the professional association representing certified nurse-midwives (CNMs) and certified midwives (CMs). According to the American Midwifery Certification Board, there are 12,695 CNMs/CMs.¹ The vast majority of midwives in the United States are CNMs/CMs.
In 2010, CNMs/CMs attended 312,129 births—a slight decline in total births, but a slight increase in percentage of births compared to 2009. This represents 93% of all midwife-attended births, 11.6% of all vaginal births, and 7.8% of total births.² (2010 is the most recent year for which final birth data are available from the National Center for Health Statistics.)
CNM/CM-attended births reflect the diversity of the US population. In 2010, CNM/CM-attended births were most frequent among American Indian/Alaska Native women (17.2%), followed by Hispanic women (8.2%), non-Hispanic white women (7.4%), non-Hispanic Black women (7%), and Asian or Pacific Islander women (6.2).²

Midwifery Practice

CNMs are licensed, independent health care providers with prescriptive authority in all 50 states, the District of Columbia, American Samoa, Guam, and Puerto Rico. CNMs are defined as primary care providers under federal law.

Because CM is a newer, equivalent pathway to midwifery, it is not yet reflected in all state legislatures. CMs are authorized to practice in Delaware, Missouri, New Jersey, New York, and Rhode Island. CMs have prescription-writing authority in New York.

While midwives are well-known for attending births, 53.3% of CNMs/CMs identify reproductive care and 33.1% identify primary care as main responsibilities in their full-time positions. Examples include annual exams, writing prescriptions, basic nutrition counseling, parenting education, patient education, and reproductive health visits.³
In 2010, 95.7% of CNM/CM-attended births occurred in hospitals, 2.2% occurred in freestanding birth centers, and 2% occurred in homes.¹ More than 50% of CNMs/CMs list physician practices or hospitals/medical centers as their principal employers.⁴
Medicaid reimbursement for CNM/CM care is mandatory in all states, and is 100% of the physician fee schedule under the Medicare part B fee schedule. Thirty-three states—roughly two thirds of the nation—also mandate private insurance reimbursement for midwifery services.

Midwifery Education

Standards for education and certification in midwifery are identical for CNMs and CMs.
The Accreditation Commission for Midwifery Education (ACME) is the official accrediting body for CNM/CM education programs. There are 39 ACME-accredited midwifery education programs in the United States.⁵
Approximately 82% of CNMs have a master's degree.3 As of 2010, a graduate degree is required for entry to midwifery practice as a CNM/CM.⁶
4.8% of CNMs have doctoral degrees, the highest proportion of all APRN groups.⁷

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(1) American Midwifery Certification Board
(2) Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Wilson E, Matthews TJ. Births: Final data for 2010. National vital statistics reports; vol 61 no 1. Hyattsville, MD: National Center for Health Statistics. 2012.
(3) Fullerton J, Schuiling K, Sipe TA. Findings from the Analysis of the American College of Nurse-Midwives’ Membership Surveys: 2006–2008. Journal of Midwifery & Women’s Health 2010; 55: 299-307.
(4) ACNM Core Data Survey, 2010
(5) Accreditation Commission for Midwifery Education
(6) Mandatory Degree Requirements for Entry into Midwifery Practice, ACNM Position Statement, July 2009
(7) Fullerton JT, Sipe TA, and Schuiling KD, Demographic profiles of certified nurse-midwives, certified registered nurse anesthetists and nurse practitioners: reflections on implications for uniform education and regulation. Journal of Professional Nursing. Vol 25, No 3 (May-June) 2009.

Updated November 2012