Inconsistent Standards: Education, Certification, and Oversight Gaps

Overview

The Certified Professional Midwife (CPM) credential is based on inconsistent and often inadequate educational preparation. Unlike other licensed health professionals, CPMs are not required to complete a degree, attend an accredited training program, or demonstrate proficiency in emergency care, pharmacology, or hospital-based collaboration.

The result is a system where licensure is based on substandard preparation, and certification offers no guarantee of safety or competency.

Inadequate Educational Requirements

CPMs are the only maternity care providers in the United States who are not required to have a college degree.
Many are trained through apprenticeship-only routes, without formal academic instruction or simulation-based training.
No hospital experience is required. Most CPMs have never managed complications such as hemorrhage, shoulder dystocia, or neonatal resuscitation in an accredited clinical setting.
Students may be trained by unlicensed preceptors. In some cases, students may be trained by preceptors who are under active criminal investigation for the care they provide
Some trainees complete their education entirely in non-accredited or self-designed apprenticeship models, without simulation or emergency preparedness training.

In most states, barbers and tattoo artists are held to stricter training and testing requirements than CPMs.

Not Qualified Here or Abroad

CPMs are not recognized as qualified maternity care providers in most high-income countries. Their education, certification, and scope of practice fall below global standards for midwifery.

In fact, CPMs would not be legally permitted to practice in countries like Canada, the United Kingdom, the Netherlands, or Australia.

International Standards Require:

A bachelor’s degree or higher
Accredited academic midwifery education
Clinical training in both hospital and out-of-hospital settings
Integration into the formal health care system
Transfer agreements with physicians and hospitals

CPMs Do Not Meet These Minimums

Most CPMs do not hold a college degree
Many are trained through non-accredited, apprenticeship-only models
They lack hospital training and clinical oversight
They are not required to demonstrate competency in managing emergencies or pharmacologic care
They often operate without physician collaboration, oversight, or malpractice insurance

According to the International Confederation of Midwives (ICM), CPMs do not meet the global definition of a midwife.
“There is no such thing as a home-birth-only midwife in British Columbia or anywhere in Canada.”
— Louise Aerts, Registrar, Canadian Midwifery Regulators Council

Not Meeting Basic International Standards Confuses Consumers

Consumers are led to believe that CPMs are comparable to nurse-midwives or international peers.
In reality, CPMs are a U.S.-only credential, developed outside the formal health system, and not held to internationally accepted standards.
If the credential isn’t strong enough to be recognized abroad, even in areas with less developed healthcare systems, it should not be licensed as equivalent to other health professionals in the USA.

Broken Promises: The US MERA Agreement

In 2013, midwifery organizations—including the North American Registry of Midwives (NARM)—agreed to raise education standards for CPMs. They promised that by 2020, all new CPMs would graduate from a nationally accredited program aligned with global benchmarks. Read the MERA Agreement here

That did not happen.

The majority of CPMs certified today have not completed accredited training.
As many as 80% of CPMs do not meet the International Confederation of Midwives (ICM) standards followed by most countries worldwide.

The profession gained legal recognition by promising reform, but failed to deliver.

Certification Without Oversight

The NARM exam (North American Registry of Midwives certification exam) has faced significant criticism—particularly regarding its lack of rigor, limited clinical relevance, and failure to meet basic standards of professional healthcare testing.

CPMs are certified by NARM, a private credentialing body that:

Does not require simulation-based testing or emergency skill verification.
Does not conduct independent investigations without maternal consent—even in cases of death or injury.
Has no mechanism to ensure consistent enforcement of standards across states.

Certification offers the appearance of professional regulation, but lacks the basic safeguards expected in other licensed health professions.

Why It Matters

Licensing a profession with inconsistent training, noncompliant certification, and no enforceable standards creates false legitimacy and real risk.

Consumers may assume that “licensed” equals “qualified.”
Midwives may practice beyond their competence, with no path to improve.
States absorb liability without the ability to enforce accountability.

Licensure should be based on preparation that meets minimum standards for public safety—not on historical precedent or advocacy pressure.

“They [CPMs] wouldn’t be allowed to work in other countries. They don’t have adequate training. They don’t have enough experience. And they’re performing dangerous procedures outside of a hospital.”